Deciding on memory care placement for a family member can be a taxing and emotional experience for many families. This is not a trivial decision, as the timing, location and transition plan are all critical to success. A move to memory care must be planned for properly and well thought out. There is also the uncertainty of the decision for most. Is it really needed? Is it time for memory care or is it too early? If they need memory care, what will be the best community for my family member based on their needs? These are all questions that I am asked by clients on a weekly basis.
I am stepping back up on my soap box a bit today....
I felt the need to blog on this topic as I have had some frustration this week in terms of memory care knowledge and understanding at one of the newer assisted living communities! The lack of knowledge and understanding by those providing guidance and recommending placement is frightening to be honest. Some facilities even have individuals with no medical training advising on this. This leaves families confused, individuals misplaced, and sometimes families being taken advantage of through the billing of elevated and not needed levels of care. This is when I step in as an advocate to get things corrected and back on track!
I therefore wanted to clarify for others more about memory care placement Memory care environments are special secured, locked areas in senior living communities. Memory care is helpful and often needed for those with specific dementia related challenges including:
Safety concerns relating to wandering
The lack of the ability to understand and recognize dangers.
Aggression, difficult repetitive behaviors, hallucinations, delusions, resistance to care and hygiene related aspects, or exhibiting other behavioral challenges requiring redirection.
Needing total assistance with ADL's and 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.
Not all individuals with cognitive impairments, however, need to be in a memory care environment. Some individuals have age related cognitive impairments that do not require memory care. They can perhaps simply have cueing for meals and activities, medication over sight, and otherwise navigate assisted living well and live a full life. Unfortunately there are facilities out there that will for a variety of reasons recommend memory care for most individuals that they assess with cognitive impairments. The MMSE is often used by facilities to assess residents and when the MMSE is misused it can lead to misclassification as I am seeing in some facilities. The MMSE cannot provide an accurate evaluation of all individuals, areas such as level of education, visual impairment, learning style all need to be factored into this. For example, I have a client with dyslexia who would have significant challenges with a MMSE, but does not need memory care. I have other clients who have been assessed by facilities using the MMSE and have visual impairments; I am saddened when I see that they are given poor evaluation scores because they cannot see to draw items on the exam. Their score therefore does not reflect accurately their cognition and the tool is clearly invalid for their purposes.
Many individuals can function very well in general assisted living with mild cognitive impairment or age related cognitive impairments. I recently had a facility say to me inferring the need for memory care about a woman who did not have any dementia related behaviors, did not have a documented dementia diagnosis, walked well with a walker, was able to feed herself and dress with stand by assistance, "well she is 98." Age means nothing and should not be considered a criteria for a locked and secured unit!!! This is a quality of life issue! For those not needing memory care, a memory care environment can be frightening and even negatively impact their cognition. In addition, it is sadly advantageous for many facilities to place in memory care as it comes with a premium in terms of cost and once placed in a unit it is difficult to get your family member moved into a general assisted living environment. I feel that memory care is being recommended at times sadly for those who do not really need it while others who have difficult behaviors due to dementia cannot find a place to be as facilities do not want to accept them as they can be a challenge to manage. More facilities need to be educated on age appropriate cognitive changes and the true criteria for memory care! It should not be used as a mechanism to bill more for those with mild cognitive impairments who can still be functional in a less restrictive environment.
Please ensure that before moving a loved one into an assisted living facility that you understand their memory care criteria and standards well! Understand your loved one's disease process. Consider having a care management cognitive assessment and evaluation. Explore all the options before moving forward. Rather than having your loved one in a secured environment perhaps a smaller personal care home may fit their needs just as well or even better? Consider all your options and do not be pressured or rush! Taking the time will make all the difference! I am always happy to provide guidance on communities that truly understand the needs of those with cognitive impairments!