What is Memory Care and How Much Should it Cost?
In 2011, it has been estimated by the Alzheimer's Association that 5.4 million people have Alzheimer's Disease and other forms of dementia. Dementia is a multi-faceted disease with no real cause, and unfortunately in most cases, no cure either. The burden of caring for a loved one with dementia often falls on the shoulders of an unpaid, untrained care giver trying to do their best to provide the care needed for the patient and in some cases for themselves.
Is it Dementia?
Forgetfulness is often a normal part of aging. Misplacing reading glasses, forgetting names or having a lot of “senior moments” is nothing more than an annoyance for many aging adults. However, this is not the case of everyone. If your loved one's forgetfulness is compounded with such things as complications completing mundane tasks, problem solving, understanding spatial relationships or change in mood and behavior then it may be a more serious form of memory impairment. If you suspect that someone you love is suffering from a form of dementia, contact your primary care physician for a screening. Medication is available to help with the symptoms and may slow the progression of the disease.
With the disease becoming more prevalent, many senior living settings are dedicated resources to caring for individuals with poor cognition. From Assisted Living Facilities to Adult Day Programs, there are several options to provide safe, secure and nurturing environments for adults with memory impairments.
If you are helping to care for someone with memory deficits this guide is intended to help inform you of the options that may be available for someone with dementia
When is it time for long-term care?
Although many are able to care for someone suffering from Alzheimer's or other forms of dementia at home, it may come to a point in the disease process that makes home care unmanageable. With the variety of home health services that are available, this may be delayed; but in some instance, placement is warranted. Some questions to consider when deciding for long-term placement is right for your loved one include:
- Have any accidents occurred recently with appliances in home such as the stove or forgetting to turn it off properly?
- In the event of a fire, do you feel your loved one would follow appropriate emergency measures including calling 911 and leaving premises?
- Has your loved one become progressively dependent with more ADLs recently? (eating, dressing, bathing)
- Has he or she or become easily threatened or suspicious of others, taking medications, or eating certain foods?
- Is your loved one taking medications on schedule, following correct dosages, and willing to use an organizer/reminder device if necessary?
- Has your loved one gotten lost or unable to remember personal information such as address, phone number, contacts that enable them to return home?Has he/she gotten lost while on a walk or running errands?
- As the caregiver, is your health at risk, are you missing a lot of work or are unable to manage other responsibilities? Do you have additional support to care for your loved one
- Is the amount of home care assistance needed likely to become so great that it is not an affordable option for your family?
Memory Care Settings:
Assisted Living Facilities
As the name implies, assisted living facilities (AL) are designed to assist individuals who may need help with their day to day tasks, but do not need the extensive nursing care provided by skilled nursing facilities or nursing homes. Most ALs are set up a small, efficiency apartments and are staffed with nursing assistants and aides who are able to help in bathing, dressing and grooming. In some state's medication administration is also a benefit for residents in an assisted living. Most facilities also offer dining programs and structured socialization opportunities. Assisted livings may also be a good choice for couples who want to remain together but simply cannot care for each other because of health limitations.
For those with mild to moderate dementia, assisted living facilities are a great choice for individuals with memory impairment without fully relinquishing independence. When choosing and assisted living facility for someone with dementia, be sure to identify some important factors:
Secure Areas:Some assisted living facilities are designed with the mild dementia patient in mind. Entire wings or even buildings may be designated for individuals suffering from memory impairment. They often provide more supervision and security as does the rest of the facility. These communities are staffed with caregivers who are accustomed to the impulsivity and poor safety awareness exhibited by many who suffer. The staff is trained in how to respectfully and humanely redirect the resident back to the appropriate activity or location.
Medication Assistance:Most assisted living facilities can aid in the administration of medication. This may be vital for a resident who is dealing with memory impairments.Knowing when to take what little white pill can be difficult for those without cognitive decline, let alone for those who do. Licensed nurses are qualified to distribute doctor-prescribed medications and can ensure compliance. This is also helpful when communicating with primary care physicians since staff can alert to an increase in behaviors or a decrease in functional abilities and know it is not a result of missed medications.
Rehabilitation Programs: Many memory centers will also offer programs designed to slow the progression of this degenerative disease or alleviate symptoms associated with dementia like agitation and aggression. Sensory stimulation, cognitive therapies, physical and occupational therapies are all included in these types of programs. There has been a lot of positive research regarding alternative therapies such as music, art therapies which tend to help reduce agitation, although no long term benefits have been identified. Most therapies and programs are performed in group settings which allows for greater supervision of the residents as well as the socialization that is needed.
