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Exploring Memory Care: Tips and insights from the field

  • Aug 3, 2023
  • Cathy Gasiorowicz
  • 7-min Read

For the past seven years, my 91-year-old mother has lived fairly independently in a little apartment in a senior living community. As her dementia has progressed, we’ve added services, like medication management and a dinner escort, but so far, that seemed like enough, in spite of her inability to make new memories and, in some cases, hang on to older ones.

For instance, she can’t remember the names or faces of her fellow residents, many of whom she’s had breakfast with since 2015. She doesn’t remember having lunch with her granddaughter yesterday or even how she’s related to this young woman. She doesn’t remember getting bitten by a dog, developing sepsis, and, not surprisingly, why she was now in the ER, hooked up to IV antibiotics. (“Well, this was certainly a waste of time. We should just leave,” she said. Repeatedly for about five hours.)

Recently, however, her brain seemed to jump the track. I’d been calling her every morning for the past three years, but in December, she suddenly become completely disoriented. She wanted to know whose bed this was, why she was in this apartment, what city was this, whether I lived there, whether she lived alone, what about meals, whether she had a job, and when my dad was coming back (he died in 2016). “I know this sounds a little crazy, but I’m confused,” she’d say. “Where am I?”

As this pattern continued, I wondered if my mom was ready for memory care. I wasn’t sure, but I knew I had to start looking.

Memory care options

A quick Google search for “memory care options” produced 447 million results, most from companies promoting their services, including:

  • In-home aides
  • Adult day centers
  • Skilled nursing facilities
  • Campus-based memory care
  • Residential care homes

Although my mom sometimes forgets to shower, she doesn’t struggle with the mechanics of Activities of Daily Living (ADLs)—such as bathing, dressing, toileting, continence, transferring, and feeding—so for now, hiring a home health aide didn’t make sense. As for adult day centers, her senior living community offered plenty of activities, so no need there. And because my mom is in good health and completely mobile, a skilled nursing facility wasn’t appropriate.

That left campus-based memory care and residential care homes. To learn more about these types of options and which might be the better fit for my mom, I set up interviews with an executive director, two owner/operators, and a family friend who recently moved her spouse into memory care. All offered helpful suggestions and insights to help guide my family’s search.

Professional assessment and red flags
Katie Keogh, LALD, LNHA, Executive Director of Legacy at Delano, a Lifespark community, oversees three area of senior living: independent, assisted, and memory care. I asked how she determines whether someone needs memory care. “It’s difficult without meeting them in person,” she said. “That’s why we always send a nurse to wherever they’re currently living to do an in-person assessment, or discovery as we call it, and see them in their own environment.”

When meeting with family members, Katie advises them to be honest about their loved one’s abilities. “It’s better to be upfront at the onset,” she said. To help her identify red flags and gage the progression of dementia, she asks them questions, such as: Are they wandering? If they get outside, will they know how to get back in? Are they dressing appropriately for the weather? Do they need verbal cuing for ADLs? Are they safe behind a closed door?

“If someone needs much more one-on-one time and attention, they might not be a good fit for campus-based memory care,” Katie said, adding that they once had a resident who was repeatedly harming himself, and although the staff worked with his doctor and family, it wasn’t safe for him to stay there.

Staff-to-patient ratio, longevity, and training
Josh Cesaro-Moxley, LALD, manages four memory care homes that can accommodate six to seven residents each. In his experience, staffing is the strongest predictor of high-quality care.

“Look for a reasonable caregiver-to-resident ratio, longevity among the nursing staff, and a dedicated team as opposed to caregivers from a temp agency, which can lead to communication problems,” he said. “Also, make sure that everyone on the staff is trained in dementia care, including redirection techniques, which are especially important with residents experiencing sundowning.”

Sundowning, or sundown syndrome, is a group of behaviors that can include insomnia, anxiety, pacing, hallucinations, paranoia, and confusion. This pattern can happen at other times of the day but typically occurs at sunset. By example, Katie of Legacy at Delano shared a story about a resident who would become anxious in the late afternoon and proceed to pack up her entire room. “Instead of trying to stop her, one of our staff would join her in her room, help her pack, and then bring her to dinner. After the meal, the caregiver would take her to her ‘new home’ and help her unpack,” she said.

Timing and availability

Ruth, a close friend of my mother’s, has been walking this path for the past ten years when her husband first started showing signs of dementia. In 2020, when he could no longer be left alone, she hired a caregiver for two afternoons a week so she could have a few hours to see friends and do errands.

By the time Ruth actively began looking into memory care last August, she’d been her husband’s around-the-clock caregiver for over a year. She put him on two waiting lists, but between his nightly incontinence and increased agitation and confusion, she had reached a breaking point. “I wasn’t getting any sleep at night and was on call all day,” she said. “I was afraid for my health.” So, when a space opened up at a campus-based location that wasn’t among her top picks, she took it.

Based on her experience, Ruth told me to start looking now. “Things can go downhill very quickly,” she said. “Meet with the directors of nursing, go on tours, ask them about staffing, and get on their waiting lists. Oh, and don’t be swayed by fancy lobbies.”

Physical environment

Jenny Morgan, MS, RN, has been providing residential geriatric care in two adjoining side-by-side ramblers since 2004. The 12 residents, mostly individuals with dementia, each have their own bedrooms, but her goal is to have them spend as little time in there as possible.

“Some of our residents like to chill for a bit after lunch, but other than that, we’re with each other constantly, going between the two living rooms and when the weather’s nice, hanging out in the backyard,” she said. “It feels like a family home.” They even have a couple of rescue dogs and a cat.

For Ruth’s husband, the long hallways at his campus-based memory care have been an unexpected source of pleasure. “He likes to walk and look out the windows, so whenever I come to visit, that’s what we do,” she said. “It never occurred to me to look for this, but it’s worked out well for us.”

Moving forward

Although this process of exploring memory care options wasn’t on my bucket list, everyone I’ve met with has impressed me with their compassion, expertise, and dedication to the people they serve. They also seem to understand how hard this transition is for family members like me. Based on what I’ve seen and heard, I trust we’ll find the next right home for my mom.

To learn more about Memory Care at Lifespark, visit Lifespark Senior Living or call us directly at 952-345-8770.

*Photo is of Hilde, my mother (Cathy Gasiorowicz)

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