Find peace of mind with the right care
Memory care is an important therapeutic strategy for those struggling with memory issues. If you or a loved one is struggling with Alzheimer's or dementia, finding the right care environment can impact both the progression of the disease and the quality of life of the patient and their loved ones.
While neither Alzheimer's nor dementia are controllable, there are things you can do to feel more “in control” of how you manage the journey. Your plan will depend largely on where you or your loved one falls on the Reisberg scale, but whether you're facing early stages of dementia or if the disease has progressed further, understanding your options for memory care will be important an important part of developing your care plan. But first let's start with some definition of terms we'll use a lot in this guide.
No, they are not. Alzheimer's is a specific disease in which memory and thinking skills deteriorate over time. In contrast, “dementia is a general term for memory loss and other cognitive abilities serious enough to interfere with daily life" according to the Alzheimer's Association.
To put it simply, Alzheimer’s is a disease and dementia is an umbrella term which describes changes in behavior which impair memory and/or judgment. Alzheimer's accounts for 60-80% of dementia cases, and neither dementia nor Alzheimer’s is considered a natural part of aging.
Memory care is designed for those with Alzheimer's or other forms of dementia. It refers not just to the type of care, but also the environment in which it is provided. Some assisted living communities have special wings designed to help residents with memory loss. Other care solutions might be standalone facilities where the entire building is designed for residents with memory diagnoses. When someone needs more supervision due to memory or cognitive concerns, and in-home care is no longer a viable option, then it is time to consider memory care. For dementia patients searching for senior living, the options can be overwhelming. Here's a quick overview of the types of care you're likely to find as you start your journey:
Both memory care and assisted living communities (sometimes called nursing homes) provide meals, housing, supervised care and help with activities of daily living, such as grooming, bathing, and medication management (ADL). Assisted living differs from memory care because it does not offer regular, skilled medical care or any kind of memory care assistance. Memory care communities generally have a more specialized living design for residents as well as trained specially trained staff to support memory care patients.
However, many assisted living communities offer an onsite memory care unit, so a facility can - and often does - offer both basic support for assisted living and specialized memory care. In short, standalone assisted living facility may also offer memory care units designed for those with Alzheimer's disease or dementia.
While both communities can support residents with memory care issues, there is a difference between memory care and a skilled nursing facility. Memory care is specifically intended for those with memory loss, while skilled nursing facilities are not. Skilled nursing facilities do not offer the same level of specialized care that you would find in a memory care communities. Instead, skilled nursing facilities provide both short-term and long-term medical care for those who can not take care of themselves in their own home. Skilled nursing is often the preferred choice for those who have been recently discharged from a hospital and need rehabilitative services.
In-home care allows patients to receive treatment at home in a familiar place instead of a facility or hospital. Home care allows the person to continue to manage care in their own home while also allowing respite for their primary care providers. For similar care levels, home care tends to be a much more expensive option.
While both memory care and home care can offer the same services for individualized treatment, memory care is different from home care because it offers an improved quality of life through continuous socialization and specialized treatment for your loved one. Memory care facilities have clinical and medical staff that are fully trained in therapy, medications, and treatments.
There may come a time when you and your family decide you're no longer able to care for a loved one with memory problems. And while the journey to that decision point may be difficult, we want to assure you that there are many benefits to structured memory care programs. Here what memory care facilities provide:
The typical caregiver-to-resident staffing ratio in memory care is 1:6, which is much higher than the assisted living ratio of 1:15. Trained staff are also available at all times, which allows for more personalized and specialized levels of care and attention.
Safety & security
The safety and security measures of a memory care community are vital to overall health and peace of mind for family members. Most units provide safety features and a little extra security going in or out of the unit to prevent wandering. This can even extend to enclosed outdoor spaces - landscaped yet secure patios or courtyards allow residents to enjoy the sunshine and spend time outdoors without endangering themselves.
Safety precautions show up in smaller ways, too. Toxic items, such as laundry detergent or shampoo, are kept locked up to prevent accidents. Residents may wear bracelets keyed to sound an alarm if they open a door to leave the facility. As another safety precaution, memory care rooms and suites don't include kitchens. As you tour a memory care facility, you'll likely notice many features to keep residents safe that simply aren't possible in a home environment.
Well-trained staff develop engagement programs to slow the progression of Alzheimer's or other dementia related illnesses. Many facilities offer physical activity in the form of exercise classes, music therapy, or group video games or video chat to increase engagement and slow cognitive decline. Brain games like puzzles, trivia nights or bingo are also fun and strategic therapies for those with cognitive impairments. For memory care residents, this kind of programming, when done well, can make a real difference in quality of life.
