How to find a good memory care facility?

secondcor521

Hi all.

My Dad is almost 88 and probably early stage 6 GDS with Alz/VD.

He's currently living in an AL facility. They called today wanting to have a discussion with me about memory care. It's scheduled for Thursday afternoon so my sisters can join the conversation.

How to find a good memory care facility?

The AL facility he's in has a MC unit about 100 yards away. It's about 15 minutes from my house, which is close enough. His whole CCRC place is high end.

My Dad said recently that he doesn't need all the fancy stuff his CCRC has - there's a gym, swimming pool, movie theater, golf course, pond, pickleball courts, bocce ball courts, pool tables, bars, etc. But he doesn't use any of these things. He barely goes to activities now because his dementia limits his abilities.

I would have kept him in the same CCRC as his girlfriend, but she moved away to another state a few weeks ago and is therefore not a factor. He doesn't really have friends among the residents.

His current AL facility does a good job of taking care of his physical needs - dressing, medications, transfers, etc. - but he's bored, confused, and lonely. The techs are well meaning but I don't think they have training or bandwidth for the dementia stuff (which is basically what the facility called to say today).

How do I tell if a place is good in general? Looking for a place that is safe. Looking for a place that can handle the other medical stuff (medications, transfers, shower assistance, etc.) plus the mental/emotional stuff. A place that is clean and well maintained. A place close by. A place that isn't violating any state laws about elder care and has no history of staff abusing patients. A place where they'll let him stay even if his dementia gets worse.

How do I tell if a place is good for him specifically? He's a retired doctor, tends towards introversion, doesn't like to do fun/silly things (like the "dress up and participate in a Mardi Gras parade around the CCRC" that happened last week), and again, stage 6 Alz/VD nearing age 88. He's vv confused, vv forgetful, has lost a lot of executive function, is having some speech difficulties, is in a power chair for mobility issues.

Are there reliable services that help evaluate / curate / recommend good options? I'm only aware of the "A Place for Mom" website and service, and have seen their ads but have no idea if they're any good or not.

Thanks for any suggestions / advice / resources.

M1

Welcome to the forum. I think most here would steer you away from A Place for Mom as it is very financially driven, they only recommend places that pay them to do so. They can also be pretty pushy, by report.

Do you have a reason not to start with the MC unit that's right there in the CCRC? If you've generally been pleased with it so far, you may not need to reinvent the wheel here. But it is probably worth touring it and others in person. Ask about what dementia training they provide for their staff.

I can certainly tell you from experience that all memory care settings are difficult for introverts. My partner also has no use for most of the group activities and is claustrophobic to boot, so that more than 4-5 people in a room really gets to her. I haven't found a good answer for this, except to try to spend as much one on one time with her as i can.

I think your sense of what to look for is about right. Hope it goes well.

harshedbuzz

@secondcor521

APFM is the devil. Their business model is to offer a curated list of facilities that pay a commission (or kickback if you wish) of about one month's fee when a resident moves in. This practice misses all of those excellent places that don't need to advertise as they fill beds by word-of-mouth. Plus, once they get your contact information you will be getting sales calls whenever a news sales agent is hired or they re-brand the facility. I got one 6 weeks after my dad died while mom was in the car. It went to Bluetooth and it took me weeks to convince mom I wasn't looking to place her.

Your list of things to ask about is an excellent start. I would also be upfront about his use of a motorized power chair. That could be a deal breaker at many facilities; most of the places I toured (over a dozen) required folks to be self-feeding and ambulatory on admission even if they allowed residents to age-in-place. A few places made an exception for those using traditional wheelchairs so long as they could mostly get around; my aunt's lovely CCRC did accept her after a stroke which caused her to be dependent on a wheelchair. None of the places I looked at allowed motorized transport for the same reasons one doesn't allow PWD to drive a car.

I would start at the CCRC where he lives now with the caveat that not all sections within such places will be of the same quality IME. There's a terrific CCRC near me that top-notch for hospice and AL but their MC is not great. Another place rocks the IL piece, but their SNF is awful.

Given your description of dad, I wonder if he's one of those folks who would be a good fit for one of the free-standing MC/PC for profit entities. Assuming he has funds enough that he won't need the safety net of Medicaid, he might have an easier time in a fancy for-profit MCF that cheery picks their residents-- he would be exposed to a population of the pleasantly befuddled rather than those with behavior issues.

Another option that appealed to me was the local state veteran's home. If your dad qualifies, I found ours to have a very masculine atmosphere that was devoid of the girly silliness so many facilities offer. This was my first choice for dad, but he died before his name came up on the wait list.

HB

secondcor521

Thank you both for the feedback, especially on APFM; I'll very likely steer clear of them.

