Someone with dementia should go into memory care if their safety is at risk and their needs are no longer being met at home by their family caregivers. Some signs it’s time for memory care may include changes in your loved one’s behavior, a decline in hygiene, or unsafe wandering. If you’re struggling to keep up with your loved one’s needs, or your own health is suffering, the right memory care facility can provide peace of mind.
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A person with dementia who struggles to complete activities of daily living (ADLs) — such as dressing, bathing, eating, and using the restroom — likely needs some assistance throughout the day. To gauge a senior’s abilities and safety, check if they’re showing the following signs:
If any of these red flags are present, your loved one’s doctor may suggest a mental status exam.
“When talking about memory care . . . I’ll center the talk around [the person’s] ability to perform their activities of daily living,” says Dr. Philip Branshaw, an internal medicine specialist in Batavia, Illinois.
Observing and evaluating your loved one’s behaviors is crucial in determining whether memory care is needed. Some behaviors are commonly associated with dementia and may worsen as dementia progresses.
“Family caregivers often don’t notice something and think their parent is OK,” Branshaw says. “It’s challenging for family members to identify whether something is a sign of dementia or normal aging.”
When you’re caring for someone with dementia full time, it can be hard to notice progressive changes, like weight loss or an increase in verbal aggression. This change could be shocking and obvious to a family member or friend who only sees the person a few times a year.
“Family members often have a tough time agreeing on when it’s time for memory care because they often see different parts of dementia,” says Maureen Bradley, a former memory care community director who now works at A Place for Mom. “One person may see Mom in the morning when she seems to be really sharp, while another may see her at night when sundown syndrome symptoms appear.”
Because of this, it’s important to take a step back and try to look at their behavior objectively. Try to identify any changes in mood, personality, or routine, and take note of anything that seems out of the ordinary.
Seniors with dementia may experience a variety of behavioral and mood changes, like confusion, forgetfulness, disorientation, or the inability to express themselves. Because of these cognitive changes, a person with dementia may feel unsafe or afraid. This can result in what caregivers may perceive as agitation, aggression, or violence towards them, even when it’s unintentional.
Individuals with dementia in a behavioral crisis might even kick, hit, or bite their caregivers if their trigger situations aren’t prevented or de-escalated. In some cases, the aggression may not be physical. However, verbal abuse, insults, and unfounded accusations can be very difficult for family caregivers to manage objectively.
“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.
You may notice changes in their personality or routine. For instance, they may begin to decline social invitations often, resulting in senior isolation. Or, they may be sleeping less due to sleep disturbances brought on by dementia. They may also seem less confident or more nervous doing daily things they’re used to, like driving or cooking. This uncertainty or anxiety may cause them to engage in their usual activities less frequently or refuse to handle certain tasks altogether.
Wandering outside of a home and getting lost is a common sign that it’s time for a memory care facility that offers security measures to minimize the associated risks. While wandering is a normal part of dementia, seniors with advanced dementia can sometimes become 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.
Memory care communities often have unique design features and outdoor spaces to permit safe, secure wandering. At home, well-placed locks and alarms may be necessary to increase a senior’s safety.
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Bringing up safety concerns is an important way to make family members aware of behaviors that could necessitate memory care, Branshaw says. Some questions to help you assess dementia safety risks at home include:
If you find multiple hazards within your loved one’s home, it can become clear that memory care is necessary.
Someone with dementia may have poor health habits like forgetting to take prescription medication — or taking too much of it. Or, they may have poor eating habits and they may forget to eat, overeat, or indulge in an unhealthy diet — leading to sudden weight loss or gain.
Mismanaged medications and a poor diet can lead to serious side effects. In early-stage dementia, reminders or pill organizers may be effective. However, people with significant cognitive decline may need more intervention. Memory care facilities can help as they offer medication management and balanced meals throughout the day to help dementia patients maintain a healthy lifestyle.
It’s vital to balance your loved one’s needs with your own, but it’s also normal for dementia caregivers to feel frustrated or overwhelmed sometimes. If caregiving is no longer going well, or if you feel like you tend to have a negative attitude toward caregiving, it may be time to seek help.
