Care Arrangement: Assisted Living Facilities

Care Arrangement: Assisted Living Facilities

Whenever someone is diagnosed with dementia, they will, sooner or later, require special care arrangements. They could be cared either at home or at an external facility. They could be cared for by family members, friends, loved ones, or care professionals. While there are numerous options available, the care arrangement best suited for a dementia patient is dependant on the progress of the disease, the choices of patient and their primary caregiver, the affodordability, and the amount of care and time needed to be given to the patient. One such care arrangement is known as Assisted Living. It involves the dementia patient having to live at an external care facility on a full-time basis, where they receive care from professionals.

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ASSISTED LIVING FACILITIES EXPLAINED

Assisted living facility, also known as residential care or adult care home, is a residential-type facility for people with disabilities or for adults who need help with a number of everyday tasks. They may need help with managing their medications, dressing, bathing, cooking meals, eating, or using the bathroom, but often they don't need full-time nursing care. In other words, assisted living is best for people who need daily assistance but are not ready for a nursing home.

The facilities provide a group living environment, supervision, and assistance with activities for daily living. Thus, they ensure resident's health, safety, and well-being by offering 24-hour support and access to care, while giving them the freedom to do what they want for theirselves. Some facilities provide apartment-style living with scaled down kitchens, while others provide rooms. These facilities range from converted homes or apartment complexes to renovated schools. Most facilities have a group dining area and common areas for social and recreational activities.

Assisted living facilities can be very different from one another as it can offer different levels of service. Among them, there are specialized assisted living facilities, where the services provided is tailored for a specific type of disability or patient need. One such facility type is assisted living with memory care. Also known as specialized assisted-living facilitis (SCUs), in this type of facilities, the staff are usually trained to work with individuals with dementia. The living environment in these facilities is designed to be very safe and comfortable. In addition, it has activities and social programs that are designed for residents with dementia. 

However, they don’t normally have full-time medical personnel. This makes the care arrangement unsuitable for those whose dementia has progressed to the later stages, but can be quite helpful for dementia patients still in the early stages. Regular assisted living facilities on the other hand may not always have the required levels of care arrangement available for dementia patients.

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THE STATISTICS OF PEOPLE IN ASSISTED LIVING

According to the National Study of Long-Term Care Providers, in 2014 there were an estimated 835,200 current residents enrolled in 30,200 assisted living and similar residential care communities. 39.6% of the assisted living residents were people with a diagnosis of Alzheimer’s disease or other dementias. The Number of licensed beds was 1,000,000 in 2014.

Source: Harris-Kojetin L, Sengupta M, Park-Lee E, et al. Long-term care providers and services users in the United States: Data from the National Study of Long-Term Care Providers, 2013–2014. National Center for Health Statistics. Vital Health Stat 3(38). 2016.

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WHEN IS IT A GOOD FIT?

In terms of level of progression, assisted living can be a good choice for dementia patients who need a higher level of personal care than what they can receive at home or at an adult day care center. They should be able to function with some external assistance. But at the same time, the patient’s progression of dementia shouldn’t be at a stage where they need the round-the-clock medical care and supervision, which can be better found in a nursing home. 

Assisted living is also suitable for patients who's families may be overwhelmed by the responsibilities of caregiving and who's schedules with work may not allow them to give their loved one the quality of care they would like to or the patient needs. As the disease progresses, their loved ones needs may become more then they can manage on their own, leaving assisted living a great option to ensure their loved on it taken care of. 

It should be noted that regular assisted living facilities may not suit a dementia patient for long. If dementia is not an immediate concern, and the patient is still relatively independent, only then regular assisted living may be a good choice. Once a person is no longer able to care for theirself due to progressive impairment, an assisted living community with memory care could be a better solution.

Before making a decision on whether an assisted living facility is needed for your loved one, there are several questions that need to be addressed:

  • Does the patient need more help in the activities of daily living than what family and friends are able to provide?
  • Is the primary caregiver unable to fully cater to the needs of the dementia patient due to other family commitments, a job, or living far away from the patient?
  • Does the person feel lonely or isolated at home and without a social life?
  • Is safety a concern? Mobility can be limited making it difficult to get out of bed and do daily activities
  • Is it necessary to manage the medication?
  • Is transportation an issue?

