Dec 26, 2011

Questions About Alzheimer's, Managed Care Facilities

Memory care facilities, I like to call them memory care communities because it doesn’t sound so institutional, are for chronic care (long term care).

By Carole Larkin
+Alzheimer's Reading Room

Q. About managed care facilities: Are they ever located in designated wings of a normal hospital, or are they usually stand-alone facilities?

A. Memory care facilities, I like to call them memory care communities because it doesn’t sound so institutional, are for chronic care (long term care).

There are many types of memory care communities and I will enumerate them as follows:

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Memory care in Residential type homes

They are homes that house several residents (usually anywhere from 2 to 10 people).

In some states it is possible to be certified by the state agency who licenses facilities as a “Certified Dementia Care” home. Certified Dementia Care homes are always “secure”; meaning to must punch a code on an electronic keypad to enter or exit the home. Some homes who house residents with dementia are not “secure”, but usually the residents are not able to “elope” (escape). T

hey may be in wheelchairs, or bedfast. Some residential care homes that are not secure do take residents who are able to elope, which I think is a disaster waiting to happen.

There are also unlicensed homes (that the state does not inspect for health and safety of the resident or for quality of the care given there). Families do put their loved ones there, generally because they are cheaper than licensed homes.

Memory Care Assisted Living communities

These can be stand alone buildings or a wing or floor of a larger building that contains either (or both) independent living (apartments with some meals and weekly cleaning included in the rent) or regular assisted living (essentially independent living with the addition of assistance with bathing, dressing, toileting, feeding and medication dispensing).

Regular assisted living is not specifically for memory care, but at least 50% of their residents are memory impaired to some extent or other (usually early to mid stage). The memory care portion of the building is “secure” or locked. Generally, but not always, there are nurses on site, or at least on call for these communities.

Stand alone memory care assisted living communities are built specifically for memory care residents.

The entire building is secure and nurses are usually on site at least a portion of the day. Normally the residents do not need procedures that only can be taken care of by round the clock nursing, although exceptions are sometimes made, bringing in home health nurses.

Nursing Homes

Regular nursing homes are not intended to be for memory care, but in fact up to 85% of their residents are memory impaired, usually in late mid to end stages. They are not “secure” and patients can (and do) elope from them. Many times patients have not only memory impairment, but also other chronic, serious illnesses that require round the clock nursing. Some nursing homes do have “secure” memory care wings or floors, for their seriously ill patients that are still mobile and can elope.

Q. Would a patient be moved to different rooms/floors periodically as his/her condition worsens?

A. That is a decision usually made on a community by community basis.

The best communities try to keep residents that are near the same functioning level together, at least during waking hours. It cuts depression levels for those who are higher functioning to constantly be faced with lower functioning individuals.

Some communities house by “neighborhoods within the larger community itself.< Some communities have more than one unit, perhaps 2 or more divided by functioning level. In that case, a person would normally move from unit to unit as function declines. Some larger communities with both an assisted living memory care unit and a nursing home memory care unit move the person from assisted living to nursing home as memory and life skills fade.&nb It’s hard to generalize this answer, but I guess I’d say on the whole yes, they are moved.

Q. I have read that Alzheimer’s symptoms often worsen at night.  Are there any precautions that managed care facilities take to lessen these symptoms? (i.e.: full spectrum lighting, early bedtimes, administering sleeping pills…etc.)

You are talking about the phenomenon known as “Sundowning”.

A person with dementia becomes agitated, angry and/or restless anywhere from mid afternoon to late evening. The agitation or restlessness may last an hour or two to 4 hours or more. It varies with each individual.

Researchers are studying the phenomenon and theorize that it has to do with human beings natural body clocks (circadian clocks). Not everyone “sundowns” and if they do sundown, sometimes it happens for a month to up to several years. It depends on the individual.

Generally the best thing to do is to let them work off the agitation themselves, if they can, by walking (pacing) or by giving them something physical to do so that their energy can be used in a positive way rather than in a negative way. If that means household chores (folding towels, sorting things like nuts and bolts {for men} sweeping or vacuuming the floor, then that is the time for them to do the chores.

If it means engaging them in an activity that they can do, such as a simple puzzle, or painting with watercolors, or similar activities then that could be a positive answer to keeping them engaged. The point is to have them focus on something other than themselves and their agitation.

That does NOT mean plunking them down in front of the TV for hours. TV’s are NOT babysitters.

Any care community that does that with their residents is either understaffed or lazy. That is the lowest common denominator way of solving the sundowning problem.

Other lowest common denominator ways of facilities handling sundowning are chemically restraining them (giving them sleeping pills or other pills that put the residents “out”. Putting them to bed early usually doesn’t work because they will get up and wander around the facility anyways.

Additional lighting is a help, but won’t stop sundowning in and of itself the residents either need to be engaged, or just let go if they are pacing and not hurting themselves by pacing. They need to be watched to make sure that they have enough snacks/food and water/hydration to help restore the energy that they are using up by pacing. They need to be redirected if they wander into an unsafe area.

Eventually they will wear themselves out and can be helped into bed. Good facilities know this and let them pace all they want. It helps the residents get better sleep because they are truly tired!

Also see, Questions About Alzheimer's

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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