While many seniors with early-stage dementia can live independently or with some help, those with greater cognitive decline may need assistance from trained professionals in memory care communities. However, dementia symptoms can vary day to day or moment to moment, so it may be difficult to know when your loved one requires that extra help. If your relative is experiencing confusion or disorientation that may affect their physical safety, or if they’ve had significant changes in behavior, those are some signs it’s time for memory care.
If you’ve recognized changes in your loved one’s behavior or think they may no longer be safe living alone, consider that memory care might be needed. Schedule an appointment to discuss options with your loved one and their doctor.
Doctors evaluate signs of dementia using several tools, and can help your family determine if memory care may be the best fit. “When talking about memory care, or some form of a different living arrangement, I’ll center the talk around ability to perform activities of daily living and safety,” says Dr. Philip Branshaw, an internal medicine specialist in Batavia, Illinois.
The decision about when it’s time for memory care varies from family to family. So, in addition to consulting with your loved one’s doctor, monitor their behavior and caregiving situation. You can use the 13 questions below to guide your decision.
senior seems lost or agitated, or if they can’t carry on a conversation, those are concerning signs.
“Looking at someone, you can sometimes see they’re not as tidily dressed, their hair’s disheveled, or they’ve lost significant weight because they forgot to eat,” Branshaw says.
From there, doctors may ask questions about a senior’s day-to-day life or perform a brief mental status exam.
“Often, seniors come in for regularly scheduled physical appointments and are hesitant to bring up memory problems,” Branshaw says. “It’s almost always the kids who bring up memory, or it’s an uncovering process to find dementia signs.”
The ability to perform activities of daily living (ADLs) — such as dressing, bathing, and using the restroom — is a common benchmark to judge whether a senior needs extra help. A dementia patient who struggles to complete daily tasks likely needs 24-hour care.
To gauge a senior’s abilities and safety, a doctor may ask if they:
If any of these red flags are present, your loved one’s doctor may suggest a mental status exam.
Bringing up safety concerns is an important way to make family members aware of dementia behaviors, Branshaw says. He may ask relatives or caregivers these questions:
A person with dementia should stop living alone if they’re experiencing injuries, wandering outside the home, or otherwise putting themselves in dangerous situations. Ask yourself whether your senior family member’s safety needs are being met and if extra assistance will keep them safe.
Additionally, you may consider the legal effects of letting a family member with dementia live by themselves. While it’s not illegal to leave dementia patients alone, it depends on the severity of their symptoms. Most states have laws requiring doctors and lawyers to report mistreatment of seniors. This could include neglect of a senior’s needs, which is a form of elder abuse.
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“In the office, we can perform a very easy, reproducible test that only takes a couple of minutes,” Branshaw says.
If the patient can read, the mental status exam may give a reliable baseline for tracking dementia symptoms and memory loss. This exercise measures short-term recall, concentration, and spatial awareness, and it may test a senior’s ability to:
Another common test is to ask someone to draw a clock, Branshaw says.
“Many people with dementia will draw all of the numbers up in one corner, rather than around the circle,” Branshaw says.
Most of the time, aging adults will visit their primary care doctor or geriatrician, who will perform these baseline tests. After that, they may refer the patient to a neurologist or other specialist for further analysis and a specific diagnosis.
“Family caregivers should reach out to a doctor right away when they start to notice signs of dementia,” Branshaw says. “That way, we can get a baseline exam done, and we can track test results over time to see if memory loss is getting worse.”
At first, a senior may score well on memory tests and only have minor impairment, like forgetting difficult words or where they left their glasses. But it’s never too early to bring up these concerns. By discussing dementia early, you give your elderly parent or relative the opportunity to be a part of senior living conversations.
“It’s better to have the conversation with the patient now, when they can feel some autonomy and take part in the decision of what happens next,” Branshaw says. “It’s helpful, physically and medically, for the senior to be a part of the decision and the transition.”
Talking with a doctor during early-stage dementia can also help with tough conversations. Professionals may be better equipped to broach topics like driving safety, home modifications, or the transition to senior living.
Worrying behavior changes, safety concerns, and caregiver burnout are top signs it’s time for a memory care facility. Ask yourself these questions to help assess your family’s situation.
“Adult kids or family caregivers often don’t notice something and think their parent is OK,” Branshaw says.
This is because when you’re caring for someone with dementia full time, it can be hard to notice progressive changes, like steady weight loss over several months. This change could be shocking and obvious to a family member or friend who only see the person a few times a year.
Seniors with dementia may experience confusion and tension leading to violence or aggression. They may kick, hit, or bite caregivers. Verbal abuse and manipulation are also common: Aging relatives may insult family members and friends or accuse them of theft.