Along with the questions above, you can also look out for some of the signs below which could indicate if the dementia patient needs further assistance:

  • Spoiled food in the house or the person is losing weight due to malnutrition
  • Bruises could be a sign of falling, or mobility and balance problems.
  • Wearing the same clothes or neglect personal hygiene. This can indicate that doing laundry and bathing is physically challenging or they simply forget to do it.
  • Forgetting things, including doctor’s appointments and when to take medication. This may be due to memory loss.
  • Strange or inappropriate behavior. For example, dress inappropriately for the weather. This can be a sign that he or she is experiencing confusion. 

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WHAT ARE THE SERVICES PROVIDED?

In general, both general assisted living and those with memory care offer basic supervised care, medical monitoring, and help with daily activities such as dressing, mobility, and hygiene. Other services that are usually offered in both types of care include:

  • 24-hour staff supervision and security
  • Emergency call systems
  • Three daily meals
  • Assistance with eating, bathing, dressing, going to the bathroom, and walking
  • Housekeeping and laundry service
  • Health and medical services
  • Medication management
  • Exercise and wellness programs
  • Social programs and activities
  • Transportation
  • Access to medical care
  • Staff to handle and help with both scheduled and unexpected needs

Other that these things, assisted living facilities with memory care often include:

  • Code locked doors to any outside part of the facility, ensuring patients who wander cannot accidentally leave the premises.
  • Structured activities or programs designed to nurture residents suffering from Alzheimer’s or dementia.
  • Outdoor and indoor spaces designed to be both secure and soothing, with a range of familiar activities available and trained staff on hand.

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HOW TO FIND AN ASSISTED LIVING FACILITY

In order to find the right assisted living facility for your loved one, you will have to start out by learning about your options. You can get excellent information on the types of facilities available and the services they provide through your local alzheimer’s or dementia association. Usually these organizations can provide information that is tailored for people with dementia. Additionally, you can also approach any other caregivers that you know of to ask about their experiences with such facilities. Even your loved one’s doctor can be a good starting point in terms of researching the assisted living facilities in your area. The internet is also a great resource as you can procure a lot of information from the comfort of your home.

Once you have assessed your loved one’s needs and progress of dementia and feel that they would benefit from staying at an assisted living facility, you should contact a case manager, clergy member, financial planner, hospital discharge planner, physician, or social worker to inquire about facilities in the area. It is advisable to personally check out the different assisted living facilities you have optioned in order to be fully informed and satisfied.

You can also find additional information about assisted living by investigating one or more of the 16 publically traded assisted living companies, including Alternative Living Services, American Retirement Corporation, Assisted Living Concepts, Atria Communities, Balanced Care Corporation, Brookdale Communities, Capital Senior Living, CareMatrix Corporation, and Sunrise Assisted Living. 

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WHAT TO LOOK FOR WHEN CHOSING AN ASSISTED LIVING FACILITY WITH MEMORY CARE?

There can be huge variations among assisted living facilities. Despite being a long and time-consuming process, rest assured that the right fit is out there. You will very likely find a facility that is well suited to your loved one and their needs.

One of the first and most important things to look out for when chosing an assisted living facility is the staff and its residents. The facility needs to have an active social atmosphere, where the residents are friendly and the staff is well-trained, caring, and warm. Thus, it is important to visit facilities during different times of the day (i.e. during activities and mealtimes) to get a look for yourself. It is also important to seek feedback from residents and their families or via online reviews. The most important factor when choosing an assisted living facility is that it feels friendly, safe, and comfortable for your loved one.

Another very important thing to pay attention to is the caregiver to patient ratio in these facilities. Typically, in a general assisted living facility, the ratio could be as high as 1:25. While some of those assisted living facilities may accept dementia patients, it is not an ideal environment for their proper care. The most effective ratios for dementia care are around 1:5 or 1:7. It should also be noted that usually a lower caregiver to patient ratio also means higher cost for care. therefore, this should be taken into consideration when seeking a suitable facility for your loved one.

