Memory care facilities offer 24-hour assistance and deliver more comprehensive, personalized care than most other forms of senior living. Larger residential care communities — those offering multiple levels of care — often have a dedicated memory care unit or wing, which is typically separate from independent living and assisted living. Other facilities operate independently, and exclusively offer memory care services.
But before you decide on a specific facility, you'll need to determine what level of care your loved one needs and whether or not memory care is right for them.
Who needs memory care?
Most families are faced at some point with the task of determining what level of care a loved one needs as they become unable to care for themselves.
According to a recent study by the U.S. Department of Health and Human Services, approximately 70 percent of people 65 and older need long-term care at some point in their lives.
The term “long-term care” is used to describe a wide range of available services and care options. Categories of long-term care include:
Although most people will need some form of long-term care eventually, not everyone who needs assistance with their daily activities will need a memory care community.
If your loved one needs help with things like cooking, cleaning, bathing, toileting, and dressing, but does not suffer from memory loss or other significant cognitive and behavioral symptoms, an assisted living community or nursing home care may be sufficient to meet his or her needs.
Offering higher staff-to-resident ratios than other forms of long-term care and providing round-the-clock supervision, memory care is specifically designed for individuals with dementia, memory loss, Alzheimer's disease and other forms of significant cognitive impairment.
People suffering from memory impairment often experience forgetfulness, confusion, disorientation, agitation, wandering or getting lost, paranoia, and a variety of other cognitive and behavioral symptoms that can make living alone or unsupervised problematic. It is important for an Alzheimer's care facility to provide a secure environment for its memory care patients, which means its doors are typically locked which takes away a significant level of autonomy for its residents.
While it is common for seniors to suffer from physical impairments and require assistance with daily activities, dementia is relatively uncommon. The Department of Health and Human Services estimates that between 4 and 7 percent of seniors suffer from severe dementia related to Alzheimer's disease and other dementias.” The likelihood of developing severe dementia increases with age; seniors aged 80 and above are far more likely to develop dementia than those in their late 60s and early 70s.
People with dementia can often live independently or with limited assistance in the early stages of the disease, but as the disease progresses, many people require intensive, round-the-clock dementia care. This is when residential memory care at an Alzheimer's care facility becomes necessary.
Most facilities will work with you to determine if memory care is the right choice for your family member or loved one based on his or her specific symptoms and needs.
Types of facilities
As discussed above, memory care facilities can operate as independent wings of larger senior living facilities with multiple levels of care, or they can be standalone facilities that exclusively provide memory care for seniors with Alzheimer's and other dementias. There are benefits and drawbacks to both arrangements, and which one is right for you will depend on the needs and preferences of your family and your loved one.
Memory care units inside larger facilities
Large facilities with multiple levels of care are often a good option for seniors in the early stages of dementia. If you anticipate your loved one needing the full range of memory care services in the future, but he or she does not yet require that level of intensive, round-the-clock care, you might consider looking for a facility that offers both assisted living and memory care options.
In these large facilities, it is common for existing residents who are already living in independent or assisted living communities to be placed at the top of the waiting list for memory care. While you may still have to wait for a memory care room to become available (depending on the occupancy rate of the unit), the wait time is likely to be shorter if your loved one is already a resident at the facility.
Other benefits of large facilities include additional amenities, added security, and well-established policies and practices. However, large facilities sometimes lack the sense of community and individualized approach that smaller, more intimate facilities provide.
If your loved one receives dementia care in a skilled nursing facility (SNF) and takes advantage of Medicaid funding, there is a good chance they may have a roommate as many SNFs provide semi-private rooms.
Dedicated memory care facilities
If your loved one is already at a stage where he or she needs memory care, smaller, dedicated communities offer some unique benefits that many larger facilities don't. These include a more personalized approach to care, fewer residents, and a higher staff-to-resident ratio.
For people who have not lived in a senior care facility before — especially if he or she is making the transition from living at home or with family — a smaller, more intimate community may feel more comfortable and homey and may be less overwhelming.
Another benefit of smaller facilities is that they are typically more affordable and are more likely to be locally owned and operated, though this is not always the case. It is important to note, however, that larger facilities almost always have better security systems in place. If wandering and getting lost is a big concern, security is an important consideration.
Adult foster/care homes
Although most memory care communities operate as dedicated facilities or units/wings within a larger residential care facility, there are some adult foster/care homes that offer memory care services in a home-like setting, generally for a relatively small number of residents.
While adult care homes offer fewer amenities and reduced security, these types of communities generally have a more homey feel and a closer, tighter-knit group of residents.
