Lessons I've learned about "Memory Care"

CStrope

I've previously made reference to lessons I've learned since placing my DH in the memory care unit on 4/1. Here are some of them. Hopefully others can add to the list and it will help others as they make this step with their loved one.

1. Nursing care and Memory Care are two different things. Many Memory Care facilities are considered CBRF (community based residential facility). CBRFs have no certification or training requirements in many states to work at these facility. They are not required to have a nurse on staff. The beautiful facility where DH is, has 1 CNA on staff, and she's the director, that's it.
2. Just because there's a calendar or chart of activities posted, doesn't mean they actually do those things. There are 4-6 activities listed every day on the calendar at DHs facility, but I have yet to see anything other than daily bingo for the same 4 ladies every day.
3. Stop in at mealtime and see how the food looks. Would you want to eat it? How are the patients situated for their dinner. DHs facility makes up exactly the same plate for each of the 20 residents. It doesn't matter how able or healthy they are. DH was active and a ferocious eater, but was constantly hungry. He did not have the ability to request more or make his needs known.
4. Ask how familiar they are with your loved one's specific type of dementia. DH has FTD, and even though they claimed they knew all about working with FTD patients, they did not…..at all.
5. Ask if you can just sit in the common area for a while and observe. What are the staff and residents doing throughout the day on their own. Is there interaction between staff and residents or are the residents plopped in front of the TV, or wandering the halls by themselves.
6. Do they chart diaper changes and is it visible for you to easily see. Knowing how often a resident has a bowel movement or urine soaked diaper could be important signals to their medical needs. DH was being given double laxative every day when he first moved in, so he was have 2-3 bowel movements a day!! Had I known this, I would have been able to question it. After that, things went the other direction. Seldom needing a diaper change is also not okay, it can mean dehydration or constipation.
7. Are the common areas and hallways easily visible to staff, or are there cameras in the areas that are not. Every time I received a call about an "incident", whether it was a fall or an altercation between residents, staff was unable to give me much information about what had happened because they didn't see it.

These are just some of the things that have caused concern and problems for us. There are plenty more but that would be far too extensive to write about!

PS67

Thank you very much, CStrope. I think unannounced, “happened to be passing by”, drop in visits are important.

M1

thanks for elaborating Cstrope. Agree completely. We are blessed with a reasonable nursing staff overseen by an RN and good food for the most part, with at least two choices at the main meal (one always being a finger food). Activities are mooted for us because she won’t participate. But a big concern for me has been the lack of visual monitoring. They don’t allow cameras because of liability issues, apparently they don’t want a record. So for most folks they want them out in common areas most of the time for group supervision. That has not worked at all for us, both by temperament and by physical limitations (bad back, needs to lie down freq, very uncomfortable if parked in a chair or wheelchair). Hence multiple unwitnessed falls, mostly in her room. Found on the floor multiple times. Bed alarms also not allowed for reasons unclear to me but have to do with state licensing I’m told.

Jgirl57

Thank you CStrope, all of this is very very helpful.

GothicGremlin

Thanks @CStrope for posting this. It seems like there have been a lot of questions about memory care recently, and your post covers a lot of ground.

As to my experiences with memory care, thankfully most of the things on your list weren't issues for me and Peggy.

But —— the big issue I had with Peggy's memory care that bothered me were the dogs. The new memory care director had two dogs that she brought to memory care every day. She kept them in her office but they were a huge distraction for staff, including her. Once she brought in her dogs, then her assistant brought in her dog, who wasn't kept in an office. And then a third person brought in their dog - also allowed to roam around free. And these were not trained therapy dogs. I was not happy. All I could see were elderly residents not steady on their feet getting tripped up by dogs. One of the dogs was a tiny chihuahua - super cute, but very fast, and a tripping hazard, imo.

note: I prefer cats, but I like dogs too — just not running around in memory care.

Joe C.

My DW has been in Memory Care for 32 months and I have had a very different experience:

1. There is an RN on staff 24/7 and during regular hours Monday-Friday there is 2 or 3 nurses on staff depending on the day.
   
2. The activities are pretty consistent with lives musical entertainment 4 to 5 days a week, exercise classes 5 days a week, arts & crafts, trivia, bingo and other activities. DW is in early stage 7 so she cannot participate in many of the activities at this point but she still loves music and dancing and goes to the other activities since she likes being around people. They also do other events for example they just had a prom with live entertainment, DW was voted Prom Queen. (See attached photo). They have a car show coming up where a local classic car group is bring their cars and the residents can be taken out to see the cars and enjoy ice cream and other snacks.