Other than that, when visiting assisted living facilities under consideration for a dementia patient, make sure you address the following items:

  • Range of services offered
  • How many rooms/residents are there?
  • How many Alzheimer's and dementia patients live there?
  • Check safety devices and precautions – door and window locks, motion detectors, monitoring systems, adequate lighting and non-slip flooring
  • How is wandering is handled?
  • Are the staff specially trained in dementia care and what is their experience in dealing with difficult situations and behaviors?
  • How are outbursts and other difficult behaviors are handled?
  • Is there is a structured routine for residents?
  • Activities that reflect the resident's personality and hobbies
  • Activities that are designed for people with Alzheimer's or dementia
  • Activities that help people succeed at familiar tasks, such as making their bed, dressing or cleaning up their home
  • Outdoor activities and safe outdoor recreation areas for walking, gardening, etc.
  • How much time does the staff take to gather information about your loved one in order to provide the best care for that individual, including safety, well-being, and comfort?
  • The appearance of residents. Do they look relatively healthy and content?
  • How many staff members are scheduled on each shift?
  • How many staff/aides work on the weekends and holidays?
  • What is the ratio of caregivers to residents?
  • What levels and types of care does the facility provide for all residents?
  • What level and type of care is provided especially for Alzheimer's and dementia patients?
  • Is transportation provided for doctors appointments or shopping?
  • What is the policy on wheelchairs, oxygen tanks, and other medical equipment?
  • Are residents allowed to bring personal items from home?
  • Are people with incontinence accepted?
  • How are aggression and other difficult behaviors handled?
  • Can a patient be asked to leave due to aggression, anger, and other bad behavior?
  • What safety measures are in place for Alzheimer's and dementia patients?
  • Will my loved one have to move if the Alzheimer's/dementia worsens?
  • Are medications used to "subdue" patients?
  • What is the process for ensuring patients get their prescribed medication on time and in the correct dosage?
  • What happens if there is a medical emergency? What is the protocol for contacting the family?
  • How is the payment plan set-up?
  • Which services are included in the base monthly plan?
  • How do they identify which care services your loved one needs, and how often will he or she be reevaluated?
  • Who conducts these evaluations?
  • What is their policy regarding use of outside services?
  • How is a laundry handled? How often will your loved one's clothes be washed?
  • How often is the room cleaned?
  • If there are issues/concerns with the quality of the care, who do you contact?
  • How are records of your loved ones care or incidents taken and what access to do you have to them?
  • How is medical attention by their physician handled and do they need to switch to another medical group affiliated with the facility?

During the visit, try to gather if the other residents appear to be happy and if they enjoy interacting with one another. Also, try to assess the different areas of the facility. Does the environment seem clean and fresh? How often is housekeeping provided for a room? Does the facility feel safe and secure? Are the areas easily accessible and have grab bars? It is also important to verify the food by sampling a meal and asking about menu options.

Finally, you will need to check if the facility is in compliance with state and local licensing requirements to make sure that the facility is licensed and in compliance. The bottom line is that the right facility is the one where it is possible to feel most at home with the best assistance that meets the patient’s needs. 

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COSTS OF ASSISTED LIVING WITH MEMORY CARE

While assisted living costs less than nursing home care, it is still fairly expensive.         The costs of assisted living and memory care vary, depending on the following factors:

  • Type of residence
  • Geographic location
  • Size of room or apartment
  • Shared or individual space
  • Services required 

Many facilities charge a basic rate that covers all services, with an additional fee for special services. Most of the assisted living communities charge a base monthly rate, which covers room and board with two to three meals per day, but there are also long-term options available. Sometimes there are entrance fees, deposits and laundry and housekeeping fees.

The average cost for a one-bedroom assisted living apartment is $3,500 per month depending on the location. Assisted living facilities are owned and operated by both for-profit and non-profit organizations and can range in cost from approximately $800 to $4,000 a month or more. When it comes to specialized care and nursing services that aren’t found in regular assisted living facilities, the cost of care can be quite steep. It can go up to $5,000 per month on average, although costs vary widely. On a yearly basis the cost varies widely, ranging from $28,800 to $66,000. Some facilities cover housekeeping, laundry, and other services in their base rate, while others charge extra. But because these all vary by community, it's important to ask each community about their individual costs and services. 

Many assisted living facilities use aggressive sales tactics to lure potential residents - this includes heavy calling and offering "discounted" pricing for the rooms and services. While these tactics can be bothersome, it gives the family the ability to negotiate for a better all-inclusive rate for their loved ones stay in the facility. Not all patients pay the same price. There are facilities that provide 'a la carte' services, meaning any additional service such as laundry, personal hygiene attention (shaving, showering..) may be an additional cost to the patient.

