Memory care is one of the rapidly growing options for elder care today. Memory care is specifically devoted to caring for patients with Alzheimer’s Disease, dementia, impaired cognition, and other memory related degenerative illnesses. Dementia is not a single disease. It is a neurological disorder stemming from damage to the brain and is caused by any number of circumstances, a specific set of symptoms that results in a decline in mental abilities.
Skilled staff within a memory care facility provides 24 hour supervised care, usually in a separately dedicated wing or floor of a nursing home or assisted living community. Staff are specially trained to aid residents with daily living activities when they are no longer able to do so independently.
Types Of Memory Care Facilities
A person with degenerative memory loss will eventually need 24/7 round the clock supervisory care. Aside from personal in home care, there are a few other options to consider. As a memory- related disease becomes progressively worse, caring for a patient in home may eventually no longer be viable due to a number of reasons. One of them being that a family member is not necessarily equipped for the level of assistance required to meet the needs of the patient, especially if there is an emergency. It is difficult to realize that not only is long term in home care financially draining, it can be emotionally taxing for everyone. Therefore, sometimes choosing a dedicated long term facility is the right choice for all involved.
Specialized Nursing Home Unit: Nursing homes and assisted living facilities provide residents with round the clock care. Specialized Care Units (SCU’s) are located within nursing homes and are dedicated to memory care. These are beneficial for patients in the early stages of dementia, as the facility is typically large with a number of other patients. Someone requiring more personalized care would not thrive in such an environment, and it may be harder to foster a sense of community. Large homes also tend to have more amenities, more security, with stricter guidelines and regulations to follow. The SCU’s (located on floors or wards) located in nursing homes and assisted living communities are designed to suit the patients, minimize wandering and provide easy navigation, with color coded hallways and monitored exits to prevent leaving the premises unauthorized.
Standalone Facility: Single, standalone facilities have the purpose of only providing memory care. There is usually a higher staff to resident ratio and a better sense of community with a minimum number of residents. The security at a dedicated memory care facility may not be as stringent than the one in place at a larger home. Dedicated facilities usually cost less as well, therefore providing less financial strain on families.
Adult Foster /Care Homes: These homes have a small number of residents, and a more “homey” approach to care in that kind of setting, however there is generally less amenities and security.
Memory Care Services
State regulations vary when it comes to memory care services provided. Generally, supervised care, medical monitoring, and help with basic, daily activities is given – these would include things like hygiene, eating, and mobility.
Other provisions can include the following, some of which may or may not be included in the base fee:
- Emergency call systems
- Health and exercise programs
- Housekeeping/laundry service
- Social activities
- 24-hour staff supervision
- Medical care/medication management
Memory care facilities may also offer more structured activities for dementia patients in spaces specifically designed to provide comfort and familiarity to residents. Many facilities can provide personalized long term care plans for the individual.
Those activities include:
- Supervised day trips, where family members of the resident can attend
- Movies and holiday parties
- Exercise classes
- Support and/pr education groups for families
- Cognitive and physical therapy (including speech and occupational)
- Specialized therapies including arts and crafts, music, and pets
Memory Care vs. Nursing Homes
There are marked differences between nursing homes, assisted living facilities, and memory care facilities. For one, Medicare and Medicaid do not cover traditional nursing home stays, while memory care facilities (skilled nursing or specialized units) are covered, at least for a period of time.
Memory care facilities are regulated by the Department of Health with more guidelines to meet. By and large, nursing homes aren’t. Skilled memory care homes have agreements with local hospitals in case patients need short term rehab or are recovering from an illness or injury. Medicare ensures that the facilities meet the qualifications and that they have the staff capabilities to take care of residents.
Care that is offered at memory care facilities can include therapies such as physical and occupational, along with medical care that necessitates skilled nursing staff. Nursing homes staff is not as expertly trained, and provide more general care, which is not as medically focused.
