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Providing the Best Dementia Care Possible

If you are taking care of a spouse or parent with dementia, there comes a time when you will need help. When and how this happens varies depending on the diagnosis and your unique situation.

There are several different types of dementia. Alzheimer’s is the most common type. Knowing the type of dementia your family member has may help with determining how the disease will progress. Regardless of type, dementia causes changes in the brain that affect these areas:

  • Language
  • Memory
  • Decision-making
  • Orientation
  • Judgment

With Alzheimer’s disease, people often have trouble speaking and walking. They may eventually have problems with swallowing. Dementia is not reversible so it will get worse with time. This decline may be gradual or sudden. The important thing to remember is that help is available. Let’s take a look at the types of care available for someone who has dementia. Knowing how dementia care works will help you make the best choice for your loved one.

What Does Memory Care Provide?

Memory care refers to the care given at a specialized senior living community for individuals with dementia and meets most of the needs that a resident may have. Care workers in a memory care facility manage medications, provide all meals, housekeeping, transportation and activities. But, memory care is not a nursing home. It is not a 24-hour nursing service with physicians and one-on-one care support.

How Does a Memory Care Community Work?

Memory care communities specialize in taking care of people with dementia. Many memory care communities are attached to assisted living communities. Although there may be people with memory problems in assisted living, their problems don’t affect their day-to-day functioning, which requires the extra attention given in memory care.

Memory care should have a higher staff to resident ratio then assisted living and they should have staff trained in dementia care. To manage wandering, most units are locked and are accessible with a code. The financial costs of memory care can be high. For example, in California, the average cost of memory care is $6,000 per month, or higher.

5 Questions to Ask About Memory Care

Before making the decision to move a loved one to memory care, ask these questions:

  1. What is the staff to resident ratio?
  2. Are care staff trained in working with people who have dementia? If so, what does this training consist of and how often does it occur?
  3. What is the makeup of the residents in memory care? This obviously changes over time, but ask about age, gender, and impairment.
  4. Under what circumstances would a person in memory care be required to leave?
  5. What kind of activities are offered and how often do they take place?

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How Does 24 Hour Care Work?

Many families find that they start with home care a few hours a day and then progress to 24-hour care. What is 24-hour care? 24-hour care means that there is a caregiver at the home every hour of the day. This includes overnight. You can expect several different caregivers to be in the home during that period of time.

5 Benefits of Around-the-Clock Dementia Care

Some of the benefits of around-the-clock home care include:

  1. Your spouse or parent is in the comfortable home setting to which they are accustomed. Their surroundings are familiar and secure. Most people don’t consider the fact that memory care communities have residents of varying degrees of impairment. Your family member may be in a setting where people have disturbing behaviors. This can be very stressful and confusing for someone with dementia.
  2. The opportunity to closely manage and monitor care. Home care companies can come up with a care plan that is tailored exactly to the needs of your loved one.
  3. The ability to request caregiver changes or other aspects of a care plan This is much more difficult to do in memory care because there isn't one assigned person to work with your loved one.
  4. The potential to develop a plan of care that is very specific for the present and flexible for the future. Having a hands-on approach to care can be very empowering for you and healthy for your loved one.
  5. A good caregiver can bridge awkward social moments. This is an aspect of care in the home that is often overlooked. Many people with dementia feel uncomfortable in social situations. Being accompanied by an experienced caregiver can help ease that anxiety.

I had a client with dementia that used to go to the senior center with his caregiver. There would have been no way he could have, or would have, gone without her. She helped him meet people and smoothed over those challenging social situations:

Jack is a gregarious 85-year-old man who loves being with people. He has had dementia for about two years. Although he is in excellent physical condition, his mind is starting to deteriorate. He loses track of what he is doing, forgets appointments, and has poor hygiene. Jack’s son hired a caregiver to be with Jack daily. Jack’s caregiver, Karen, knowing that Jack loves being with people, suggests they go to the senior center together. Jack is no longer able to drive, so Karen drives him. As they get ready to make their first trip, Karen makes sure that he is clean and well groomed. When they arrive, Karen engages Jack in a game of tabletop shuffleboard. Soon, a couple of other men join in. In the coming weeks, Jack starts to ask to go to the senior center so he can join his “buddies” in playing shuffleboard.

