As many of you know I write about some of our experiences each week - this week is about memory care! When is it really needed?
Let's start at the beginning with what Memory Care is. Memory care is a specialized, secured care environment designed to be frustration free, with dementia trained staff in place to effectively meet the changing and long term care needs of those with dementia or other types of progressive cognitive impairments. Not every one with cognitive impairment requires memory care and memory care should only be recommended when truly needed. Memory care is needed for those with specific dementia related challenges including:
Safety concerns relating to wandering and being an abatement risk with routine exit seeking.
The lack of the ability to understand and recognize dangers impacting safety.
Judgment issues relating to safety.
Agitation, difficult repetitive behaviors, hallucinations, delusions, resistance to care and hygiene related challenges, or exhibiting other behavioral challenges requiring redirection and other specialized interventions.
Progression of dementia requiring total assistance with ADL's, incontinence care, eating. Progressive difficulties forming in terms of ambulation or needing total assistance with transfers.
Structured routine, specialized recreation and socialization needs
Those who require more frequent monitoring and changes in collaboration with geriatric psychiatry, or neurology.
Again, not all individuals with cognitive impairment need to be in a memory care environment. Being in memory care when you do not require it can from my perspective and experience be stressful and detrimental to overall health and cognition. It is clearly difficult and discouraged for couples to be separated, but when one individual truly needs specialized dementia care and the other does not this is often the best situation for both parties. I am therefore dismayed that some care communities are encouraging families to have a non-dementia spouse live within a memory care unit. To put a competent individual in a locked environment with limited opportunities for socialization and engagement on their terms in my opinion is cruel and highly inappropriate. The stress of the environment and at times often reliance on the spouse as a caregiver by staff for onsite 24 hour care support can also lead to the caregiver predeceasing their cognitively impaired loved one. A care community where the competent individual can live in general assisted living or independent living and have regular visits onsite with a loved one in memory care is ideal for this type of situation.
In addition, some individuals have age related cognitive impairments that do not require memory care. They can perhaps have cueing for meals and activities, medication over sight, and otherwise navigate assisted living well and live a full and vibrant life. Unfortunately there are some care communities out there that will for a variety of reasons recommend memory care for most individuals that they assess with cognitive impairments, which I also do not feel appropriate or in the best interest of the individual. We can provide a detailed cognitive evaluation with recommendations for these types of situations to provide clarity and to avoid an incorrect move to a care community. We can also be clinical advocates in these types of situations.
When considering a relocation note that a strong memory care environment needs to focus on the care of residents with memory-impacting conditions and encompass these five key areas in doing so:
1. Coordination of Care: Staff collaboratively assess, plan, and provide care that is consistent with current advances in dementia care practices. Minimial turnover ot front line staff members and leadership.
2. Staff specialization, knowledge and competency: Staff have the training, qualifications, skills, and education to assess and provide care for a resident population with cognitive impairment. Training across multiple areas as there are many types of dementia.
3. Specialized activity programming based on abilities: Staff provide individualized activities that match the resident’s cognitive ability, memory, attention span, language, reasoning ability, and physical function. The activity calendar should be posted and match what is happening on the unit.
4. Behavior management expertise: The care community places emphasis on the use of non-pharmacological interventions as an alternative to antipsychotic medication use. Collaboration with Geriatric psychiatry should be done as they are a key member of the care team.
5. Program provides a flexible, safe, frustration free, and supportive physical environment: The organization modifies the physical environment to promote safety and minimize confusion and overstimulation. This should done in an individualized manner to meet ALL resident needs!
If you or your loved one requires guidance on memory care or assisted living please feel free to reach out via our contacts area. A move to a care community is much more than a simple move, it is something that requires careful consideration along with proper planning and guidance from a clinician to determine the best and clinically most appropriate fit.
Your loved one can live a vibrant life in memory care, but a cookie cutter approach can never be taken as finding the right fit based on a variety of advanced care planning factors is critical to success. A trauma informed approach is also helpful. Care management can help by evaluating and advising on key considerations and in forming a strong transition plan in collaboration with the care community. All these steps will assist in minimizing adjustment challenges and transition trauma which is common when relocating any individual with cognitive impairment. We can help in making a transition easier and effective for all!
Sources:
https://health.usnews.com/health-news/patient-advice/articles/2016-06-01/what-nursing-home-memory-care-means
https://www.alz.org/help-support/caregiving/care-options/residential-care
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