The 2nd entry in the series of touring a memory care unit will focus on the medical and personal care services provided in these settings. Now that we are more familiar with the physical environment, let’s talk about the real reason why your loved one needs to move into memory care.
The reasons for this major transition are endless and they certainly vary by each unique situation. I can personally attest to the challenge and stress created by moving forward with acknowledging that your parent or loved one needs memory care. We want to hold off for as long as possible. But the decision for memory care is often based on some primary factors that will differentiate the services from traditional assisted living such as safety, wandering risks, behaviors, medication management, nutrition, and personal care are at the top of the list. For my mother it was the wandering risks. Used to walking daily it was no longer safe for her to walk down a 5 lane road, sidewalk though she saw no harm, had been walking for years. But as her judgement became impaired the risks for getting lost, taken advantage of, and falling were magnified.
Focusing on our expectations the secured unit is the first step in ensuring that your loved one remains safe. The locked doors are often the most restrictive and difficult for anyone to accept. Equally important is what care is provided that may help to reinforce your decision. Your parent is still very capable of taking care of their dressing and bathing, do not need help with eating, and is still very active. I recently worked with a family whose father was living alone and isolated in his home of many years. He looked well, hadn’t lost weight so appeared to be fixing meals and eating all right, read the paper daily, and naturally saw no reason to make any move to assisted living, never mind memory care.
Often the key issues are subtle, difficult to see on the surface and this gentleman had become quite skilled at hiding his memory loss and covered it well. On closer inspection of his home we learned that he was no longer able to manage his medications. Even though the family filled a weekly pillbox he would forget to take his medications or take them in correctly, and a peek inside his refrigerator found multiple partially eaten take-out meals, on the counter were packages of cookies and various sweets, and the freezer was filled with plenty of ice cream. An important ritual for this gentleman that he and his wife had thoroughly enjoyed was their nightly highball before dinner. The family began to try and keep an eye on how often he went through his bottle of whiskey and the concerns grew as it appeared that the before dinner drinks continued well into the evening.
Memory care is by no means the end of enjoying sweets or a nightly cocktail but it is time for these habits to continue in a more controlled environment ensuring that they will also eat well, stay well hydrated, remain socially active, and with their care well monitored.
Medical and personal care:
- What are levels of care and how do they determine how much care my loved one needs and
- Based on the primary care physician’s recommendations and a nursing assessment each community has its own system for measuring the needs of your loved one.
- What if I don’t agree with their assessment
- Am I allowed to hire an advocate like a care manager to assess my parent
- Am I allowed to provide additional help with caregiving
- How do they manage personal care and showers, especially if someone is resistant to any assistance and has no perception of a need
- Incontinence care – do they use toileting schedules, provide incontinence products
- Medications – can you choose your pharmacy or required to use the community’s specified pharmacy service
- How do they ensure no medication errors are made
- What is the ratio of caregivers to residents? Does this meet the state’s standards?
- What types of caregivers are providing care – nurses, certified nursing assistants, med techs
- What are the caregivers allowed or not allowed to do
- Do they receive specialized training to work with dementia residents
- How do they manage behavioral issues
- Is there onsite medical care available
- Are other services provided in-house such as psychiatry, podiatry, audiology, dental care
- Is staff available to accompany resident to a medical appointment if needed
- At what point can they no longer manage my loved one’s care, what medical or behavioral issues may force a move
- End of life care – is hospice care allowed
For a more in-depth look at the details surrounding the quality of dementia care please take a look at this resource from the Pat Summitt Foundation.