Alzheimers-care to meet special needs

Alzheimers-care has greatly improved since I became a long term care administrator some thirty-five years ago. At that time, Alzheimers-care was provided in distinct “memory care” units of some skilled nursing homes but in many cases residents with dementia were cared for in the general nursing home population without regard for their special needs.

Programming was not as good as it is today but many facilities did offer secured access to outside furnished courtyards with walking paths. Assisted living was not a factor in those days and nobody talked about prevention. But today there are a growing number of medical practitioners and researchers that believe that Alzheimer's prevention is possible.

Today Alzheimers-care is typically provided in distinct part specialty units of both nursing homes and assisted living facilities. Additionally, there are now free standing facilities that specialize in providing Alzheimers-care. For the most part, these free standing facilities are assisted living communities. Many continuing care retirement communities also offer Alzheimers-care as a part of their care continuum.

The program intent in most of these designated units is specifically designed to meet the special needs and behaviors of persons living with various forms of dementia. Most of these secure memory care communities whether free standing or distinct part offer easy access to a secure outside court yard area during good weather.

Since wandering is a part of the Alzheimers disease process, supervision and a secure environment are both important and priority considerations. Decreased judgment, disorientation to time and place are also a part of the disease process and make the resident more vulnerable.

Every facility must have an effective “elopement” policy that is tested with periodic, realistic drills to check staff and equipment readiness. The key is prevention. The facility has an affirmative responsibility to protect the resident at all times. No administrator wants to report that a resident is missing.

Staffing at adequate levels to protect the resident and provide quality care to Alzheimers residents is essential. Dementia care is best provided in small groups with a lot of one-on-one time.

An alzheimers-care facility should provide a program of care that:

  • Includes a calm, peaceful and homelike environment. The environment should offer visual cues for residents including memory boxes with personal items outside resident rooms. This homelike environment should extend to the dining room and the dining experience. This would include the provision of home style meals at consistent times.
  • Is provided by staff who are dedicated to that unit. The practice of pulling staff from a dementia unit to fill schedule holes elsewhere should be strictly prohibited by facility policy. Consistent staffing contributes to trust and affection and is very important in maintaining consistent quality care in a calm environment.
  • Is provided by staff uniquely qualified by temperament and training to meet the special needs of dementia residents. Most jurisdictions have regulations on mandated training for staff. These should be considered as a minimum. The really good facilities providing dementia care offer additional specialized training for staff. They also screen potential new staff and provide meaningful orientation.
  • Provides structured activities tailored to the specific interests of each resident. They strive to keep activities challenging enough to maintain interest but avoid those that are too challenging.
  • Encourages the use of properly oriented and screened volunteers to enhance activities and increase meaningful one on one time with residents.

Alzheimers-care is provided in both nursing homes and assisted living communities. There is a need for both but my personal bias leans to assisted living communities because they tend to be more home like. However, assisted living communities often have to consider transfer to another facility if and when they can no longer meet the resident’s functional needs. This can be a traumatic event to the resident and needs to be considered before placement. What options will you have and what help can you expect?

Alzheimers-care in an assisted living community is mostly paid from private funds. Some long-term care insurance policies cover licensed assisted living and Medicaid funds are available in some jurisdictions for assisted living. Care in a nursing home is either from private funds, long-term care insurance or Medicaid.

There are a lot of fine facilities that provide excellent care for victims of Alzheimers and other forms of dementia. Selecting the right assisted living community or nursing home to care for your loved one requires thoughtful due-diligence. The Alzheimer's Association is a great source for a wealth of information on dementia and the Alzheimer’s disease process.

As good as most of the memory care facilities (SNF or ALF) are, care provided at home with friends and family is infinitely better and a lot less expensive. Caring for a mother, father or spouse with dementia is not easy. Such caregivers need a support system to help manage their stress and maintain their own physical and emotional health. Support can come from other family members, your church, outside support groups, government agencies, home health care and resources such as the Alzheimer's Association. Check this link for additional support and resources for caregivers.

References and suggested reading:

  • "Alzheimer’s Disease and Other Dementias - The Caregiver’s Complete Survival Guide" by: Nataly Rubinstein, MSW, LCSW
  • Go to retirement resources.

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