Your aging mom who's living with dementia has always been conscientious about opening her mail and paying her bills. You and other family members check on her regularly to see she's OK. Yet over time, relatives notice she's letting her mail accumulate unopened and forgetting to pay her bills.
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These are potential signs that someone who's living with dementia may need memory care, says Dr. Elaine Healy, a geriatrician and vice president of medical affairs and medical director of United Hebrew of New Rochelle in New York.
About 5.8 million people in the U.S. have Alzheimer's, the most common form of dementia, according to the Alzheimer's Association. Family members care for some people with dementia, and others live in nursing homes or assisted living facilities.
Memory Care Units
People with dementia who exhibit certain kinds of behavior that affect their day-to-day living are better off in the memory care unit of such facilities, Healy says. These are units where staff members are trained in working with people with dementia who require specialized care.
Here are five behaviors or circumstances that can indicate someone needs memory care:
• Changes in behavior.
• Confusion and disorientation that imperils physical safety.
• A decline in physical health.
• A caregiver's deterioration.
• Incontinence.
1. Changes in behavior.
Some people with dementia may start acting in dramatically different ways. "Someone very independent may suddenly be apprehensive about driving, decline social invitations and become withdrawn," Healy says. "Someone meticulous about their appearance may suddenly forget daily hygiene or how to do basic tasks like bathing and hair styling, and are too embarrassed to ask (for help)." A person may become more anxious or agitated.
2. Confusion and disorientation that imperils physical safety.
Dementia can cause confusion and disorientation, which can lead to car accidents. For example, someone with dementia could forget the rules of the road and run through a traffic light. Some people with dementia wander from home on foot and don't know how to get back. "Someone with dementia symptoms may forget where they've walked, and end up somewhere they don’t recognize," Healy says. "When your loved ones are continually putting their physical safety at risk, it's time to consider memory care."
3. A decline in physical health.
"Physical changes are often the first noticeable differences when someone has dementia or Alzheimer’s," Healy says. If someone becomes thin or frail, it may mean he or she is forgetting to shop for groceries or take medications as directed. Some people with dementia forget to take their prescription medication. And some forget whether they've taken their medication and take more than they are supposed to.
4. A caregiver’s deterioration or death.
Some people with dementia are cared for by relatives, often a spouse or significant other. When the caregiver dies or his or her health falters, that often means the spouse or significant other who is being cared for needs a higher level of attention, like memory care, says Dr. Rhonna Shatz, a behavioral neurologist at the University of Cincinnati’s Department of Neurology and Rehabilitation. She's also an associate professor or neurology and the Bob and Sandy Heimann chair in research and education of Alzheimer's disease at the University of Cincinnati. In addition, Shatz is medical director of the Memory Disorders Center at the UC Gardner Neuroscience Institute. Shatz says she recently had a patient with Alzheimer's whose health seemed to be faltering rapidly. He'd lost weight and was increasingly confused. Shatz identified that his wife, the primary caregiver was impaired. Shatz investigated and learned the wife had developed dementia and was unable to shop and cook for him and make sure her husband took his medications. A daughter then arranged for the couple to move from their home into memory care.
5. Incontinence.
Caregivers can handle a lot, but if incontinence begins to be a big problem, many start to look for memory care, says Dr. R. Scott Turner, professor of neurology and director of the Memory Disorders Program at Georgetown University in the District of Columbia. "They feel overwhelmed, they feel it's more than they can handle, more than they signed up for," he says. "It becomes too much." This can affect both nonprofessional caregivers like family members and hired medical providers who come into the home to provide assistance.
Should My Loved One Be in Memory Care?
It's important to keep in mind that memory care units are typically for people with mid- to late-stage dementia, says Ruth Drew, director of information and support services at the Alzheimer's Association. Therefore, some people who may need memory care are already living in a nursing home or assisted living facility. Such facilities sometimes have memory care units, which are run by staff members trained in working with people who need additional care with day-to-day living.
"Alzheimer's is a progressive disease and as care needs intensify it may not be possible (for family members) to provide around-the-clock care as needed,” Drew says.
If you're wondering whether a loved one should be in a memory care environment, it may be helpful to consider a series of questions regarding the well-being of a person with dementia, says Sandra Connell Jones, an adjunct instructor at Middle Tennessee State University in Murfreesboro, Tennessee. Jones, who's also an adjunct at Motlow State Community College in Smyrna, Tennessee, is a member of the Positive Aging Consortium at MTSU, where she teaches in the psychology department and the aging studies program.
Here are some questions to consider:
• Is it safe for the person to continue living in his or her current environment?
• Is the person's behavior likely to cause harm to others?
• What does the person want, need and say about the situation?
• What do medical professionals and other family members suggest?
• Are there resources and support systems which can help the person to continue to "age in place," or is a move necessary to provide care and protection?
It's useful to ask, "If I were the person, what would I want done for me?" Jones says.ration 1:09
If you're worried that a loved one may need memory care, get a primary care doctor, a geriatric psychiatrist or a neurologist to diagnose that person, Drew says. The Alzheimer's Association lists an array of care options on its website.
Different Memory Care Options
If a medical professional recommends memory care, here are some options, according to Nora O'Brien, executive director of Willow Gardens Memory Care, on United Hebrew's campus in New Rochelle:
1. Assisted living.
Many individuals diagnosed with mild or moderate stages of Alzheimer's disease or dementia can live to the fullest with some help, such as the kind provided in an assisted living environment. "Assisted living provides supportive care based on individual needs; that means we develop a customized care plan to provide an array of services including medication management, assistance with personal care and daily living, nutritious meal service and an enriching activity program," O'Brien says.
2. Dedicated Memory Care Community.
A dedicated memory care community is a specialized form of assisted living that provides comprehensive care in a secure environment, O'Brien says. “That means that residents are free to move about, often in indoor and outdoor spaces, without the fear of getting lost,” she says. Physical spaces are often designed with visual cues and artwork to help with navigation and ease anxiety. Meal preparation, medication management, assistance with daily life and personal care and enriching activities are all part of a memory care community that meets residents' health care needs and keeps them engaged in the world around them.
3. Skilled nursing.
A secure memory care unit in a skilled nursing facility is the best memory care option for those with greater health care needs, O'Brien says. The same daily care that is provided in assisted living and dedicated memory care is applied, with a greater emphasis on meeting the medical needs of those with chronic or complex illnesses.