@M1, the MC facility at his CCRC would be the default option, and the only option if his GF was still living there. But I haven't been super impressed with their AL operation - it's wholly adequate but I wouldn't describe it as wonderful. Although he can afford it, it is quite expensive (probably double the local market average although I need to confirm that) and it feels like he's paying for stuff there that he doesn't care about and doesn't use. Finally, the CCRC is about 15 minutes away and it feels like if he's going downhill and needs more help from me it would be nice to have him even closer. And if he has to move anyway to new surroundings / new staff / new routine, I don't know if it matters whether the move is 100 yards or five miles.

I'm not saying we wouldn't keep him there. And my sisters both obviously get to provide their input which will weigh heavily on what happens. And my Dad of course has a say, although I don't think he would understand the question or the situation very well at this point.

On the introversion thing, one thought from my sister's friend was to consider putting him on hospice just so he would have someone who could visit him maybe once or twice a week and give him some pleasant, no pressure companionship. For whatever reason, he associates with the staff at the current AL place more than the other residents, so maybe a hospice nurse would be viewed in a friendly light. It wouldn't necessarily be "full on hospice" though; not sure if the hospice folks can do that sort of thing.

@harshedbuzz, he did serve honorably in the USAF for about 9 years, so he is probably eligible. There is a VA home here in town, but it's further away and I don't know if they support MC. Good thought and we'll check it out.

And yes, his "driving ability" is getting more questionable. He would regularly disable his older power chair by driving it into elevator walls, fireplaces, door jambs, etc. which would trip a safety feature. His new one doesn't seem to have that problem, but there are marks all over the doors and baseboards. We were advised a year ago that he might eventually lose "driving privileges". His current AL facility requires him to have liability insurance so in case he drives over someone's dog or knocks over a grandkid he's covered (and more importantly, I'm sure, the facility is covered).

Additional comments / feedback welcome.

jfkoc

Training...you want to know the specific training for new staff as well as on-going. Get a copy of the contract and read the small print. Get a copy of the state license to see exactly what services they provide. You might also ask to attend their caregivers support group.

Have your planned visit but also drop in unannounced. Talk to people in the parking lot.

Go to a local support group meeting. The people attending know all the clear dope and will share the good the bad and the ugly.

MN Chickadee

I would tour a few MC facilities even if you think you will settle at the current campus, at least it will give you perspective. Taste the food, talk with staff, catch other visiting family members in the parking lot and see what they think of the place. No place is perfect but many are very good and give good care. Sounds like you wouldn't care so much about the activities but it's possible a good activity person could coax him into doing more things. There is far more structure in MC usually and they have better training at relating to a PWD; activities are not geared to dementia in AL so of course many PWD wouldn't be interested. MC makes the world and focus smaller and simpler and many PWD do better with this and struggle less. Word of mouth is usually the best way to vet a place. Ask on the Nextdoor app or join a local support group. Heck, ask at your hair salon - they could probably conjure up recommendations because dementia touches so many lives.

terei

I had a private pay companion come in at AL + MC once a week to augment family visits. They took walks, went for ice cream, organized pictures, went to lunch + garage sales, just visited.

You are saying he is bored, but there are activities there that he doesn’t participate it. I’m not sure how to fix that. I had the aids turn on music daily mom liked in her room that was on a loop. She had no interest in TV.

secondcor521

Thanks for the additional comments and suggestions - I'm taking notes!!

@terei, yes, it's an ongoing conundrum. He had very narrow interests before, and now his dementia reduces his ability and willingness to participate even further. He's bored or "has the mulligrubbies" and calls asking for suggestions, then doesn't like any of them. I have another thread on that topic here earlier. I try to help him with the executive function aspects, but the rest of it is simply a hard situation.

CaliforniaGirl-1

Call your local Alzheimer's Association and get some recommendations for local Senior Placement Managers/Advisors and talk to several of them. You don't pay them, they get paid by the place you choose. They will know all the local places, which ones have turn over, which ones are good and which ones have openings.

At your dad's age you are right to look at which places can keep him if he needs more care or his capabilities decline. It is awful to have to move him once he acclimates. A big help has been finding a doctor who comes and sees patients there and takes her insurance.

We visited a lot of places and when we found the right one, we liked the atmosphere and the staff and the way they interacted with the residents. You need to like the staff because at some point your LO will go through challenging periods and you want to feel like they are working with you and they really care about your dad.

You want them to get to know your dad well enough that if some aspect of his behavior changes they notice.

I know that when my LO was recently hospitalized people from the MC went to visit her.

Like everyone we resisted MC but it turned out to be the right move for my LO and they are doing much better in the smaller more structured environment.

Sapphire68

https://alzconnected.org/discussion/68244/how-to-find-a-good-memory-care-facility

If it is financially possible to keep him where he is currently at then that would be the best option IMO. He doesn't have to partake in those extra things but the fact that they offer those things makes it a more exceptional care facility. You already know some of the staff there too and he would be familiar with it. That would at least give you time to look around if you decide you want to move him later.