Memory care regulations
In the United States, long-term senior care facilities are not regulated at the federal level. Instead, licensing is managed at the state level and each state has its own unique set of requirements.
While all 50 states require senior care facilities to become licensed, only 23 states currently have specific laws regulating memory care.
In 2014, The Joint Commission — the tax-exempt nonprofit organization that manages accreditation of health care organizations and programs in the United States — established a set of memory care requirements for accredited nursing care centers to adhere to. It is important to note, however, that not all memory care facilities are accredited by The Joint Commission, so you can't assume that all facilities adhere to this standard set of rules.
Due to the lack of federal regulations governing how memory care facilities operate, and the fact that many states do not have specific laws relating to memory care, it is important to thoroughly research the practices of the facilities in your area and to understand your state's laws prior to choosing a facility.
Typical memory care services
Memory care facilities vary greatly in terms of size, scope, and the range of services they offer.
Most, if not all, memory care facilities provide the following:
- 24-hour staffing and supervision
- Skilled nursing and other medical care
- Passcode or lock-and-key security and alarm systems
- Emergency call buttons
- Assistance with activities of daily living (ADLs) such as bathing, toileting, and dressing
- Medication management
- Personal care services
- A minimum of three meals daily (snacks between meals are also often included)
- Routine housekeeping and laundry services
- Individualized care plans
- Supervised activities (families are sometimes invited to participate)
- Transportation to and from medical appointments
In addition, some memory care facilities offer the following:
- Secure courtyards or other outdoor spaces
- Supervised day trips (some facilities welcome family members on outings)
- Movie nights, holiday parties, and other events
- Salon and barbershop services (haircuts and styling, manicures, etc.)
- Support groups and educational programs for families and loved ones
- Exercise classes
- Cognitive and physical therapies
Most long-term care facilities have a basic plan which includes some combination of the above services, and nearly all memory care communities will work with you to develop a customized care plan to meet the individual needs of your family and ensure the health and well-being of your loved one.
Respite care for Alzheimer's disease and dementia
If you are a caregiver at home taking care of a patient that requires memory care, you may be able to temporarily place them in a dementia care facility for a short period of time. This does not require a full-time move, but it can alleviate the responsibilities for full-time caregivers.
When care needs increase
Alzheimer's disease and other forms of dementia are degenerative, and the needs of memory care residents tend to increase in scope and degree over time and with age. According to the Alzheimer's Association, Alzheimer's dementia accounts for 60-80% of all dementia cases. Memory care facilities are aware of this and will typically work with you on an ongoing basis to ensure your loved one's needs are monitored and met.
In the early stages of dementia, seniors are likely to be able to carry out most daily activities themselves. For example, a resident with early- or mid-stage Alzheimer's may need to be reminded to eat at mealtimes but may not need assistance feeding his or herself. As the disease progresses, residents may develop difficulty recognizing food and/or swallowing. Since dementia residents often need help at mealtimes and with other daily activities as his or her dementia progresses, it is important to monitor symptoms and update care plans accordingly.
Most memory care facilities will have an initial meeting with you prior to move-in to develop a customized care plan for your loved one and to discuss the day-to-day operations of the facility. Subsequent meetings may be scheduled on a monthly or quarterly basis to ensure proper communication and to update the customized care plan as needed.
Memory care costs
The cost of memory care can vary greatly depending on a variety of factors, including the size of the facility, the size and privacy of rooms, the services and amenities offered, the location of the facility, and your loved one's individual care needs.
Although costs vary, the Alzheimer's Association estimated that in 2014 the average cost per month of memory care in senior care facilities was $59,250 per year (or $4,937 per month). This number is significantly higher than the cost of basic assisted living services, which were estimated in the same report at $43,756 per year (or $3,646 per month).
The higher costs associated with memory care as opposed to assisted living can be explained by the increased security, specialized staff, and additional services provided. Although memory care is expensive, the average resident does not cover the total cost out-of-pocket, and customized services and amenities drive up the average. It is common to add services on an as-needed basis over time, which can help limit overall cost.
Although costs are high, it is important to note that most memory care facilities do not charge additional fees for utilities. Meals, transportation, and laundry services are also typically included in base monthly costs.
Paying for memory care
Few seniors with Alzheimer's disease and other forms of dementia have sufficient income, long-term care insurance, and/or savings to cover the cost of memory care for the number of years required.