Most facilities offer physical, occupational and speech therapies. Many also offer sensory stimulation programs, which the Alzheimer's Association has reported as being beneficial for Alzheimer's patients and their cognitive abilities. Innovative therapeutic support can help with cognitive ability, memory, attention span, and language skills, to name a few.
Medical care & support
Most facilities are staffed with registered nurses, licensed vocational nurses, and certified nurse assistants. The objective is to have enough qualified staff to care for residents' needs and to maintain resident safety. Ideally staff members remain at the facility for a long time and work consistent shifts as residents with Alzheimer's disease or dementia respond best to familiar faces.
Typically, medical and non-medical staff are trained in dementia-related care practices that stem cognitive decline, including training in the progressive symptoms of dementia and communication strategies for those with diminishing verbal skills.
Memory care written plan
Part of the care for your loved one at a memory care community will include a written plan. While the facility's medical director leads the development of this plan, the attending physician, related medical staff, and family members also contribute.
The written plan for your loved one should reflect their personal preferences and long-term interests. It should provide as much freedom of choice as is possible and safe. Among the topics covered in the written plan for any resident's medical care are:
Staff with specialized training will work together with your doctors and others that are helping with their memory care. So if, for example, your loved has multiple diagnoses, you'll receive holistic care specific to their needs.
Specially designed environment
A good memory care facility will incorporate strategic design elements to minimize disruption and reduce confusion for residents. For example, some facilities are centered around a circular hallway that's easy to navigate and allows residents to stroll without ever losing their way. Other communities might use personalized way-markers, like memory boxes, to help residents remember where their room is. We’ve even seen some luxury communities employ circadian lighting, which has been shown to minimize sundowner’s symptoms and reduce episodic anger and outbursts. Facilities that feature lots of natural light, bright colors and common areas for residents to gather are wonderful. Overall, seniors living in memory care community truly benefit from a well-planned environment designed by experts.
memory boxes positioned outside of resident entrance, to help with way-finding. Courtesy of Coterie, San Francisco.
memory care common area with circadian lighting. Courtesy of Coterie, San Francisco.
Memory care facilities are designed to help those with Alzheimer's and other types of dementia feel comfortable and at home. The level of services provided often overlap with what is offered in an assisted living community. Typically, memory care communities offer
In addition, residential memory care provides assistance with activities of daily living (ADL), including:
In 2021, the average monthly cost for a memory care facility was $6935, according to a recent 2022 study performed by the National Information Center. While average costs vary state to state and are affected by the level of care provided and cost of labor, memory care costs are typically covered by private pay. Long term care insurance will supplement private pay.
In some cases, you will find qualified memory care in a skilled nursing facility (SNF). This will afford the senior resident some level of government assistance, such as Medicare. Your state's Medicaid program can also cover a SNF if you’re considered low income.
Each state has their own licensing regulations. Therefore, the cost varies state by state for the memory care services provided and the government assistance available.
PRO TIP: Veterans Benefits are often available for assistance with care needs.
Finding a way to pay for memory care services can be challenging for many families. There are four main options to consider when trying to cover memory care costs:
Medicare covers some, but not all, costs of care of memory care. It doesn’t cover any type of long-term care, but it does cover the following: inpatient hospital care, semi-private rooms, meals, general nursing care, medications, hospital supplies, diagnostic testing, 100 days of skilled nursing home care and hospice care.
The majority of people who enroll in Medicaid are unable to afford other forms of health insurance. Medicaid by law can not pay for room and board, but will cover the cost of care for residents. In most memory care facilities, the Medicaid waiver can be used for the cost of room and board.
Long-term care insurance
Long-term care insurance can cover different types of long-term care, such in-home care, assisted living, respite care, hospice care, nursing home/skilled nursing, Alzheimer’s or dementia care.
Out of pocket
Out of pocket pay is also referred to as private pay. This is when the cost of memory care is paid out of pocket by the individual or their family.
When you or a family member are searching for assisted living and memory care communities, questions abound. While cost is usually the primary concern for most families, it's certainly not the only consideration.
There are a lot of considerations in choosing a facility and neither you or the facility should ever shy away from asking and answering questions. Before choosing a facility you and your family members will want to compile a list of questions that covers your concerns about your loved ones’ care.
