Welcome to Memory Care Support’s 
February 2016 newsletter!

How to Choose a Memory Care 
Program in Assisted Living

This newsletter is in response to a frequent question I receive.  My neighbor Pat said it very clearly...

Question: My sister and I have been looking at Assisted Living locations for my mother who has Alzheimer's disease.  I'm really confused... every location says they have great care.  But how do we know what to look for and if they will take good care of my mom?

Answer: This is the bottom-line question so many families have.. "How do I know if they will take good care of my Mom?"  Providing dignified and life-affirming care is a very complex undertaking.  Good care is not an accident.  There are a lot of "moving pieces" behind the scenes that need to be coordinated, put into place, and monitored.  

Here are some suggestions on how to start your search for good care in Assisted Living:

1.  Planning ahead is the best option.  If possible, begin your search before you think you will need services.  If there has been an acute change of health, of either the person living with dementia or their family care partner, there is an urgency to find a place quickly.  Tours of Assisted Livings are completed rapidly and decisions are made, often without sufficient time to gather all the information. Getting a head start can avoid having to make decisions during a crisis.

2.  Look for care that is person-centered with dignity, choice and purpose.  Just because someone is diagnosed with dementia, that doesn't take away their personhood, their desire to contribute, to grow, to experience new things.

3.  Senior search agencies such as "A Place For Mom" or "" can be helpful in doing some of the "leg work" for you.  However, be aware that they receive a large fee when they place a person in an assisted living facility and their recommendations may be biased by which facility will pay the highest fee to them...

4.  There is a lot to be learned if you visit an assisted living facility yourself.  And it is okay to arrive at a location unannounced-- "you were just driving by and noticed their sign".  It is advised to visit a location more than once-- see the interactions going on at different times of the day.

5.  As you enter an Assisted Living, see how long you sit in the lobby without someone acknowledging you.  Is there a sense that you are welcome and the staff are noticing what is going on around them?

6.  From the first moment you enter, shop with all your senses--

Sight - does the environment appear clean and welcoming and well lit?  Is the flooring/carpeting/upholstery clean without stains and rips?  What is your overall impression of the physical environment-- has it been maintained adequately?  Is the lobby area clean and fancier than "back of the house" where the residents spend their time?  Do the residents look well-groomed and dressed in an age-appropriate and dignified manner?  Are the resident rooms cheerful-- curtains open, beds made, personal photos hanging in the rooms?  Do you see staff interacting in a meaningful way with residents or does staff walk by without acknowledging the residents?

Smell - always important-- not an overuse of room deodorants to mask dirty areas.  Of course there should be no odor of bowel or bladder activity in any areas.  Are there pleasant fragrances/aromas in the environment-- smell of fresh baked bread/fragrant lotions/smell of an upcoming meal?  Is there fresh air coming in through open doors and windows if the weather allows it?

Sound - what do you hear?  Do you hear gentle voices, encouragement, residents being addressed by their proper names?  Does the staff acknowledge each resident when they ask for assistance or attention?  Is there the sound of an overly loud TV blaring?  Do you hear the sound of "life" as in a home-like environment-- friendly conversations, music, and various activities going on, people greeting each other?

Touch - as you walk through the care community, touch the tables and arms of the chairs-- do they feel clean, not sticky?  Do you see staff touching residents in a supportive and compassionate manner?

Taste - very important-- our oral stimulation is often the last sense for pleasure.  As part of your tour, you can ask to see the plate of food residents are receiving for the next meal and sample it.  Older people often have decreased appetites and need snacks throughout their day because they don't finish their food at meal time.  Are snacks available as desired and if so, what type of snacks?  As your tour, look at all areas.  Almost always, the lobby and front area will be the most polished and luxurious.  Do the residents have use of the lobby area or are they securely kept behind closed doors so they're not seen?  Also, as you are touring, ask to see the activity rooms, bathrooms, any spa areas, dining areas, several different resident rooms.  Is there access to outside patios and gardens?

Ask if residents are separated into different areas by stage of dementia?  If this is the case, be sure to see the area where the most severely affected residents are staying.  This area is the one that often receives the least attention and it may not  be included in tours of their care facility.