When caring at home is no longer viable for a dementia patient, whether financially or emotionally, their family must begin to research facilities. Many memory care facilities will meet with you prior to a resident moving in, and develop a personalized plan after a needs assessment for care. Residents will need to be increasingly monitored as the disease progresses. There are several options for dementia patient residences including assisted living facilities and memory care units. At some point, a nursing home with a dedicated memory care unit may be moved into. A nursing home memory care unit or skilled nursing facility provides round the clock care, with specialized assistance for medication management. When residing in a nursing home, patients have typically progressed to a later stage of the disease and require more supervision regarding eating, walking, or communicating.
Memory Care vs. Assisted Living
Assisted living communities enable seniors to continue living an independent lifestyle while receiving assistance for certain daily needs. Memory care units provide the same, but are specially designed to suit Alzheimer’s and dementia patients.
Assisted living communities can have specialized memory care units on site, and the two are distinctive from one another. Memory care, or specialty care units, require skilled nursing staff to provide for patients with Alzheimer’s, dementia, and other degenerative brain problems. These communities support the transition to living in a nursing home or memory care facility. Assisted living offers the introduction to being helped with the daily routine a resident had previously, and integrates this new lifestyle with no longer living completely alone.
Though Alzheimer’s affects memory, behavior, and thinking, dementia patients in the early stages of the Disease have the ability to continue functioning independently. Since the disease is degenerative, as it progresses those who have it will require more supervision and care as time goes on. Assisted living is a good option for the care Alzheimer’s necessitates. In assisted living, residents can live in private or shared apartments, where watchful staff are on call 24/7. The arrangement is ideal for residents needing assistance with housekeeping, bathing, mealtime, mobility, and medication management. Often, transportation and social activities are offered, the latter being beneficial for companionship to combat the loneliness seniors face that can come with aging.
Who Needs Memory Care?
Dementia, Alzheimer’s Disease, and other degenerative brain issues are not a part of normal aging. As symptoms gradually worsen over time, the patients quality of life will diminish. There are a number of things to consider when determining if a loved one needs to be moved to a memory care facility. It can be easy to notice some symptoms of dementia, it is much harder to decide if a relative needs more care than you can provide at home. If a loved one is putting themselves, you, or anyone they come into contact with in danger, it is definitely time to examine care options.
Situations to consider are:
- Forgetting, misplacing, or ingesting wrong dosages of medications
- Forgetting to lock up at home, or leaving on appliances
- Forgetting phone numbers, names, or addresses
- Misplacing items
- Getting lost, wandering
- Decline in daily activities, such as bathing, cleaning, or eating
- Changes in personality, such as becoming more aggressive, angry, or confused and mistrustful, disoriented, among others
- Family members fearing for their safety in case of emergency when the patient lives alone
- Would they benefit from more structured living that is given in a facility
- Would they benefit from companionship
The topic of transferring to a care facility is a difficult topic, and can cause familial strife. If you feel a conversation is necessary, keep the lines of communication open. Present your arguments for the reasonings with conviction, armed with research and care options. Early intervention cannot prevent the progression of the disease, but it can alleviate symptoms and ease the future. Therapies can help people live more comfortably and benefit their well being in the long run.
Memory Loss Explained
What causes memory loss? Dementia comes in many forms. Alzheimer’s Disease is not synonymous with dementia, but it has become the “face” of the disease when in reality it is only one branch. Having an occasional memory lapse may come with age, however any of the below signs and symptoms deserve a second look and cause for concern.
A few of the more commons forms of dementia are:
- Alzheimer’s Disease: the most prevalent and characterized by abnormalities in the brain
- Vascular Dementia: caused by a stroke ( or several strokes) damaging the blood vessels in the brain
- Parkinson’s Disease: cells in the brainstem are destroyed, affects movement, coordination, muscle control, and balance
- Huntington Disease: the nerves in the brain break down over time, affecting the mind, body, and emotions, causing uncontrollable movements and impairing cognitive functions
What does Dementia Look Like?
