Specialized Care Facilities

How to Select a Facility for Someone with Alzheimer’s Disease or Related Dementia

The diagnosis of Alzheimer’s disease and related dementia presents families with a complex set of difficult decisions related to the care and well being of their loved-one. One of the most difficult of these decisions involves the placement of the person with Alzheimer’s disease in an assisted living facility (ALF) or skilled nursing facility (SNF). Families often struggle to find just the right facility for their loved-one, one that will care for that person diligently and with respect for dignity. It is important to everyone that the decision be based upon a thorough search for options and alternatives, and a thoughtful comparison of those options given the needs and unique characteristics of the memory-impaired person.

This article is meant to help family caregivers sift through the increasing number of specialized care programs and facilities designed to meet the needs of people with Alzheimer’s disease and related dementias. It provides a set of questions and issues that should be addressed when visiting and selecting a facility. In doing so, we are assuming that the decision for placement has already been made, and that other more basic issues of nursing facility selection (for example, questions related to financing care, visiting hours, physical appearance of the facility, etc.) are being addressed as well.

Be aware of the differences between skilled nursing facilities and assisted living facilities. For example, for families in Ohio, if you select a skilled nursing facility, your first request should be to review the last inspection by the Ohio Department of Health (ODH). This will list all the deficiencies, which will indicate areas of weakness. Depending on their licensure status, some assisted living facilities are not subject to mandated ODH inspections. Also, note that a position of medical director is mandated for skilled nursing facilities, but there is no such requirement in some assisted living facilities.

It must be emphasized that it is crucial for anyone considering this type of placement for a loved-one to actually tour the facilities being compared, talk with staff, and ask questions and make observations related to the following issues. You may wish to go prepared with a list of questions important to you, and make note of answers and observations for comparing facilities later. Following are some examples:

Is the facility wholly dedicated to care for Alzheimer’s disease patients, or does the facility have only an “Alzheimer Unit”?
When you enter the building, are you immediately addressed and attended to? Does the facility feel friendly?
To what extent are programs and care truly specialized to the needs of the individual resident? In other words, what effort is made to treat residents in the different stages of Alzheimer’s (early, middle, late, etc.) differently, rather than grouping residents together regardless of stage?
Is the Medical Director a “Certified Medical Director”? Has he/she been trained to treat and supervise care for persons with Alzheimer’s disease and related dementia?
How often is the Medical Director in the facility?
Are the staff at all levels and in all departments well trained to provide specialized care knowledgeably and competently for persons with Alzheimer’s disease? Is that training ongoing, beyond new employee orientation?
Does the interaction among staff appear to be positive? Are there indications of good staff morale?
How stable or consistent is the management and staffing of the facility? How often does the facility use temporary agency staff?
What is the attitude of staff toward current residents? Do you observe the staff to be respectful, caring and compassionate?
Is the facility committed to promoting family involvement and support? How is this evidenced?
Does the facility provide daily activities for residents with opportunities for socialization, achievement and recreation? Are these activities tailored to their individual capabilities, interests and stage in the disease process?
Does the activities program include opportunities to experience life outside of the facility on a routine basis? Is there a secure space for residents to walk outside?
Is the specialized care program self-contained and secure?
Does the physical layout of the facility provide both community and private space for residents?
Does the facility seem noisy or unusually cluttered?
How are residents with difficult or aggressive behaviors managed? What is the philosophy of the Medical Director and facility regarding the use of physical restraints and drugs in behavior management?
What skilled-care services are available should a resident require such care (i.e., in the event of an illness requiring a higher level of nursing care)?
What characteristics will qualify and disqualify the individual for being a resident in the unit or facility? What happens when the individual becomes disqualified because of a behavior or symptom (for example, aggressive behavior, incontinence, undressing, etc.)?
Does the facility have 24 hour visiting hours? – this is a good indication that staff have nothing to hide.

In making this important and difficult decision, families often consider the location of the facility as high on the list of priorities. You will find this criterion on many checklists for assisted living and nursing facility selection. However, our experience indicates that the closest facility is not necessarily the most qualified. When a family affected by Alzheimer’s is comfortable and confident with the quality and focus of the specialized care unit or program, geographical location becomes secondary to knowing that their loved-one is receiving knowledgeable, compassionate care from experienced staff on a 24 hours basis.

Whatever your stage in this decision-making process, taking the time to tour facilities and compare them thoughtfully based upon the above considerations is a good way to gain confidence in your decision. If your presence makes anyone in the facility nervous, cross it off your list. It is important to select the facility that best fits the needs for care, comfort and dignity of a loved-one affected by Alzheimer’s disease or a related form of dementia.

For more information:

Go to the Senior Health health topic.