“Often, patients will get agitated or defensive in the office when we start to have the conversation about dementia — that’s a sign in itself,” Branshaw says.
Aggression can be particularly dangerous when a senior with dementia is cared for by an elderly spouse. Agitation and violence are most common later in the day, due to sundown syndrome.
Someone struggling with dementia may begin to decline social invitations and withdraw. Lower energy levels are a normal part of aging. However, avoiding favorite activities is a red flag. Similarly, someone who was once confident could become nervous to drive, opting to go on walks alone.
A senior who took pride in their appearance may forget daily hygiene practices, like bathing or changing clothes. They may also struggle to style their hair or apply makeup and become too embarrassed to ask for help. In severe cases, people with dementia may develop elderly incontinence or neglect to clean themselves after using the bathroom.
Wandering is a common sign it’s time for a memory care facility. Seniors could become confused or disoriented and wander far from home without realizing it. This can lead to dangerous situations like walking on busy roads or getting caught in severe weather.
At home, well-placed locks and alarms may be necessary to prevent wandering. Memory care communities often have unique layouts and outdoor spaces to permit safe, secure wandering.
Someone aging in place with dementia may begin to hoard household items or neglect laundry and cleaning. They could eat spoiled food or forget to clean up pet waste. Alzheimer’s safety risks at home may include trip hazards, fall risks, kitchen appliances, guns, or household chemicals. Dementia care at home often requires significant safety modifications.
Forgetting to take prescription medication — or taking too much of it — can lead to serious side effects. Reminders, alerts, and pill separators may be effective for seniors with early-stage dementia, but people with significant cognitive decline need more intervention. Medication management is an important feature of memory care.
Seniors with dementia may require special diet plans to combat existing health conditions. Adults aging in place may forget to eat, or they may overeat after forgetting they’ve recently had a meal, leading to significant weight changes.
Balancing your loved one’s needs with your own is vital. It’s normal for dementia caregivers to feel frustrated or overwhelmed sometimes. But if left unaddressed, those feelings can lead to caregiver burnout and negative consequences for the caregiver and their loved one.
If your immediate answer is that nothing is going well, or you have to really think about it, it’s time to seek help when caring for someone with dementia.
If you can’t think of anything positive about your loved one, you may be burned out. Too much time together can lead caregivers to focus on the negatives. Take the space and time to consider your relationship with your loved one and recharge.
Caregiver burnout can have serious consequences, physically and emotionally. If your own mental or physical health is declining, consider the effect caregiving has taken on your life: Are you feeling depressed or anxious, or are the physical elements of caring for a loved one becoming painful? Remember, declining health can put both you and your loved one at risk.
Signs of dementia anger may lead to physical, sexual, or emotional aggression. It can be hard to accept that your loved one might threaten your safety. However, remember that these severe behavioral changes are common. Monitor violent behaviors, especially if you’re a sandwich generation caregiver with children in the home.
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Aggression and agitation are among the most common reasons for a dementia crisis. It’s important to develop a plan if your loved one’s dementia behaviors are suddenly no longer manageable at home.
An in-patient geriatric psychiatry unit is one option as an emergency placement for dementia patients.These facilities commonly treat seniors with dementia by offering medication management, therapies, and other treatment options. Additionally, they can help you develop a plan for returning your loved one home or finding them a care facility.
Dementia hotlines are another helpful source of information. Typically, organizations staff hotlines with professionals or trained workers who can offer guidance.
Generally, a senior with dementia should go into a care home if you’re struggling to meet their needs and your mental and physical health as a caregiver are at risk. Importantly, the safety of your loved one should be a key factor in deciding whether it’s time for memory care.
If you’ve determined your loved one needs additional care, ask their doctor about next steps following a dementia diagnosis. You can also ask about signs that it’s time for memory care.
Memory care communities can provide the support needed for your loved one to age in a safe, stimulating environment where their medical and emotional needs are met.
If your family decides in-home care or memory care is the best option, A Place for Mom’s Senior Living Advisors can tailor a list of options in your area and schedule tours. Plus, they can help plan the logistics of a move.
Branshaw, P. (2020, October 29). Personal communication [Personal interview].
National Institute on Aging at National Institute of Health. (2020, July 29). Elder Abuse.
Backhouse, T., Camino, J. & Mioshi, E. (2018, February 6). What do we know about behavioral crises in dementia? A systematic review. Journal of Alzheimer’s Disease.
Marsh, C. The who, what, and why of acute geropsychiatry inpatient care. Alzheimer’s Association.
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