Dementia symptoms are progressive. Signs and symptoms may include:
Short Term Memory Loss: The inability to recall details further back than a few minutes or days ago. This makes it difficult for everyday activities like bill paying, locking up a house, or traveling.
Speech Issues: This includes comprehension, as a person with dementia can lose the ability to communicate. It may result in replacing normal words with gibberish or calling objects and people by different names.
Disoriented: Dementia sufferers become addled and confused easily even in familiar environments.
Delusions: As dementia becomes progressively worse, delusions and paranoia may become present; when a person is convinced of something that is overtly incorrect.
Learning Impairment: Difficulty learning and remembering new information.
Executive Functions: The reduction of executive functions affect the ability to plan and execute tasks, especially regarding memory, language, and logic. Everyday things such as driving or cooking become difficult. It is also a challenge to learn anything new. Impairment of executive functions can lead to trouble walking and falling.
Depression: There is not enough data to support that dementia causes depression, although a number of people with dementia are depressed. Moodiness, irritability, apathy, emotional and physical withdrawal, insomnia, weight loss, and suicidal tendencies are all side effects of depression.
Behavioral Disorder: Dementia sufferers can begin to act inappropriately, whether societally and against norms, or opposite to their regular personality.
Finding a Memory Care Facility Near You
Finding a memory care facility when everyone is on board for that type of transition can be relatively straightforward. Your parent or loved one may still be independent, but crave more companionship on a daily basis, and may need help with simple daily tasks. Some people may require round the clock care, something family members cannot provide or are equipped for. There are a number of choices for care treatments to suit your loved ones’ needs.
The decision becomes more complicated and difficult depending on the severity of the medical issues being faced. Since dementia, being degenerative, is incurable, the only option is treatment, making the progression of the disease easier on everyone involved, most of all the person suffering from it. More than likely, a dementia patient will not be returning home from a long term care facility, so more factors should go into choosing a location, given they might be there for a number of years.
Dementia and its symptoms present differently in patients, and there are instances where emergences of clarity can strike, resulting in the patients reverting to “normal” with lucid moments. This makes it hard not only on family members, but also medical personnel and caregivers to assess a patient’s current and future needs to give the correct treatment.
When living at home is no longer viable, joining some type of support network (in person or online) is beneficial. There are many others who have more experience and knowledge with this situation willing to dispense advice to help you navigate this new path in life.
Ask yourself if the dementia patient is unsafe in their home, and if their health or yours, as the initial caregiver’s, is at risk. If care needs are beyond your capabilities, or your other responsibilities are being neglected, finding a facility is advantageous.
How To Select The Right Memory Care Facility
Once you decide your loved one needs a long term care facility, you will have to research your surrounding area for one that can provide the level of treatment they require to suit their needs. Narrowing down a list of choices can be made easier by scheduling tours for prospective options. Visiting first hand will give you a better idea of the environment, and you can meet the staff, residents and their families, explore the layout, and compare costs and care services.
Throughout your visit, there are some things you should check out:
- Safety precautions: locks on doors and windows, bright lighting, non slip floors, monitoring systems, grab bars in the restrooms, hallways, and common areas
- Healthy and happy residents treated with dignity
- Attentive and friendly staff
- Structured routines
- Clean common areas
- The facility is easily navigable
- Range of social activities including outdoor activities held in a safe place
Questions to Ask
While observations are a reliable way to see day to day functions, there are questions that must be asked.
- Request to see an up to date inspection report for any facility under consideration?
- What are the state regulations and procedures that must be upheld?
- Ask about room availability and waiting lists?
- Does the facility accept Medicare and Medicaid?
- What insurance providers does the facility accept?
- What are out of pocket costs?
- What is the number of rooms/residents/maximum capacity?
- Does the staff undergo continual training and education?
- What is the ratio of staff to residents?
- How does the staff handle outbursts – aggressions, wandering, and other dementia symptoms?
- If a patient is unusually aggressive on a regular basis will they be asked to leave
- What is the discharge policy?
- Is transportation provided for medical appointments?
- Can residents bring personal items from home?