Here are some questions to ask during your tour of any memory care facility. You can also read more here How To Evaluate Memory Care Facilities
Assisted living communities are an ideal choice for seniors who are still active and fairly self-sufficient, but who need a little help with daily personal tasks, housekeeping, and medication management. Memory care is similar to assisted living, but it provides 24/7 care from staff members specially trained to handle the special needs of those with Alzheimer's disease and dementia. Nursing homes, also known as skilled nursing communities, care for seniors who have significant medical needs and need round-the-clock care.
No, memory care is not considered skilled nursing. Memory care is similar to assisted living, but it provides 24/7 care from staff members specially trained to handle the special needs of those with Alzheimer's disease and dementia. Nursing homes, also known as skilled nursing communities, care for seniors who have significant medical needs and need round-the-clock care. Assisted living communities are an ideal choice for seniors who are still active and fairly self-sufficient, but who need a little help with daily personal tasks, housekeeping, and medication management.
Access to the outdoors and to sunlight can help residents with Alzheimer's and dementia maintain normal circadian rhythms. A beautiful view or a pretty garden is soothing, and features like bird feeders or fountains provide positive stimulation for the brain.
Check out the outside areas to see if there are pleasant and safe walkways and restful spots to sit and enjoy being outside — and don't forget to check out the view from your loved one's window. In addition, find out if the residents have unlimited access to the outdoor areas and what any restrictions are.
Sometimes a memory care community seeks to discharge a resident because they can no longer provide the specialized care the individual requires. This is a legal discharge. A community can also discharge a resident if their remaining in the community poses a risk to their own health and safety or that of the other residents. Find out what type of medical care the memory care community of your choice can't provide, and how they handle the transition to a skilled nursing community if needed.
However, in most cases, a memory care community isn't allowed to discharge a resident for switching the manner of payment. For example, if you find your loved one needs to switch to Medicaid to continue payment, the community can't discharge them (as long as they accept Medicaid). While no one likes to think about worst-case scenarios, make sure you understand the circumstances under which your loved one might no longer be able to stay in the memory care community of your choice, and seek out the recourse you have available.
To find the best memory care facility, begin by searching our listings. Then select the communities you want to tour. Next, connect with a Seniorly Local Advisor who can arrange tours at all the properties. Prepare all your questions ahead of time so you don't forget to get all the information you need when visiting a memory care community. Take a good look around as you visit to see how much the community matches the impression you've gotten from the website or various brochures. Keep your eyes open for any hygiene or safety issues.
Most memory care communities provide three meals a day for their residents, but you may want to probe a bit to find out the details. Are there options if your loved one doesn't like the food being served? Will the kitchen take your loved one's preferences into consideration when planning the menu? This can be vital, since some people with Alzheimer's disease and dementia go through stages where they refuse to eat.
Ask whether it's possible for residents to get something to eat outside of regular dining hours, and whether they can enjoy meals in the privacy of their rooms. If you visit the communities you're considering, try to show up at mealtime, and ask for a sample of the day's menu to see how delicious and nutritious the food is.
Memory care communities always welcome family and friends as visitors. Check to see if there are visiting hours, if you need to call ahead, or if you're welcome to just drop in, though you will most likely need to sign in.
Some memory care communities have community pets, since interacting with cats and dogs provides positive stimulation for those with dementia. It's unlikely that your memory care community will allow your loved one to bring their own pet; if they do, expect to pay an additional charge for pet care. You might also want to check to see if your loved one's dog can come visit when you do.
Memory care residents often have far less need for transportation away from the community than assisted living residents do. Many communities will provide transportation to medical appointments, but ask to make sure if it's available and if there's an extra charge.
Some residents in memory care communities need walkers, wheelchairs, or other mobility aids to stay mobile. All areas of the community should be fully wheelchair accessible, of course.
But in addition, take a look at the design of the community. Is it easy for someone whose memory and cognition are impaired to find their way around? Are rooms marked clearly, so they can always find their way back to their own private space? Is there a safe space in which they can walk around without getting lost? For example, many memory care communities offer circular walks indoors or outside that always lead the stroller back to where they started.
Larger memory care communities are likely to have a nurse on staff around the clock. If this level of staffing isn't available in the communities you're considering, what are the hours of the on-duty nurses? What medical staff are on-call when no one is on duty? What staff are on duty through the night, when many Alzheimer's and dementia residents are active?