5 Questions to Ask About 24 Hour Care

  1. How many caregivers will be in the home during a week’s time?
  2. How will changes in caregiving staff be handled?
  3. If you are dissatisfied with a particular caregiver, how should you let the agency know?
  4. How are changes to the care plan made?
  5. Who is the care manager that is managing your family member’s care?

When to Consider Memory Care or 24 Hour Care

Most families wait too long to get help. It is human nature to want to care for those we love ourselves. But there comes a time for everyone when the stress becomes too much to bear. As the symptoms of dementia progress, you may find that you will want to consider home care or memory care. The time to consider help will be different for everyone, but a good place to start is if there are safety or daily care concerns. There may be limits to what you as a caregiver can continue to do. You may want to consider additional care if:

  • Safety becomes an issue. For example, the person you are taking care of wanders. Or, they aren’t able to get in and out of bed safely without assistance. Difficulty navigating stairs could be another sign the person cannot be left alone.
  • Help is needed with bathing, dressing, cooking, preparing meals, or housekeeping.
  • Medications aren’t taken correctly, if at all.
  • Your parent is not safe driving and/or cannot get to appointments.
  • They become aggressive or agitated easily.
  • They wander. Some people with dementia will leave their home unattended and get lost. Or worse, venture out into bad weather without adequate protection.
  • Assistance is needed with getting out of bed safely or to the toilet.

woman with plants

5 Tips on Choosing Between Memory Care and 24-Hour Care.

There are several factors to consider when choosing between memory care and 24- hour care. These factors will likely change over time, so you will need to be flexible.

  1. Level of Impairment. If your parent or spouse is mildly or moderately impaired, in-home care may be the best option. You can tailor caregiving tasks and responsibilities to meet their specific needs.
  2. Availability of Good Memory Care. Some communities will have limited options for good memory care. Or, the memory care community you have selected is full. Consider 24-hour care until an appropriate memory care community becomes available.
  3. Expenses. Most people don’t have endless funds. Both memory care and home care costs can be high. It's important to review the prices for both options and, if possible, speak to a financial advisor about how to best fund the care.
  4. Caregiver Management. A good agency will do a good job managing caregivers. They can interview you and your loved one and find caregivers who will match your loved one's needs and personality.
  5. Isolation. Despite caregivers coming to the home on a regular basis, people can become socially isolated. For some, being with other people their own age may be more beneficial. But keep in mind you don’t get to choose your neighbors in memory care.

The example below illustrates how care in the home can be tailored to meet very specific wants and needs.

Patricia is in her 70’s and has been diagnosed with Alzheimer’s. Her memory is starting to fail her and she has become quite anxious in social situations. Her husband, Kirk, travels for his work and he has become concerned about leaving her alone. Although Patricia’s memory is getting worse, she is an avid walker and gardener. These activities help ease her anxiety.

Kirk decides to hire a home care company to be with Patricia during the day. Caregivers stay overnight with Patricia when Kirk is out of town. Kirk is very specific about the activities that Patricia enjoys. The agency is able to assign caregivers who walk with Patricia and garden with her so she is able to continue to enjoy the activities that are meaningful to her.

If Patricia was in a memory care community, they would not have the staff to engage in this level of activity. A group of caregivers gives you the opportunity to tailor tasks to the specific needs of your family member.

The decision between memory care and 24-hour care is a very personal one. If things stayed the same, these decisions would be much easier! Accept that your family member’s situation will change. Be flexible and adapt to the challenges that are a part of twenty four hour caregiving. Take the time to examine your needs as well. Taking good care of yourself is an important part of taking good care of someone else.

About the Author(s)

Amanda Lambert is the owner and president of Lambert Care Management, LLC which provides care management for older and disabled adults. She is the co-author of Choose Your Place: Rethinking Home as You Age (November 2020) and of Aging with Care: Your Guide to Hiring and Managing Caregivers at Home (Rowman and Littlefield, 2018). She has worked for over 20 years in the senior-related industry including mental health, marketing and guardianship. She has a passion for topics related to health, wellness and resilience as we age.

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