When it comes to who pays the bills, it is normally the dementia patient themselves (through their financial executor) or their family members. Health and long-term care insurance policies may cover some of the costs. However, Medicare does not cover the costs of assisted living. In terms of financial assistance, There are some options available to help pay for this care and reduce the out-of-pocket price tag, such as Medicaid and veterans’ benefits, long-term care insurance, Supplementary Security Income, or Social Services Block Grant programs.

To be sure, you should check your private long-term-care insurance plan to find out how much is covered where assisted living is concerned. In the United States, Medicare, government health insurance for older adults, does not cover the costs of assisted living. In some cases Medicaid—government health insurance based on financial need—may provide a limited benefit. Additionally, there are some board and care homes that will accept Supplemental Security income as payment. However, a limited amount of assisted living facilities accept these programs because of the lower rates they receive. Special populations like veterans may have access to VA-approved board and care homes, or veterans’ homes which provide a continuum of care. However, 86.2% of assisted living residents today pay for long-term care from their personal financial resources.

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POTENTIAL ISSUES IN ASSISTED LIVING

Errors in Medication Management

Medications are essential for the care of seniors. A great number of assisted living residents depend on medications for treating short-term and chronic illnesses. 85% of the residents require assistance with management of their meds. Unfortunately, medication errors are one of the most common typs of errors in long-term care facilities. This is particularly a problem at assisted living facilities where non-nursing clinical staff (such as medication aides) are often charged with administering medications. Also, these facilities have a high volume of medicines and compressed time frame for medication administration.
Some types of errors include:
  • Wrong time administration (71.3%)
  • Omitted dose (12.2%)
  • Wrong dose (11.3%)
  • Extra dose (3.7%)
  • Unauthorized drug (1.4%)
  • Wrong drug (0.2%) 
The possible causes of these errors can be:
  • Miscommunication
  • Wrong ordering
  • Mis-dispensing
  • Faulty admin Process
  • Other staff factors
A few simple ways to limit these errors are by limiting the distraction faced by the medication administering staff member. They should also be adequately trained and appropriately supervised by clinical staff to ensure that errors do not happen. However, given that most medications administered in this setting are deemed low risk, the errors don’t usually result in serious harm. Generally, most the errors are judged to be no more harmful than potentially causing some symtpoms. While the bulk of medicines are low risk and routine, it is still important to pay close attention to the high-risk medications and its corresponding resident in order to minimize the possibility of severe harm.

Incident Reports

The responsibilities of an assisted living facility toward its residents can vary depending on state law and on the specifics of the contract between the facility and the resident. But in general, an assisted living is responsible for:
  • providing meals for residents
  • offering residents help with the activities of daily living
  • helping residents to take care of their living spaces
  • monitoring residents’ health and medical appointments
  • supervising residents’ medication needs, and
  • planning social events, amongst other things. 
Assisted living facilities can be negligent by not exercising reasonable care. Alternatively, the facility could be negligent for violating the terms of its contract with the resident or for violating any provision of the state law governing assisted living facilities. Most of the times this occurs due to understaffed facilities.
In ordinary negligence cases, negligence is doing something that a reasonably prudent person would not do under the circumstances or failing to do something that a reasonably prudent person would do. In medical malpractice cases, negligence is defined as a health care provider’s failure to exercise the degree of care and skill of the average health care provider who practices the provider’s specialty, taking into account the advances in the profession and resources available to the provider.
For example, if an employee of the assisted living facility was a health care provider who was performing a health care-related task, such as a nurse administering medications, that will most likely be considered a medical malpractice case. But if the alleged negligence was something unrelated to health care, such as failing to clean up a slippery substance on the floor, that will most likely be considered a standard negligence case.
Another important difference between standard negligence cases and medical malpractice cases is that, in medical malpractice cases, the plaintiff’s lawyer in most states has to hire an expert medical witness before filing suit, and the expert witness has to prepare a written report stating how and why the defendant committed malpractice. 
Different forms of abuse or financial exploitation can also take place in assisted living. This includes:
  • Physical abuse – includes unwarranted physical harm such as slapping, hitting, pushing, or kicking. Improper use of restraints and excessive restraints are also included. Physical abuse occurs when the resident is denied food or drinks, or forced to consume certain foods or drinks.
  • Sexual abuse – occurs when an individual engages in non-consensual sexual acts with an assisted living resident.
  • Psychological abuse – may occur as verbal assault, harassment, bullying, and degradation. Psychological abuse may also occur as “babying” a resident or giving the “silent treatment” as a result of undesired actions.
  • Financial exploitation – occurs when an assisted living resident is taken advantage of financially. This may include the unpermitted use of the resident’s money or property for the benefit of another.
At the base, the facility must have policies and procedures in place to assure the prevention and appropriate response to any such incident. In the case of incidents of abuse, suspected abuse, or injury of unknown cause, policies and procedures must follow the requirements outlined below. In the case of incidents that are not abuse or injuries of unknown cause where abuse has been ruled out, the facility must have policies and procedures in place to respond appropriately, which may include such things as re-assessment, monitoring, or medication review.