- Can family members attend events or meetings?
- Are support groups available?
- Ask to see a typical activity calendar and dining menu?
- Are dietary needs provided for and is residents nutrition monitored?
- What are the visiting hours?
- How often are assessments/care plan revision meetings held?
- How are changes in care plans communicated to family before being put in place and how involved are family in decisions?
- What safety measures are in place for dementia patients?
- What therapies are available?
- What occurs in case of an emergency?
- Are there physicians on the premises?
- Is hospice care/end of life care available?
Memory Care Facility Costs
Any kind of medical care is expensive, especially long term. There are additional costs when it comes to dementia care since this disease can be unpredictable, long, and slow. It is in everyone’s best interest to make some type of financial plan for the future if at all possible. Unless Medicaid or Veteran coverage is available, many senior residences are privately paid out of pocket. Medicare does not cover the cost of long term care facilities. Care costs vary on a number of factors, including geographical location and type of facility (nursing home or assisted living, private or shared room).
Despite a combination of other resources, dementia patients still incur very high out of pocket costs, equaling to almost five times higher than the average for seniors without memory care.
Some of the long term care costs may be tax deductible, if they exceed more than 7.5% of your adjusted gross income. However, the memory care resident must be deemed chronically ill, or as having a chronic condition. Meaning, it must be certified by a medical professional they cannot perform at least two daily living activities (bathing, eating, etc.), and they require supervision due to their impairment.
Generally, facilities charge monthly rates, and depending on the facility, housekeeping, laundry, and other services will be covered in the fee. It is important to ask for a breakdown of costs for this reason.
What types of financial questions should be asked when looking at facilities?
- What is the monthly fee?
- What does this fee include? Are meals, snacks, transportation, and activities included or do they cost extra?
- Is insurance or Medicaid/Medicare accepted?
- What happens if paying out of pocket is no longer feasible?
How to Pay for Memory Care
Long term memory care can be paid for publicly or privately. Though paying out of pocket provides families with more provider options, care is very expensive, and more often than not personal funds are not able to cover costs for an extended period of time. Private insurance, Medicare, and Medicaid can help out here, along with other financing methods.
Medicaid and Medicare
Medicaid and Medicare are synonymous with elder care in the United States.
A federal insurance program for people who have paid into it over a period of years, Medicare primarily serves those who are aged 65 and over, no matter what their income is. Monthly premiums or deductibles are paid by the patient, and Medicare will cover hospital care, doctor fees, medications, and various other medical necessities for dementia patients. It will not cover the cost of long term care, and only pay for up to 100 days of skilled nursing care- and usually then it is under supervision or immediately after a hospital stay. Medicare has no eligibility requirements.
Medicaid is a low income assistance program for any age. Typically, patients do not pay any costs out of pocket, and if they do it is a small copay. Medicaid follows federal guidelines but is managed at state and local government level. Eligibility is determined by the state you reside in, and each state has different requirement to assess qualifications for receiving aid. At a minimum, the person applying for Medicaid must have a limited income or assets. Medicaid is basically the last option for someone who has exhausted all of their other financial choices. The program will cover either all or most of long term care and nursing home costs. However not all facilities will accept Medicaid and this may factor into your decision of choosing one.
Other Methods of Payment
Veterans Benefits: The tax free Aid & Assistance benefit is set up for war era vets and their spouses. Designed to provide financial assistance to help with long term care costs, A&A will help cover stays at home, in nursing homes with memory care wards, or in assisted living facilities. The designee must be either mentally or physically incapacitated, or need a caregiver for at least two daily activities (bathing, eating, etc.).
Private funds can include retirement accounts, 401ks, savings, annuities, trusts, and insurance plans through employment. Home equity loans and Social Security can be used as well when paying out of pocket. Most often, a person will have to live off a combination of or all of these monetary avenues. The cost of living today is simply too high to sustain a quality of life one is used to with only one financial stream – and elder care is expensive.
