You may have begun to notice serious memory problems with a loved one. Perhaps there have been meetings with memory specialists and even a diagnosis of some sort. It’s a confusing time for both of you, but one thing is clear: It is unsafe for your loved one to continue living alone. There’s too high a risk of wandering off and injuring, plus loneliness and social isolation can set in.
Is a nursing home appropriate? It could be, but memory care might be better.
Nursing Homes for People Struggling with Serious Dementia
In most cases, if not all, nursing homes aren’t ideal places for those who have serious dementia. In this case, serious means that most of the time, they don’t remember who you are and have a lot of difficulty with daily living tasks. Security at a nursing home can be an issue in such situations. For example, someone who has dementia may be able to wander off fairly easily and get lost in the wide world out there.
Another potential issue is that dementia care brings serious challenges, and nursing homes aren’t designed to address these. For instance, nursing homes may put on entertainment programs such as crafts, parties, chair aerobics and scenic bus tours. These activities aren’t developed specifically to engage a person with dementia.
Moreover, nursing homes can be large and impersonal spaces with shadows, confusing layouts, muted colors and designs (not all homes, of course!). In contrast, people who have dementia tend to do better in spaces with brighter colors and that have environments reminiscent of home. It also helps a great deal if the walking corridor is circular, as people with dementia tend to walk a lot. They get frustrated if they encounter a door or end of hallway that they cannot get through. On the other hand, constantly walking in a circle lends a sense of forward progress. There are much fewer opportunities to stop and get frustrated.
Also, did you know that people who have dementia might perceive extremely dark carpets as holes? Imagine having to step into a gaping hole—how scary.
Okay, but the above issues concern people who have serious dementia. What about cases of mild or moderate dementia?
Nursing Homes for People Who Have Mild or Moderate Dementia
If your loved one is in the early or middle stages of dementia, a nursing home may be okay. That said, wandering is something that some people with moderate dementia do, so whether a nursing home is appropriate depends on the specific person and circumstances.
The personnel at nursing homes will definitely be able to help with grooming, dressing, bathing and other daily living tasks that the dementia might affect. Oftentimes, your loved ones get frustrated when going into a nursing home, and this isn’t necessarily related to the dementia. Rather, it’s because they feel dismissed and like no one is listening. It’s good to acknowledge their fears and show that you understand what a scary life change this has to be. Validation goes a long way.
However, nursing homes, as touched on earlier, aren’t designed with dementia residents in mind. There are things you can do to help slow the spread of dementia in your loved one, and these are things the nursing home won’t necessarily do or think to do. Examples include playing music from your loved one’s younger years (there are even board-certified music therapists) and helping your loved one go on walks and socialize.
The bottom line: Even if your loved one is in a nursing home because of early dementia, your involvement may be necessary to slow its spread. It’s essential to talk to each of the nursing homes you consider and figure out what they can offer someone who has dementia. Also ask how they deal with common dementia-related behaviors such as aggression. Unfortunately, some nursing homes harm people who have dementia, although it’s usually not malicious. For instance, understaffed nursing homes might turn to psychotropic drugs to keep residents sedate because they have been aggressive.
Memory Care Facilities for Those with Dementia
A memory care facility is a type of skilled nursing facility and may be located within a larger facility. As such, some memory care facilities are connected to assisted living centers, residential care facilities and nursing homes. Many people like the idea of entering a nursing home that has a memory care facility on the premises. That way, changing over is easier if another move becomes necessary.
That said, your loved one may be better off at a standalone memory care facility rather than in a memory care unit that is part of a larger nursing home. The personnel at a standalone building might be trained better in how to respond to dementia-specific concerns such as aggression and wandering. The design of the space may be friendlier and the programs more appropriate. The building itself might be circular, and doors and exits painted the same color as the wall to camouflage them so residents don’t feel as trapped.
A nursing home that also has a memory care wing might use the same person to lead activities in both units. The activities aren’t at the same time, of course, and may even be different. Still, the same person is in charge of them, and that person might lack specific training with dementia. Conversely, the activities director at a standalone memory care facility should have more experience in dementia-specific concerns and be able to design programs targeted toward those who have dementia.
That’s just a basic example, though. It pays to chat and ask questions. It could be that the activities director in the memory care wing you’re considering does have specific dementia experience and tailors her programs with that in mind.
Here are some things to look for or ask about in memory care, whether it’s in a standalone facility, assisted living facility or nursing home:
- Stations that let residents do/recreate daily activities from their younger years such as office work or child care
- Intimate dining environments such as when everyone sits around a personal dining table compared with taking meals in a large cafeteria
- Ability to engage all senses (smell of cake baking in the dining area, hearing music from childhood, etc.)
- Consistency in patterns and objects (for example, those with dementia may see something that looks like wood and become alarmed when it doesn’t feel like wood)
- Safe indoor and outdoor spaces for active wandering
- Lighting that is consistent and even (a room shouldn’t have dark spaces and glare off the windows or floor)
- Nice views that allow for natural light (a view of nature is much better than a view of cars filling a parking lot)
- Thermal comfort to reduce or eliminate areas with hot or cold drafts
Look for a ratio of no more than five staffers per resident, or you run the risk of your loved ones spending most of their time in front of the TV. Visit each place you’re considering a few times, including at least one surprise visit. Look for active engagement versus passive engagement like you’d get with a TV. A healthy ratio of 5-to-1 or better also means more staffers on hand to detect anger triggers such as hunger and pain. Early detection and stable routines reduce the risk of a blowup, and later, the need for psychotropic drugs.
That’s a lot to think about and hopefully provides more insight into why a standalone memory care facility might fulfill your needs better.
Financing Memory Care
It can be easier to find a place in a nursing home than in memory care. One reason is the involvement of red tape and bureaucratic requirements when it comes to memory care. Plus, there may be a limited number of beds if Medicaid or Medicare is in play, and your loved one may face a long wait to get in. Meanwhile, your loved one can generally qualify for nursing home care as long as their assets are under a limit that varies by state.
Long-term care insurance and other avenues of private pay such as a reverse mortgage could get your loved one in a memory care facility much more quickly. It’s ideal to start purchasing long-term care insurance when you’re in your 50s and to add inflation protection so you’re not faced with steep monthly payments in your 70s or 80s when you might still be living independently at home.
Nursing Home vs Memory Care: A Comparison Chart
|Nursing Home||Memory Care|
|Assistance with ADLs||Yes||Yes|
|Safe for Those with Dementia||Depends. Many nursing homes are unsafe, and dementia residents get stressed easily or wander off||Yes—should be better in standalone buildings compared with memory care units or wings|
|Government Assistance||Programs such as Medicaid can help greatly if assets meet criteria||Available in many cases but a wait may be necessary and the facility not top-tier.
For access to the best memory care options, long-term-care insurance and other private pay approaches are often necessary
How to Know Where Your Loved One Belongs
It can be difficult to tell where your loved one belongs, especially in the early stages of dementia. Fortunately, people in the early stages still have enough capacity to make informed decisions much of the time. This may have to be a decision you make jointly with your loved one.
If the dementia has progressed and your loved one has the private means to pay for memory care, then explore that option thoroughly. Chances are high your loved one will thrive more with memory care than in a nursing home. Otherwise, your loved one should still be able to get into memory care thanks to government programs, such as Medicare and Medicaid, but there may be a wait.