Abuse reporting

All facility employees are required to immediately report abuse and suspected abuse to the local, Seniors and People with Disabilities Division (SPD) office, or the local Area Agency on Aging (AAA), the facility administrator, or to the facility administrator’s designee. The facility administrator, or designee, must immediately notify the local SPD office, or the local AAA, of any incident of abuse or suspected abuse, including events overheard or witnessed by observation.
The local law enforcement agency must be called first when the suspected abuse is believed to be a crime (e.g., rape, murder, assault, burglary, kidnapping, theft of controlled substances, etc.). Physical injury of unknown cause must be reported to the local SPD office, or the local AAA, as suspected abuse, unless an immediate facility investigation reasonably concludes and documents that the physical injury is not the result of abuse.

Facility investigation

In addition to immediately reporting abuse or suspected abuse to SPD, AAA, or the law enforcement agency, the facility must promptly investigate all reports of abuse and suspected abuse and take measures necessary to protect residents and prevent the reoccurrence of similar instances. Investigation of suspected abuse must document:
  • Time, date, place and individuals present;
  • Description of the event as reported;
  • Response of staff at the time of the event;
  • Follow-up action;
  • Administrator’s review. 

Immunity and prohibition of retaliation

The facility licensee, employees, and agents must not retaliate in any way against anyone who participates in the making of an abuse complaint, including but not limited to restricting otherwise lawful access to the facility or to any resident, or if an employee, dismissal or harassment. Anyone who, in good faith, reports abuse or suspected abuse shall have immunity from any liability that might otherwise be incurred or imposed with respect to the making or content of an abuse complaint.

Filing a complaint with the management

In the case of negligence or abuse in assisted living, be sure to report those problems to the facility management, but also know that you should report those problems to the state licensing agencies that oversee assisted living. Contact Adult Protective Services (APS) or the state's licensing agency for assisted living in addition to the Long-Term Care Ombudsman in your area immediately. In some states, APS staff are responsible for investigating complaints.
It is important to record all the details of the complaint. The more information that you can record, the more effectively the complaint can be handled. Some details that you will need o record include:
  • What happened?
  • To whom did it happen?
  • When did it happen?
  • Where did it happen?
  • Who did the abuse?
  • Who was responsible for the neglect?
Assisted living residence operators must provide residents with their internal complaint resolution process that explains how complaints are handled in the residence. Individuals are encouraged to raise their concerns through the operator’s internal complaint resolution process. If you do not get a satisfactory resolution using the operator’s internal complaint resolution process or by talking to a health authority case manager (where involved), you can make a complaint to:
  • The assisted living registry by contacting registry staff. No one should try to prevent you from reporting concerns to registry staff. The operator must continue to provide agreed upon services as outlined in the residence occupancy agreement and personal services plan after a complaint is made.
  • The Patient Care Quality Office for your regional health authority – If you live in a publicly subsidized assisted living residence and feel that your concern about the quality of service delivered by the residence operator has not been addressed, you are encouraged to contact the Patient Care Quality Office for your region if you want to make a formal complaint.

Filing a complaint against an assisted living facility

If you feel that your complaint has not been appropriately addressed by the assisted living registry staff, you may contact the Office of the Ombudsperson who may investigate complaints about unfair administrative decisions or actions of a public agency. Long-term care ombudsman programs in the complainant's state may be able to assist with filing a complaint against an assisted living facility to the regulatory agency. A local ombudsman can assist with filling out complaint forms, following up on complaints and advocating for the rights of elders in assisted living homes through local law enforcement agencies and government organizations.