Developing a long term financial plan early is highly recommended, especially in uncertain economic times. If early planning was not an option for whatever reason, seek out advice from an expert as soon as possible to guide you through the ins and outs of the system and how best to maximize what funds are available to you for the future.
Private insurance purchased through a company depends on age, health, and the amount of coverage needed. There are no guarantees with private insurance even though you have paid into it, as coverage can be denied for certain pre – existing conditions including dementia related diseases.
Life Insurance Conversion
Investing in life insurance can be beneficial at any age, as it can provide for yourself or your loved ones with financial assistance depending on the type of coverage you get. Some policies can be used or converted to money that can be used for care or senior residence expenses. This is different from the senior life insurance which is known as the “death benefit” and used solely after the policy holder has passed away. Some types of insurance conversion include:
Long-term Care Insurance: Considered one of the best types of insurance to have. A portion of it is tax deductible, and cash withdrawals are permitted. Long term care insurance is designed to help cover long term health care needs, which Medicare will not. This includes care at your own home or an outside facility. Every insurance company has its own benefits and care options to choose from.
Taking into consideration how much you want to pay into long term care insurance, research national average costs for at home care vs. facility costs, and prepare a plan based on your findings. The insurance company will assess the type of coverage they are willing to parse out as well – looking at age, gender, general health, and service coverage among them.
Some things to consider when looking into long term care insurance is to be wary of offerings for cheap insurance – in the long run this kind of company may be unable to cover care. On the other side of the coin, there is probably no need to buy the most expensive insurance out there either. If possible, speak to an insurance broker, and go over every detail of a policy, and the insurance company’s own history.
Viatical Settlements: This insurance is for patients that are terminal with less than two years to live. They can cash in their policy for roughly 60-90% of its value.
Term Life Insurance: Insurance with an expiration date; set term years depending on when they are purchased that will pay out if the purchaser passes away during their term. This policy can be changed into a whole life policy, and gives the option to cash out to pay for care.
Universal/Whole Life Insurance: Converting a policy to whole life insurance enabling seniors to have coverage that lasts “a lifetime” – paying for the care they need for their remaining number of years. The conversion does need to happen during a certain timeframe or age of the policyholder, but it doesn’t require a medical exam.
Insurance Annuities: These are long term investments issued by insurance companies to protect their finances in an effort to reduce the risk of you outliving your income. It is almost like a savings account, and you can receive a payout as needed as you get older.
Home Care Loans: A senior uses their home as collateral for a loan in the interim of waiting for other benefits to come through or finalize.
Reverse Mortgages and Home Equity Loans: A reverse mortgage loan should really only be used in case of an emergency, as it means you exchange a share of the home equity built up – in lieu of making a monthly mortgage payment, you will receive the payment instead. This loan doesn’t need to be paid back, until that is, you no longer live in the residence. For someone who has paid off their mortgage and owns the home outright making the decision to obtain a reverse mortgage may be a viable option.
Memory Care Regulations
Long term care facilities are only regulated and licensed at a state level, each state has its own requirements, and nothing is managed by the federal government. Since that is the case, it is very important to research the laws followed by the facilities you are considering. All states require licensing, but only 23 have memory care specific regulations.
Despite state regulations varying, as a general rule memory care and assisted living facilities offer care in a supervisory role, medical observation, assistance with daily living activities, access to emergency care, health and exercise programs, meals, social activities, on call staff and security 24 hours a day.
The Joint Commission, a tax exempt non profit managing accreditations of healthcare agencies, set out memory care regulations in 2014. Not all facilities are officially recognized by the Joint Commission, but the ones who are must follow the standards put forth. These standards include:
- Care coordination: staff asses and plan to provide care in conjunction with any advances dementia care
- Staff knowledge and competency: staff meet all qualifications and requirements to care for dementia patients
- Activity based programs: staff coordinate activities suited to all residents abilities
- Behavior management: the facility emphasizes non medical intervention alternatives
- Safety and support: the facility promotes a safe and supportive environment in regards to preventing confusion and overexcitement.