IMG_3524.jpeg

3. For each meal there are 2 entree choices with soup salad and desert. I find the food generally pretty good and will eat there went there at mealtime.

4. I am always notified immediately when there is an incident and with one exception the staff has informed me of the situation. When it is an incident between residents they cannot disclose who the other individual is but otherwise they are forthcoming with the information available.

5. I know the staff changes residents on a defined schedule and also as needed. I do believe they keep track of bowl movements since at times they will tell me she has been constipated but I have never asked to see the chart.

I will say that I spent a long time researching and touring facilities before make a choice which was my preferred facility. The facility I choose was the furthest from my home but was the best in my opinion. I put a deposit on a room at the facility probably 18 months before placing DW. I tour facility that I would not have considered placing DW do to a range of reason from staffing, cleanliness, ability to age in place, etc. Like in any business MC are not all equal and you really need to do your homework before placement.

I visit DW almost daily so I see a lot of the goings on. Some staff are better than others at engaging with residents but in any business there is always a range on performance among employees. I can say that at DW facilities the residents that do not have any or few visitors receive the same quality of care as DW.

ghphotog

My experience has been mostly positive. A few times I was there during meals and most of it was inedible until I mentioned it to the director. The food has since improved. The only other is, just like everyone, certain residents tend to get on everybody's nerves and there can be name calling, tension and threats of violence at times but the staff was always able to diffuse it. I don't know about overnight staff or how patient they are with my wife and they need a lot of patience.

GiGi1963

The MC facility I chose for my husband is similar to the facility described by Joe C. Toileting on a 2 hour schedule. Food is very good with options for special needs. Musicians frequently perform to the residents delight. Right now they are holding Olympic competitions with gold, silver and bronze medals. I took my husband out of the first MC facility after observing no activities and ignoring a new resident who was confused and couldn't find his room. He is content and settled now.

FTDCaregiver1

I ended up doing short respite stays before placing in an MC facility, I ended up working on weekends, 8 hours a day for 2 months with one MC facility. A couple of MC locations, owned by one company I placed DW I noticed the quality of food was much different, difference was the cook. One cook went out bought local food, prepared food with fresh ingredients, fruits & veggies, she even asked what my DW liked when I was hanging out in the kitchen as she was heading out to the market. The other mostly processed food, out of can, frozen or fried, was a blank slate to talk to. Complaining doesn't help. So for me, meet/talk with cook staff and see the kitchen, forget the menu its worthless see/talk and eat some of the foods. RNs vary but line staff I talked with and focused on, asked about their training, spent time with them when I visited, and I shouldered care while I was there. Noticed quality of care suffered on weekends or where a superviaor, beyond that of a lead worker, was absent, too many heads looking into Iphones, maintenance problems overlooked, heat was so bad on weekends because staff kept propping doors open, thinking it would get cooler, so then the AC gets overworked, had to bring in a window AC just for DW's room. These little things mean alot if neglected in MC and the stress it causes directly impacts health of LOs. Overall, 4 different MCs, total of 7 months and last August I voluntarily brought her back home, where I care for her.

Jeanne C.

Added to Placement Discussion thread in the new caregivers group.

CStrope

https://alzconnected.org/discussion/comment/218544#Comment_218544

I am so happy for you that you're having a good experience. Our facility also had a prom, but only 2 people participated. There was a car show for Father's day, and the only person was a grandchild that came in her battery operated power wheel!

M1

Just an added observation: we witness a "fire drill" today during lunch when one resident was missing. Supposedly all the rooms had been searched, but finally one of the janatorial staff found her in the bathroom of another resident, not anywhere near her own room. The intensity of the response was somewhat reassuring to see. But: how did she get in there in the first place? No one had a clue. I think it supports my argument for at least some capacity for visual monitoring.

ThisLife

Both MC facilities I used for DH had a common area with two parallel halls going back. There was a hallway across the back and another hall across halfway up. The line of sight was about halfway down. The first had cameras which could be monitored from an app of staff phones. There was no one monitoring. The other had the same set-up but no monitors, so they had no clue what was happening in the cross halls and halfway down. Facilities that had a layout designed for consistent in person monitoring were out of my price range.

Both had two meal options, but residents just had a meal set before them. No inquiry as to what they wanted. Several drink options available, but staff just placed a drink in front of each person.

The were ALF with a MC wing. The activity calendar I was shown was for the ALF side.

From what I observed in the two I used and the others I toured at least twice, it is a business and a scam mostly. I did the best I could with the money I had available from a good LTC policy. He ranted and rage at home. Every visit was raging at me because he was there. Thirty minutes was the longest visit because he would become physical. Not conducive to observing conditions on a frequent basis.