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TRANSITIONING INTO AN ASSISTED LIVING FACILITY

How to get loved one to go if they are resistant

Convincing dementia patients, especially those who are elderly, to move from the comfort of the home they've known for many years into an assisted living facility can be tough. Your loved one will want to stay in their own home or with their own family for as long as possible. Therefore, it is very important to communicate with them about this change.
The patient may see the changes as being another step closer to death. Therefore it is important to let your loved one know and explain to them the disadvantages of living alone or refusing to leave home and the advantages of an assisted living facility. These things should be clearly communicated to them, in order to make the dementia patient more agreeable to the arrangement.
Disadvantages of staying at home:
  • There's no one to get help for them
  • Less socialization
  • Malnutrition
  • Memory loss leading to accidents
Advantages of opting for assisted living:
  • Less responsibility when it comes to their living space.
  • People around should they need medical help or other assistance
  • Better nutrition
  • New friends and activities
Regardless of the reason or situation, moving is an emotional decision. So you should have this conversation before the disease deteriorates to the point where there can be no reasoning. It won’t be an easy discussion, and usually and resistance should be expected. Below are some tips to convince your loved one:
  • Visit Personally: Help them feel the environment of the facility and talk to as many professionals and people as possible.
  • Look into Multi-Level Care Facilities: Be sure to consider the benefits of a multi-level facility or a CCRC (additional services provided, which can be good as only one change will be needed). Seniors progress through different levels of the facility as their dementia worsens.
  • Taste Test: Test the meals
  • See the Accommodations: Don’t believe everything you are told and visit the space so you will know how well your loved one will be accommodated.
  • Activities: This will help your loved one try new things and get new hobbies. This is a major factor for breaking the initial resistance.
  • Build Relationships: People that work in these places are used to resistance, ask for help and learn from their experience as they are confronted with these types of situations daily.
  • Create Need: You can try to get a social worker to ask for your loved one’s help with some task or job. For people who respond to this, it can be a contributing factor to their happiness.
  • Safety: Don’t wait for something terrible to happen before you make this decision. Analyze the situation rationally. If there are safety risks involved and your loved one can’t stay at home alone, act. 

What to bring when moving into assisted living

Try to create a familiar space but keep in mind that it is a smaller place and that there are regulations and restrictions for safety. It is best to collaborate with your loved one and get their insight on what they would like to tak with them as well. Make it a team effort. Depending on your loved ones state,their tendency to misplace or grab items and what the facility provides, some basic items that you can bring along for your loved one includes:
  • Bed Sheets (Atleast 2 sets)
  • Comforter
  • Blankets
  • Pillows
  • Pajamas
  • Sweaters
  • Jackets/Coats
  • Towels (Atleast 2)
  • Personal Hygiene Products (Razors, Deodorant, Soap)
  • Formal clothing (for special occasions) 
  • End tables (If not provided by facility)
  • Nightstand
  • Lamps
  • Picture Frames
  • Artwork
  • Clock
  • Vase of flowers
  • Music player
Make sure you label EVERYTHING with your loved ones name so the staff can distinguish their items from another persons and leave valuables at home. It is very common for wanders to grab things from each others rooms. Avoid having lost items by labeling them and by leaving valuable items such as jewelry at home.

Tips for transitioning into assisted living facility

Adjusting to a new care and living arrangement can be hard, but you should try to ensure that your loved one keeps an open mind and start preparing for the transition as early as possible. Any change to a person with dementia takes an adjustment period that may include exacerbated symptoms, new symptoms and behaviors, and disrupted routines.  Give them and yourself atleast 2 weeks to transition into the facility before feeling panicked that there is something seriously wrong with the decision. 
Another thing they should do is to socialize. For as long as possible, physically and mentally, the dementia patient should socialize with others instead of isolating themselves as it can be crucial for adaptation to the environment. Try to explain how important it is to make new friends and ask for the staff’s help if you are dealing with a person that usually keeps to him/herself. And lastly, as a primary caregiver or family member, you shouldn’t be afraid to ask the staff for help or clarification. The same goes for the dementia patient. If you or your loved one has any doubt, it is best to get is sorted as soon as possible.
To some, sending your loved one to an assisted living facility may make them feel guilty for ‘abandoning’ their responsibility toward the dementia patient. However natural the feeling may be, there is nothing to be guilty about as you should always strive to provide your loved one with the best possible care for their needs. And of course, once your loved one has been settled into the facility, you and other close family and friends should keep in touch. Visiting your loved one regularly is a very good way to also ensure they don’t feel abandoned at the facility. And lastly, when moving into an assisted living facility, the patient should bring in personal items with them to make it feel more homely. You can also request other family members and close friends to ocassionally sent presents, postcards, and other items to make the patient feel remembered and valued.