Aggression is a symptom that occurs in almost half of all people with Alzheimer's. Memory care staff should be specially trained to deal with these episodes by calming the residents with regular routines, gentle responses, and music therapy.
The treatment of dementia-related aggression is controversial. Talk to your loved one's physician about the options, and make sure that any memory care community you're considering is willing to abide by your wishes.
Some memory care communities check in with families every week or month, while others wait for family members to call and ask for updates. You may have a strong preference. Ask the memory care community who your contact person will be and how communication is usually handled, and make sure you're comfortable with the answer.
In addition, you should be informed of and participate in any changes to your loved one's individualized care plan. Ask how often this plan is discussed and how you can participate.
Each memory care community has its own policies for notifying families in the event of medical emergencies. They may let you know if your loved one is showing signs of aggression — or they may wait until psychiatric care is called in. Some communities will let you know if your loved one is put on oxygen or IVs for medical reasons. Go over the policies to make sure you understand them and are comfortable with them. If you want to be notified in case of specific medical actions, ask if that's something you can arrange.
Some memory care communities charge one flat fee that covers all services. Other communities separate the fees for medical care and housing. The differences may matter to your loved one's health insurance or long-term care policy. In addition, there may be tax consequences. Seek professional advice from a health care advocate or your tax accountant if these issues might matter.
Also find out how the community handles billing, especially if you will be responsible for all or part of the payments. Do they bill insurance, or will you have to pay upfront and seek reimbursement? Are there one-time fees to pay before your loved one can take up residence in the community? How can you structure payment arrangements if needed?
Many memory care and assisted living communities charge for cable or satellite TV service and for internet access. If meals are available outside the standard mealtimes and three-meal-a-day structure, you can probably expect to pay extra for those meals. Transportation, including visits to the ER, may also incur an additional charge. All these fluctuate from one community to another, so be sure to ask about your specific concerns.
You may also have to pay an upfront fee to reserve your loved one's spot in the community. Check with each memory care community you visit for details, since they can vary widely.
Medication management and basic monitoring of your loved one's health should be included in the cost at your memory care community. However, some memory care and assisted living communities charge extra for certain medical care, for example, diabetes care. If your loved one has a colostomy bag, or if they're confined to a wheelchair, there may be additional charges.
Don't hesitate to ask about various types of therapy — physical therapy, occupational therapy, and so on — to see what services are included, what might be covered by insurance, and what incur extra charges. Immunizations, care for injuries, and any emergency care are also likely to be add-ons financially.
Prepare all your questions ahead of time so you don't forget to get all the information you need when visiting a memory care community. Take a good look around as you visit to see how much the community matches the impression you've gotten from the website or various brochures. Keep your eyes open for any hygiene or safety issues.
If your loved one can handle it, you may want to bring them along on the visit to see how they react emotionally to each place. Their ability to make the trip will of course depend on their medical condition and the stage of dementia they're at, so you may have to be their eyes and ears on your own.
Once you've confirmed that a memory care community you're interested in has available accommodations for your loved one, either schedule a visit on the community's website or call to make an appointment.
Try to visit at mealtime, so you can check out the food and see the community in action. You may want to try to schedule a second visit late at night, if possible, to be aware of the care provided overnight.
When you visit a memory care community, you should first meet either the head of the community, the head of marketing, or the head of medical care. They'll start by explaining what the community offers in terms of medical care, amenities, activities and communities. They'll also go over costs with you, so have all your questions regarding finances ready.
Next, you'll be given a tour of the entire community. Depending on the size of the community, this could take as little as 30 minutes, or it could take over an hour. Make sure you see every corner of the place, and keep your eyes open for cleanliness and friendliness everywhere you go. Try to stay for a meal so you can determine whether the food's up to your standards and whether it'll make your loved one happy.
Spend some time talking to staff at every level. Ask the medical staff and nurses your medical questions, but chat with the housekeepers and caregivers to get a sense of their helpfulness and kindness toward residents. If possible, try to talk to some of the residents to see how they feel about their community.
Marlena del Hierro is Vice President of Partnerships and Seniorly’s Lead Gerontologist. Marlena earned her Master of Arts degree in Gerontology from San Francisco State University and her Bachelor of Arts degree in Human Development from California State University. She also serves in an advisory capacity for Jukebox Health. As Seniorly’s first employee, Marlena is a vocal advocate for evolving the aging paradigm, and is a frequent contributor to public discussions about aging. She has served as a resource for media outlets like WGBH, FOX News, CNBC and the Today Show.
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