A Typical Day at a Memory Care Assisted Living may look something like this:
|7:00-9:00am||Breakfast Morning Routines (Dressing, housekeeping, etc.)|
|11am-1pm||Lunch Quiet time/Rest|
|4pm-6pm||Dinner Even Activities|
|7pm-8pm||Personal Time Even routines Bed|
*Typical schedule at Arden Courts
Cost: Most assisted living facilities are paid for with private funds. The average costof assisted living varies from state to state and depends upon the service selected by the resident. Medicare does not cover the cost of assisted living facilities and rarely does Medicaid. There may be some state programs or even federal programs, like the Veteran's Aid and Attendance benefits that can help cover the cost.
Pros and Cons of Assisted Living Facilities
|Assistance with basic health care needs and medication administration||May not have licensed nurses available 24/7|
|Greater sense of independence and privacy||In some locations, rooms may be hard to come by|
|Assistance with activities of daily living||Cost: Most ALs require private funds to pay for room and board.|
Skilled Nursing Facilities
Skilled Nursing Facilities, also known as nursing homes, are often the choice of last resort. Usually, if a person needs permanent placement in a nursing home, the supervisory care needed exceeds that which can be offered at home or in an assisted living. Many of these patients are exit-seeking or are more difficult to redirect. Some people with dementia may also develop aggressive behaviors which can pose a threat to themselves or those around them. Others simply are no longer able to perform most or all of their activities of daily living and need a higher level of care.
If you are considering placing a loved one with dementia into a skilled nursing facility, there are several factors to consider, including:
Secured Unit:With exit-seeking behaviors being one of the biggest threats to a patient with dementia, many facilities offer secure units that are kept locked 24/7.These units are generally smaller in nature and are accessed by staff and visitors with authorization. They should be inclusive areas with their living areas, activities and dining all within the secured areas. Some facilities also offer secure courtyards or outside areas in order to give their residents the opportunity to spend time in the fresh air while maintaining their safety.
Security Systems: For dementia residents residing on the secure unit and for those on the mainstream floors, additional security measure may be needed to ensure the residents safety. There are several types of security devices that may be used including:
- Personal Security Alarms:These are devices often placed on wheelchairs and beds of patients whose cognition no longer allows them to understand their safety deficits. For example, if a patient is a fall risk because of poor balance a seat alarm may be placed on their wheel chair to help deter the patient from standing. The sounding alarm will hopefully re-direct the patient back into their sea while alerting staff for assistance. These types of alarms are also vital for patients who are sun downing. The bed alarms alert staff to an out-of-bed patient where they can provide assistance and maintain safety.
- Door/Elevator Alarms:For some patients whose needs to not warrant a secure unit, alternative security measures may be needed. Some facilities are equipped with systems designed to alert staff members that a dementia patient is close to an exit or elevator. Patients are often outfitted with a bracelet or anklet that is used as sensor for such alarms. Some facilities will place the bracelet on the patient's wheel chair to keep it hidden for the resident.This is less restrictive than the secured unit but provides the needed security.
Day Programing:Many skilled nursing facilities will provide patients with dementia programming throughout the day designed to help keep their minds active, lessening the symptoms of sun downing and hopefully slowing the progression of the disease. If you are considering placement in a skilled nursing facility, be sure to find out if they have structured daily activities for their patients with dementia.
Psychiatry/Psychology Services:Many facilities will have visiting specialists who are trained in caring for the psychological needs of those suffering with dementia. Because dementia and Alzheimer's is such an individualized disease, it is often trial and error before the right medication regimen is established. It is important to have the advice of specialized caregivers available to help develop and maintain such programs.
Cost:The cost of care in a skilled nursing facility is expensive. Unfortunately, most residents with dementia do not qualify for Medicare or insurance benefits. Medicare guidelines require a 3-midnight hospital stay in order for a benefit period to begin and then patients must meet certain criteria,such as a need for intensive nursing care or rehabilitation in order for the federal program to continue paying. Some dementia patients may initially qualify upon admission, but quickly become what is known as custodial care. If a resident is in a skilled nursing facility under custodial care,private funds or medical assistance will most likely be required to pay for outstanding balances.