The transitioning period

The transition process during the first few weeks will be complicated, There may be anger, guilt, rage and many other negative emotions. Regardless, you should prepare for the worse. Keep in mind that as each day goes by, your loved one will be feeling better and more at home with your decision. To facilitate the transition process it is important that you do not, or at least try to not express any negative feelings or attitudes, such as crying, towards the new change. This emotional rollercoaster will start from the moment you start the conversation about moving until you leave the assisted living facility on moving day. Don’t bottle up, ask for help from friends, family or even the staff and most importantly, take the time to plan all these changes as you will probably feel sad, angry, and exhausted during this period. Everyone has a different way of handling these situations. Most importantly, remember that it is a stressful time but it is all for the best. 

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TIME TO FIND A NEW CARE ARRANGEMENT

The best time to consider changing to an assisted living care arrangement is when you know that you can’t trust your loved one to be at home alone, and you also know that specialized care is required. As you may know, the transition is going to be difficult but it is important to keep in mind that it should happen before your loved one’s condition becomes critical.

Similarly, after some time, when the progression of your loved one’s dementia renders them completely dependant on others for assistance with even basic personal tasks, a slightly more specialized facility might be better. For example, nursing homes can be a good care arrangement where where they can receive the focused full-time care they need.

Fortunately, there are several options available for care including Care at Home, Personal Care Homes, Nursing Homes, and Continuing Care Retirement Communities. 

Assisted Living Dementia

 

However, before coming to a decision about this, it is best to speak to th current assisted living facility management and staff to evaluate whether your loved one’s needs are fully being met. The patient’s doctor should also be involved in this process. Only when it is deemed that their needs can be better met at a nursing home or other kinds of facilities should you move the dementia patient out of their current care arrangement. 

Medication rebalancing – Geriatric Psychiatric Unit

Medication is a very sensitive issue, even in places that have trained staff. To avoid errors in medication it should follow five basic principles:

  • Right time
  • Right dose
  • Right medication
  • Right resident
  • Right route

Although medication errors are known to occur, it is highly likely that there are fewer errors in these facilities than when a dementia patient is living at home, alone or with their family. Changes and progressions in the disease can bring new behaviors and symptoms that their current medications may not be mitigating as effectively as they could be. 

In the case where your loved one has an extreme episode outside of the normal such as severe aggression towards the facility staff or residents, physical changes causing severe changes - seeking help from a geriatric psychiatric facility is a great way to rebalance your loved ones medications so their quality of life and the people around them improves. 

Although there is a stigma and fear associated with these facilities, they are specialists that are there to help when you need it the most and might be at your wits end with helping your loved one through their disease. A typical patient stays in the in-patient facility 1-2 weeks (although dementia patients tend to stay longer) and has their medications adjusted until they are "stable" and showing improvements, eventually being discharged. 

The hospital will also provide a social worker to assist with discharge planning to ensure the transition back to their original Assisted Living Facility or another care home goes smoothly and is in accordance with the needs of the patient and family.

One of the best things these facilities can offer is access to healthcare professionals. It will be easier to control the medication and there will be a closer, specialized follow-up, culminating in a treatment designed for the patient instead of a treatment designed for dementia in general.

As the medication and other parts of your loved one’s life will be more controlled, there is lesser risk of drug interactions or food interactions, for example. As a family member or former caretaker you can have an important role when it comes to medication control by sharing with your loved one's doctor, pharmacist or nurse details about the former drugs or foods your loved one used to take and contribute to a treatment that will be tailored to your loved one. Don’t forget to share anything that may be relevant in case your loved one goes home for the holidays or family activities. Don’t forget that you are an essential part of your loved one’s life, as they are an essential part of your life. 

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