There are a number of options available to seniors who require assistance paying for memory care. These include:
Many seniors living with Alzheimer's and other forms of dementia qualify for Medicaid benefits. In 2014, Medicaid provided $25,494 to the average beneficiary living with dementia in a long-term care facility. Although Medicaid is federally funded, each state is separately responsible for managing and administering Medicaid programs, so the benefits available to your loved one depend on his or her state of residency.
In most states, you must meet the financial eligibility requirements (which place a limit on income and sometimes assets) and the functional eligibility requirements (which most mid- to late-stage dementia patients easily meet) in order to qualify for Medicaid assistance paying for long-term care. Learn more about your state's Medicaid benefits and requirements.
If your loved one does not meet the financial eligibility requirements needed to qualify for Medicaid coverage immediately, he or she may qualify over time as his or her needs increase and financial resources are reduced due to the high costs associated with memory care.
It is important to note that not all memory care facilities accept Medicaid, so it is helpful to inquire as to whether or not any facility you're considering accepts Medicaid, even if your loved one does not yet meet the financial eligibility requirements.
Other state programs
In addition to Medicaid, there are many non-Medicaid state programs available to low-income seniors, and some states even offer specific programs for people with Alzheimer's and other forms of dementia. It is worth checking your state's .gov website to learn about available options and find out if your loved one qualifies.
If your loved one served in the armed forces, he or she may be eligible to receive VA benefits for memory care, even though the VA does not currently offer programs specifically designed to address the additional needs of veterans with dementia.
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Choosing a memory care facility
Finding a memory care facility that meets the needs of your family and loved one starts with determining what those needs are.
Understanding your loved one's needs
Talking to your loved one's current caregiver, spouse, and/or primary care physician can give you a better sense of his or her ability to perform basic activities and help you determine his or her current cognitive and behavioral symptoms.
It is a good idea to sit down and make a comprehensive list of the activities your loved one needs assistance with as well as the symptoms they are experiencing. This will help guide you in determining the specific services and care your loved one needs and will help you in your search for the right memory care facility.
It is also important to consider your loved one's wishes as laid out in an advanced directive or through talking with him or her. Some people prefer a larger facility with more residents and additional amenities, security, and structure, while others prefer the more homey feel and personalized approach at a smaller facility. Either way, it's important to consider the cultural fit of any facility with the personality and preferences of your loved one. Ideally, you will find a place that makes sense both practically and culturally.
Costs and levels of care
Cost is an important consideration for most families, so making sure a facility accepts Medicaid or other forms of financial assistance can be important in narrowing down your options.
As previously discussed, if your family member or loved one does not yet need memory care, but you anticipate that he or she will in the near future, finding a facility that offers both assisted living and memory care can be a good way to save money and make the transition from his or her current living arrangement to memory care more comfortable and smooth.
Geographic location and family involvement
If you plan to visit your loved one regularly and would like to be involved in his or her care and any activities offered by the community, the facility's proximity to your home and the homes of any other close family members or friends is an important consideration.
Memory care facilities differ from one another in terms of the level of family involvement they encourage. Some facilities welcome family members at mealtimes and on outings or for scheduled activities.
In addition, visiting hours are an important consideration. Some facilities have designated visiting hours, while others allow visitors to come and go as they please. It's also important to understand any rules or procedures surrounding taking your loved one out to lunch, back to your house, or on any other outing not organized and facilitated by the staff.
The amenities offered by memory care facilities vary greatly, and some amenities may be optional (offered at an added cost). You can often find a list of available amenities on a community's website.
Amenities at memory care facilities may include:
- Individual or shared rooms
- Private bathrooms
- Beauty salon and barber shop services
- Communal seating area
- TV room
- Exercise classes
- Private dining rooms for family gatherings
- Secured courtyard, garden, or walking path
- Supervised day trips and outings
If there are particular amenities you believe your loved one would enjoy, many communities offer the option of bringing your loved one along for a visit or guided tour. Most facilities will also provide lunch for you and your loved one when you visit, which will give you an idea of the types of foods and portion sizes they provide.
Questions to ask on a tour
While each individual has different needs and concerns and will have specific questions for memory care administrators and staff. Below is a list of general questions to help get you started:
- What security measures are in place? Is there an alarm system? Is the community secured 24/7?
- Are there call buttons in every room? Bathrooms?
- Are all rooms private or are some rooms shared? What is the price difference?
- Do rooms have private bathrooms?
- What is the size and layout of the memory care unit?
- What communal rooms do you have? (Dining room, TV room, seating area, etc.)
- Is there a secured courtyard or other outdoor space?
- What supervised activities, classes, and amenities do you offer?
- Are there special events for holidays and birthdays? Are families welcome?