Pros and Cons of Skilled Nursing Facilities
|24/7 supervision by licensed nurses and clinical staff||Cost: The most expensive of the senior housing communities; however has the most options for subsidized funding|
|Intensive medical services available if needed||Perceived Loss of Independence|
|Most regulated of the senior living settings which creates a more consistent level of care||Stigma associated with nursing homes is still alive and well|
|Certified and trained clinical staff||Bed availability in secure units may be hard to find|
Skilled Nursing vs. Assisted Living
The question now becomes does my loved one required skilled nursing care or assisted living. There is sometimes only a fine line that separates anappropriate assisted living resident from one who would be better in a skilled nursing facility.
Here are some questions to consider when deciding on what level of care your loved one may need:
· Is 24/7 supervision necessary? Since nursing homes offer 24/7 nursing staff, a resident who requires more supervision may fare better in a nursing home than an assisted living. Remember that residents in an assisted living facility often reside in private apartments where it is more difficult to provide 24-hour supervision.
· Is the resident easily re-directed? If the resident can be redirected to an appropriate behavior without much effort, an assisted living facility maybe a good choice.
· Is the resident able to perform most or all of his/her activities of daily living? If the answer is yes, assisted living may be an ideal setting for someone who can perform daily tasks but suffers from memory impairment.
· Is the resident able to communicate his/her wants and needs? Again, if the answer is no, a skilled nursing facility may be a better option. The inability to communicate may threaten the safety of someone living in a private apartment or suite.
Adult Day Programs
In light of the fact that many Americans are trying to “age in place,” adult day programs are becoming more and more popular. These programs provide day-care like settings for adults suffering from many ailments including dementia and Alzheimer's Disease. These programs are geared for participants who need supervision or socialization while their primary caregiver works, runs errands or just takes a break from their duties. Some programs are accredited by Medicare and Medicaid and can provide the same services as a skilled nursing facility without the overnight stays.
Some skilled nursing facilities that offer dementia programs may also offer day programming opportunities. Usually the program is held within the dedicated dementia unit and participants interact with facility's permanent residents.
Traumatic Brain Injury Programs:
Traumatic Brain Injury centers are specialized in the care of patients who have memory deficits as a result of a traumatic injury or stroke. Most of the patients are younger and the onset of the injury was sudden. These facilities are few in number as compared to skilled nursing facilities or assisted livings and stringent criteria must be met for admission. Most of the patients involved in programs are in need of increased safety awareness and help with short-term memory loss. Some of their symptoms, such as poor memory, poor decision-making, impulsivity and disorientation, mimic those of dementia. The hope for many is for some of their cognition to be regained, but the outcomes are individualized and full or even partial recovery may not be possible.
For all of the options listed above, entering into the setting armed with as much information as possible is the best line of defense. This very well may be the hardest decision you will ever make and touring the facilities will help make an informed decision. When touring any facility or program,here are some questions to consider:
· What security measures are in place to ensure safety?
· What happens if my loved one declines in health, either physically or cognitively?
· What will happen when the private funds are depleted? Are there alternative programs to help pay for room and board?
· What types of activities will my loved one be able to participate in?
· Is there any type of rehabilitation program available to help with the decline of activities of daily living?
- What are the visiting hours?
When touring the memory center, be sure that you take note of several key factors that will help the facility become home:
· Do other patients have personal belongings in their room to help remind them of their home?
- Is it clean and free of odors?
- Is the staff respectful to the other residents?
- Do the residents appear neatly dressed?
· Does it appear as if the residents are having a good time?
The transition from home to either an assisted living facility or a skilled nursing facility is difficult. Do not be surprised if your loved one is agitated, confused and persistent about returning home. This is common and will most likely subside as they become acclimated to their surroundings.Speak with the nurse or administrator about visitation guidelines or suggestions during those first few days. You may find that some facilities will ask that you not visit until the resident has had the opportunity to adjust to his/her new surroundings.
Most memory care centers will not only focus on the well-being of the resident, but also that of the family. Be sure to ask if there is a support group that is hosted at the facility or one which they can refer you to. These groups will help ease the guilt and hopelessness that may accompany the transition. If you have questions about the resources available in your area, contact the Alzheimer's Association.
Choosing a long-term care setting for your loved one may be the most difficult decision you will ever need to make. This guide has been created to help you make an informed choice and find the best possible care for someone suffering from memory disorders