Sep 22, 2011

Types of Dementia Care Communities, the Semantics of Confusion

Identifying a good memory care facility for a loved one is very difficult.

Identifying a good memory care facility for a loved one is very difficult.

I’ve seen videos on the Lakeview Ranch (by the way, a center of excellence if there ever was one!) and thought to myself, “no it’s not a group home, it’s a memory care assisted living”, at least that’s how I’d refer to it.

Then I began thinking about definitions of types of care communities that house people with dementia. I did some research and found much to my surprise and consternation, that there is no agreed upon definition of the types of homes that have people with dementia living in them.

What is termed a memory care residential care home in one state could be called a memory care facility in another state, or a memory care assisted living community in still another state. How confusing!

By Carole B. Larkin
Alzheimer's Reading Room

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The laws regulating these communities vary considerably from state to state, and I’m sure from country to country. I can talk about Texas, because that’s where I practice. Scanning Minnesota’s laws for similarity to the laws I am familiar with was futile. I would be interested in hearing from people in other states and countries on what they call their communities and the types of laws governing them (or not!).

In Texas there are communities known as residential care homes or sometimes referred to as small assisted livings. They are literally houses where unrelated adults live and are cared for by caregivers 24 hours a day. Each person has a bedroom, or sometimes shares a bedroom with another person.

Their medication taking is monitored by the caregiver. Their meals are served there, usually around a large dining room table. Sometimes each room has its own bath, sometimes two or more rooms share a bathroom.

Some activities are planned for the residents each day. Sometimes the activities happen; sometimes they don’t, depending on the workload of the caregivers. They are usually quieter types of places and seem to work well for people who become agitated with too much visual and auditory stimulation. The TV seems to always be on.

The size of these homes can range from three bedrooms to a specially built high end home with say, a dozen bedrooms. In Texas, any home that houses more than 3 residents must be licensed, inspected yearly and regulated by the State of Texas. The state concentrates its efforts on monitoring the safety of the home and in the general care of the residents. Any home containing three or less residents does not have to be licensed in Texas.

If my clients prefer or are better suited to a residential care home type of community I always show them licensed homes only.

As far as I’m concerned, if the owner/operator of the home is not willing to be inspected to make sure they meet minimum (and I do mean MINIMUM!) safety and care standards, I’m not interested in having my clients live there.

I also prefer for RN’s (Registered Nurses) to own or manage them. The nurse has a higher stake in the residents’ health when she owns/manages the residence. I will refer to homes without nurse owner/managers if there is a regular visiting physician or nurse practitioner contracted with the home

These homes may or may not have a keypaded entry and exit door. Usually if there is no keypad there is a wanderguard system to let the care giver know that someone has eloped.

There are two different categories of these homes/assisted living in Texas.

Type “A” homes which service a lower level of care for the residence. Residents in a type “A” home must be able to evacuate the home on their own, meaning with no assistance from any one.

“B” homes can provide more care and are appropriate for frailer, sicker people with dementia. They must be able to exit the home in a certain number of minutes, but can have someone assisting them (think wheelchair).

Type “B” homes can take hospice patients as long as there is a hospice company that takes medical responsibility for the patient. These are the type of places that people take their loved one if to die if they can’t take them back to their loved one’s home (They come from out of state) or they don’t want them to die in a hospital and there is no inpatient hospice facility in the area.

Semantics aside. Identifying a good memory care facility for a loved one is very difficult. Most families have little or no experience in making a decision of this type. As result, they don't know what to ask or how to do the appropriate due diligence.

It doesn't stop there. Even if you find a "high quality" facility, changes in key personal, or cut backs due to profit motive can change the quality over night.

Next time, I’ll discuss how I assess memory care facilities and personal. I'll include the kinds of questions you should ask, and information you need to make an informed decision. I'll also talk about how you go about selecting the right type of facility.

You would be surprised to learn that a facility might accept a patient, and then decide they don't want them. This leads to the need to find a new place literally over night.

I know what it feels like, and how frustrating it can be. when you have to change facilities due to changes in personal, or because of a need for a new and different type of care.

I know because I had to "move" my own mother -- more than once.

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Carole Larkin MA,CMC,CAEd,QDCS,EICS,
is a Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She also trains caregivers in home care companies, assisted livings, memory care communities, and nursing homes in dementia specific techniques for best care of dementia sufferers. ThirdAge Services LLC, is located in Dallas, TX.

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