6.  Listen for the "stories"-- does the staff initiate stories that honor the residents and highlight their abilities and successes, rather than their disabilities?  Are residents directly acknowledged by the staff?  Does the staff speak at a rate of speech that is easy to understand?  Does the staff give the resident eye contact when they are speaking together?  Are there restricted visiting hours or is family able to visit anytime?  Is there a waiting list?

7.  Costs - Is there an initial "move-in" or "administrative" fee?  What is the basic monthly cost?  If your family member has specific needs, such as assistance with medications or bathing, what is the extra monthly cost?  Read the contract carefully to look for additional fees related to care levels.  Contracts can be lengthy, ask for a copy to take home and read in advance of signing.

8. Training - who receives training related to providing care for someone living with dementia?  Is it only the direct care team or does everyone that works in the community receive training?  How many hours of training?  How often are they retrained?

9.  Leadership - how long has the leadership been in place?  Do you hear a passion for the job?  How do they inspire those that work for them?

Choosing a Memory Care Program in Assisted Living is a big decision.  If possible, don't rush to make a decision but learn as much as you can from visiting several locations.  Public information regarding licensure and complaints is also available on licensing websites in each state. 

Have a great day!

If you work in Assisted Living and want
To make your dementia care program even better,
Or if you need assistance in
Planning care for a loved one,
E-mail or call me for a free consultation.

Anne Ellett, N.P., M.S.N.
AANC Certified Gerontological Nurse
Founder, Executive Director - Memory Care Support
Ph. 949 933-6201

Anne Ellett

Dementia Care Specialist AANC Certified Gerontological Nurse
Founder, Executive Director

Memory Care Support

CNN has followed Sandy Halperin for the past 3 years as he explains his experience since he was diagnosed with Alzheimer's disease.  Sandy says, "One of the things that Alzheimer's patients struggle with is getting validated." Sandy is a dentist and Harvard professor.  How would he find meaning in his life now?  He has welcomed Dr. Sanjay Gupta into his life as he talks about his motivational bucket list, family and his volunteer work giving him purpose.  The series of short films about Sandys life is remarkable as he  helps us understand his perspective.
It's Not Always Alzheimer's... What is LBD?

Lewy Body Dementia is the second most common type of progressive dementia.  Recently many in the public heard the term for the first time when it was announced that Robin Williams had been diagnosed with it.  If LBD is a progressive dementia, how does it differ than Alzheimer's?  There is some overlap of symptoms with Alzheimer's disease and people with LBD may be misdiagnosed. However, there are some characteristics of LBD which are unique. The Lewy Body Dementia Association lists some of them on their website.
  • Visual hallucinations, such as seeing people who aren't there.
  • Shuffling walk, tremors, and slowed movement.
  • Trouble with sleeping, including acting out dreams.
  • Attention problems with periods of drowsiness or long daytime naps.
  • Memory loss.
  • The nervous system is affected by LBD so there can be poor regulations of bodily functions.

People affected by LBD often have periods during the day when they need to be up and moving.  It can be difficult for them to sit for extended lengths of time and meal times can present a challenge.  A healthy menu of portable "finger-foods" can be helpful to maintain good nutrition since they may not want to sit at the table for a full meal.
7 Essentials of Good Care:
We all deserve GOOD CARE. Whether you or your loved one affected by dementia are receiving care in a private home or an assisted living community, there are seven essential elements that I believe are crucial for providing good quality of life.

Essential #1 Dignity
Essential #2 Loving and Compassionate Relationships
Essential #3 Stimulating and Age-Appropriate Activities
Essential #4 Choices
Essential #5 Safety
Essential #6 Attentive Medical Care
Essential #7 End of Life Planning and Support

You can read more information here about these 7 Essentials.
We Were Meant To Move

A study conducted at Wake Forest Baptist Medical Center in North Carolina showed that adults with Mild Cognitive Impairment (MCI) who were involved in aerobic exercise for 45 - 60 minutes, four times a week had improved brain function.  Adults 55 - 89 years old with MCI were randomly assigned to a structured aerobic exercise group or group that did stretching.  Participants in the aerobic exercise group had higher cognitive scores and also decreased tau and beta amyloid levels in their cerebrospinal fluid.  MRI's showed that the aerobic exercise increased circulation to areas of the brain even after the exercise was completed.  The aerobic exercise group also benefited from improved glucose tolerance.  These are great results!  Come on now, everybody up and moving!
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