En español | When it becomes difficult to care for someone with Alzheimer's disease or dementia at home, you may want to consider memory care. Memory care is a form of residential long-term care that provides intensive, specialized care for people with memory issues.
Many assisted living facilities, continuing care retirement communities and nursing homes have special memory care “neighborhoods” for dementia patients. There are also stand-alone memory care facilities.
Memory care is the fastest-growing sector of the senior housing market, with the number of units doubling over the past decade, according to the National Investment Center for Seniors Housing & Care, a nonprofit that tracks trends in the industry. However, occupancy rates plummeted in 2020 as COVID-19 ravaged many long-term care facilities.
Many facilities have struggled with staffing in the wake of the pandemic, and the quality of memory care units varies widely, says Megan Carnarius, a registered nurse and memory care consultant in the Denver area. It's important to visit and ask questions as you consider whether memory care is the right fit for your loved one.
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What makes memory care different?
Memory care is designed to provide a safe, structured environment with set routines to lower stress for people with Alzheimer's or dementia. Employees provide meals and help residents with personal care tasks, just like the staff at an assisted living facility, but they are also specially trained to deal with the unique issues that often arise as a result of dementia or Alzheimer's. They check in with residents more frequently and provide extra structure and support to help them navigate their day.
Is your loved one ready for memory care?
Many people diagnosed with Alzheimer's can live on their own during the early stages of the disease, especially if a family member or paid caregiver provides regular, in-home support. But there may come a time when your loved one needs more care than you feel you can provide at home. Here are some questions to help you determine if it's the right time for a move.
- Is the person with dementia becoming unsafe in their current home?
- Is the health of the person with dementia or my health as a caregiver at risk?
- Are the person's care needs beyond my physical abilities?
- Am I becoming a stressed, irritable and impatient caregiver?
- Am I neglecting work responsibilities, my family and myself?
- Would the structure and social interaction at a care facility benefit the person with dementia?
Source: Alzheimer's Association
“In regular assisted living, residents are expected to manage their own time; menus and mealtimes are posted, but staff is not checking in on them,” Carnarius says. “In memory care, the staff ensures residents are getting to meals, coming to activities and moving on to the next thing.”
Because people with dementia are prone to wander (6 in 10 do so, according to the Alzheimer’s Association), memory care facilities have alarmed doors, elevators that require a code, and enclosed outdoor spaces to keep residents on site. Many offer tracking bracelets that give residents the freedom to explore but still allow staff to monitor their location.
Activities are designed to improve cognitive function and engage residents at different stages of the disease.
Choosing a memory care facility
You can start the search at AARP and the Alzheimer's Association's Community Resource Finder, an online directory of senior care services. Click on "Housing Options," select a type of residence (for example, assisted living or continuing care retirement community) and enter your zip code; the results will include information on whether the facility provides memory care.
Once you've narrowed down your choices, experts recommend visiting each memory care residence on your list several times, including at least one unannounced visit in the evening, when staffing is thinner. Here are some factors to consider during your search.
Layout and physical environment
Is the facility clean and pleasant? Does it have circular hallways, so residents don't get frustrated by dead ends? Are rooms and doors clearly labeled (with words and pictures) to help residents find their way around? Is there an enclosed outdoor area with walking paths? Do residents seem happy?
The COVID-19 pandemic has left many long-term care facilities nationwide badly short-staffed. Ask about shortages at communities you visit and keep an eye on how staff members interact with residents: Are their needs met quickly? Is there a nurse who works in the building? What kind of dementia-specific training do employees receive?
“Ask how they manage a person who becomes aggressive,” suggests Laura Gitlin, dean of the College of Nursing and Health Professions at Drexel University and coauthor of the book Better Living With Dementia. “They shouldn't be relying on antipsychotic medications.”
Long-term care facilities were particularly hard-hit by the pandemic, and many memory care patients struggled with isolation and loneliness during lockdowns. Studies show the social restrictions created a spike in mental health problems, agitation and severe behavioral disturbances among people with dementia.
“They couldn’t remember why they had to wear a mask or why they couldn’t see their family members, so of course that was upsetting,” Carnarius says.
When considering a center, ask what rules will go into effect if there’s an outbreak. Will visitation be allowed and in what form? How will the staff communicate with families? Which residents will be quarantined and what does that look like?
Food and activities
Does the facility offer activities that would keep your loved one engaged? What strategies does the staff use to encourage residents to eat? Carnarius recommends having at least one meal and participating in an activity at any residence you're considering.
“Watch to see how staff engages residents during the activities,” she says. “Do they seem to know residents personally?”
Availability of continuing care
Some assisted living memory care units can't provide complex medical care. Find out what health conditions or behaviors might require your loved one to leave or to be moved to a more expensive level of care within the facility.
Also ask if the facility accepts Medicaid. If not, your loved one may have to move when he or she runs out of money.
How much does memory care cost?
Not surprisingly, the higher level of care and supervision in a memory care unit comes at a price.
The average memory care monthly rent is $6,935 in the U.S., according to 2021 NIC statistics. That’s significantly more than assisted living, which averages $5,380 a month, but a lot less than the $10,562 average monthly cost of a nursing home.
Costs vary state to state and are affected by the level of care provided.
Medicare and Medicare Advantage plans generally will not pay for room and board or personal care in an assisted living facility, although they will pay for medical care the facility provides. Veterans benefits typically help cover the cost for eligible veterans and surviving spouses who are over age 65. Once your loved one no longer has any assets, Medicaid may offer some coverage for long-term care, but only if the facility accepts it.
Most families that utilize memory care have to pay out of their own pockets, says Richard Newman, an elder law attorney in Pennsylvania. Long-term care insurance, if your loved one purchased it previously, can be a big help, he says. Families might also sell off personal assets or tap the “living benefits” on a life insurance policy to help cover the cost.
If you think your loved one is going to need memory care, Newman recommends planning if possible. “There are ways to protect some assets and qualify for Medicaid, but it's complicated, so I would recommend talking to an elder law attorney,” he says.
Editor’s note: This article, published Oct. 21, 2019, has been updated with more recent data on the memory care market and the impact of COVID-19.
Michelle Crouch is a freelance journalist who writes about health, personal finance, parenting and more from her home in Charlotte, North Carolina.