Choosing a residential care facility for a person with Alzheimer's disease requires special considerations.
Alzheimer's disease is a progressive condition that slowly erodes an elder's ability to think clearly, take care of basic daily needs, and maintain emotional and psychological equilibrium. In its earlier stages, Alzheimer's may cause confusion about time and place, short-term memory loss, and minor mood swings. As the disease progresses, an elder with Alzheimer's may stop recognizing familiar faces, wander away from home, lose the ability to apply simply logic and language, and experience hallucinations or paranoia. Eventually, Alzheimer's will cause a complete deterioration of cognitive functioning.
Given these symptoms, it's no surprise that elders with Alzheimer's have special care needs. When you are trying to find the right residential care facility for an Alzheimer's patient, consider the following factors.
For any senior, you'll want to find a facility that is roomy and comfortable. But for someone with Alzheimer's, the physical design and layout of a facility are also important. If the person is physically active, as so many with early and middle stage Alzheimer's are, the facility must provide enough space to move about freely, without a sense of confinement. But because Alzheimer's patients often wander and become disoriented, the space must also be safe and constraining. Some facilities combine space and constraint by using a circular design for hallways, which permits residents to walk about in any direction for as long as they want, without being stopped or confused by dead-ends, intersecting corridors, or locked doors.
Some facilities admit only residents with Alzheimer's, while others admit a mix of residents. Facilities that admit only Alzeimer's patients can provide some advantages. The staff can organize meals, activities, and care -- including the monitoring of wandering and disorientation -- solely with Alzheimer's residents in mind. The staff is likely to develop good skills in handling the particular difficulties Alzheimer's presents. And some Alzheimer's-only facilities have educational programs, family counseling, and support groups that might not be available at other facilities.
But facilities that admit a mix of residents also offer some benefits. People in early and middle stage Alzheimer's often benefit from contact with non-Alzheimer's residents. The conversation and activities of these other residents can help those with Alzheimer's remain oriented, alert, and calm. If the facility permits residents to come and go freely, however, make sure that the facility pays close attention to the safety and security of residents with Alzheimer's. Some open facilities rely solely on the watchful eyes of staff to monitor the movements of Alzheimer's residents, while others add closed-circuit monitors, door alarms, or sensors (used with a wristband or other device) to alert staff when an unattended Alzheimer's resident wanders or attempts to leave the premises.
Perhaps the single most important quality to look for in a residential care facility is the staff's skill in dealing with Alzheimer's. Because it can be difficult to gauge staff skills during a brief visit or tour, you should try to visit a facility several times before making a final choice. Be sure to visit at different times of day, including meal times. Meals are the highlight of the day for most residents -- how well the staff helps residents in the dining room will have a big impact on how happy the residents are. Try to make a night visit also -- evening is an especially difficult time for those with Alzheimer's.
Your main focus should be on how the line staff -- the personal care aides who spend the most time with residents -- interact with their charges. Are they calm and soothing, or cold and abrupt? Do they treat the residents like children, or respectfully as adults? Do they acknowledge resident comments and requests and offer solutions, or do they simply try to quiet or distract residents? Try to observe the staff with the most seriously ill Alzheimer's patients -- this will be your best measure of staff attitudes and capabilities. Do the Alzheimer's residents seem comfortable with the staff? If a resident is distressed or disruptive (as many people with middle stage Alzheimer's can be), how well do staff members respond?
Regular visits from family members can greatly improve an Alzheimer's resident's comfort and sense of well-being. Therefore, you should look for a facility that makes family visiting easy and encourages participation in a resident's care. When you visit facilities, try to see how family members of current residents interact with the staff. Do family members move about the facility easily or do they seem like uncomfortable guests? Do they know staff members by name, and vice versa?
Special Programs for Alzheimer's Residents
Those with Alzheimer's can benefit from programs designed to address symptoms particular to the early and middle stages of the disease. Special arts and crafts work, reading, word games, and outings can help residents stay mentally alert. Memory enhancement programs can slow memory loss. Resident participation in room and hallway decoration can help residents stay oriented within the facility. And physical exercise can be tailored to those with relatively healthy bodies but poor balance or coordination.
Medication and Medical Care
Find out whether the facility is licensed to administer drugs by injection and deliver other types of medical care that a patient cannot administer to him- or herself. Those with Alzheimer's are not immune to other ailments and may need regular medical attention.
Also look into the facility's policy on using medications to control the symptoms of Alzheimer's. There are drugs that can help control the anxiety, aggressiveness, agitation, and insomnia of those with Alzheimer's. The proper use of these drugs can make life much more comfortable for residents. However, some facilities also use medications to control residents' behavior -- although this may be legitimate and necessary in the later stages of the disease, you'll want to make sure that residents are not over-medicated. Find out who decides what drugs will be administered, in what dosage, and with what frequency. Ask about the facility's policy on the use of behavior-controlling medication. Is a resident's personal physician consulted regarding medications? What about family members? And make sure that the facility keeps a written record of each administration of these medications.
With sensitivity and clarity, Long-Term Care: How to Plan & Pay for It, by Joseph Matthews (Nolo), gives you everything you need to help plan for and make the best arrangements for long-term care.