- What is your fire/emergency evacuation plan?
- How do residents receive their mail?
- Can you accommodate special dietary needs or preferences?
- Do you offer family support groups?
- Could you tell us about your person-centered care programs?
Staff and medical care
- How are staff members trained?
- Is there a nurse on the premises 24/7?
- What is your staff turnover? How long has the average staff member been here?
- What medical care can you provide? (Be sure to ask about any specific ongoing medical treatments or care your loved one requires)
- Do you have a visiting physician?
- What is the staff-to-resident ratio? Is it different at night?
- Do you manage and administer medications and prescriptions?
- What steps do you take to monitor changing medical needs?
- What is your procedure in case of a medical emergency?
- Can you provide end-of-life/hospice care?
Policies, care plans, and pricing
- How do you assess residents' needs upon move-in? After that?
- Are there move-in fees? Can facility staff help with the move?
- Can residents bring their own furniture? Can they hang things on the wall?
- How customizable are care plans?
- What services are included in the base price? How do add-ons affect cost? Are utilities included?
- Do you accept Medicaid? Other assistance programs and benefits?
- How do you update families? Will we have regular meetings to discuss the effectiveness of the care plan and any changes?
- Are you able to move residents from assisted living to memory care when needed?
- What are the visiting hours? How do visitors sign in and out?
- Are family members welcome at mealtimes and during scheduled activities?
- Can a spouse who doesn't require memory care live with the resident? If so, how does this affect cost?
- Do you have a dress code in communal areas?
- Do you allow pets or visits from pets?
- What is your discharge policy?
In addition to the questions you ask the staff, it's important to ask yourself some basic questions about your impression of the facility, staff, and residents. For example:
- Do the residents seem happy?
- Are residents engaged in activities and/or conversations? Are they dressed in day clothes? Do they seem well cared for?
- Do staff members seem competent and caring?
- Do staff members seem familiar/friendly with individual residents?
- Are most residents in their rooms or out in communal areas?
Memory care FAQs
1. What is Alzheimer's disease?
Alzheimer's disease is the most common form of dementia, accounting for 60 to 80 percent of dementia cases, according to the Alzheimer's Association. Another common type of dementia is vascular dementia, which manifests itself similarly to Alzheimer's and occurs following a stroke. Most forms of dementia are chronic and progressive, and symptoms tend to worsen over time and with age.
2. What is memory care? How is it different from assisted living?
Memory care is a form of long-term residential senior care that serves the unique needs of people suffering from Alzheimer's disease and other dementias.
When compared with other forms of long-term care like independent and assisted living, memory care is unique in that it provides additional security (typically with an alarm system), 24-hour supervision, and skilled nursing to address the specific cognitive and behavioral symptoms of dementia. Because of the intensive needs of memory care residents, this type of care is generally more expensive than other forms of long-term care.
3. How do I know if memory care is right for my loved one?
Determining whether or not your loved one requires memory care involves a thorough assessment of his or her current ability to perform daily activities, as well as the cognitive and behavioral symptoms he or she exhibits.
A good place to start is at the office of your loved one's primary care physician. He or she can perform cognitive and behavioral tests, discuss the severity of your loved one's symptoms, and help you determine the appropriate next steps.
Most memory care facilities will also perform an assessment prior to move-in to make sure that memory care is the right choice for your loved one.
Questions to ask yourself when trying to decide if your loved one needs memory care include:
- Is there a concern that he or she will get lost or wander?
- Does he or she require 24/7 supervision?
- Is he or she irritable, aggressive, or paranoid?
- Does he or she require assistance at mealtimes?
- Is his or her current living situation unsustainable?
4. How do I talk to my loved one about the need for memory care?
Discussing the need for memory care with your loved one can be difficult, and it is not uncommon for one or both of you to have an emotional response.
Before you breach the subject with your loved one, it's important to have as much information as possible so you can help to answer any questions or concerns he or she might have.
How effectively you are able to communicate with your loved one about the need for memory care and his or her ability to participate in the decision will, of course, depend on what stage of dementia he or she is in and his or her overall level of cognition.
Here are a few tips for communicating with your loved one about the need for memory care:
- Choose when to begin a conversation carefully. Try to approach the subject when his or her symptoms are not at their worst.
- Try to be understanding of his or her fears, frustrations, and concerns.
- Make sure to take the time to listen as well as explain.
- Be prepared. Your loved one is bound to have questions, and the more information you have the better prepared you will be to answer those questions.
- Treat it as an initial conversation and make a plan for future discussions.
- Allow him or her to process the information in his or her own time and way.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.