If caregiving becomes exhausting or burdensome, it could result in caregiver burnout, which is a state of exhaustion from the stress caused by caregiving. Symptoms may present physically or mentally, and they may include headaches, poor sleep, anxiety, forgetting obligations, and withdrawing from loved ones.
If burnout is left unaddressed, it can lead to negative consequences for both the caregiver and their loved one. For instance, you may feel resentful and your loved one may start to notice, which could strain your relationship.
To avoid the consequences of caregiver burnout on you and your loved one with dementia, think about respite or memory care.
Anger or aggression from an individual with dementia may place others in physical, sexual, or emotional danger. It can be hard to accept that your loved one might threaten your safety. Remember that these behavioral changes are common with advanced dementia, though the severity of aggressive symptoms varies. Some people with dementia may not exhibit violent behaviors at all.
The decision about when it’s time for memory care varies from family to family, according to Maureen Bradley, a senior support specialist at A Place for Mom with two decades in the senior living industry. She reminds us that it’s common to see families disagree on the course of action over their loved one’s care.
During patient visits, doctors look for red flags signaling progressive Alzheimer’s disease or other forms of dementia. Certain telltale characteristics can suggest that it’s time for memory care. Concerning signs include a senior getting lost or agitated often, or an inability to carry on a conversation. It’s crucial to bring these issues up with your loved one’s doctor.
“Often, seniors come in for regularly scheduled physical appointments and are hesitant to bring up memory problems,” Branshaw explains. “It’s almost always their kids who bring up memory, or it’s an uncovering process to find dementia signs.”
Doctors may ask questions about a senior’s day-to-day life or perform a brief mental status exam to help you and your loved one decide next steps.
“In the office, we can perform a very easy, reproducible test that only takes a couple of minutes,” Branshaw says.
If the patient can communicate, the mental status exam may give a reliable baseline for tracking dementia symptoms and memory loss. This exam measures a senior’s concentration, short-term recall, and spatial awareness.
Another common test is to ask someone to draw a clock, according to Branshaw.
“Many people with dementia will draw all of the numbers up in one corner, rather than around the circle,” Branshaw says.
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Because dementia presents itself uniquely in each individual, there’s no one-size-fits-all approach to deciding when a dementia patient should stop living alone. However, assessing their stage of dementia can be a good starting point when it comes to decision-making. Some people with dementia may begin to put themselves in dangerous home situations in early stages while others may be fine until they reach the middle to late stages.
To help you ultimately decide, track your loved one’s symptoms and see whether they’re safe living alone. Signs that it’s time to stop living alone vary, but may include frequent falls, wandering outside the home, or failure to follow healthy habits. Keep in mind that new symptoms may appear or existing symptoms may worsen without warning as dementia progresses. New medical conditions, stress, or difficult caregiving situations can also contribute to new symptoms.
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.[01] This could include neglect of a senior’s needs, which is a form of elder abuse.
Aggression and agitation are among the most common reasons for a dementia crisis.[02] If your loved one with dementia has always had aggressive tendencies, it’s best to think of a contingency plan ahead of time. If your loved one’s dementia behaviors become suddenly unmanageable at home, then you should consider local, emergency memory care placements.
An inpatient geriatric psychiatry unit is one type of emergency placement for people with dementia in crisis.[03] Some hospitals and long-term care facilities may also provide emergency placement in a designated dementia care unit. These types of 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 local memory care facility.
Seniors with dementia who also have serious medical conditions requiring 24-hour skilled nursing services may require nursing home care. Some of these facilities also provide a designated unit to accommodate the needs of people with dementia.
Dementia hotlines are another helpful source of information. Typically, hotlines are staffed with professionals or trained social workers who can offer guidance.
If you’ve decided your loved one needs memory care after reviewing the list of signs above, take a look at our checklist to help you find the right memory care facility.
However, keep in mind, memory care facilities aren’t the only dementia care option. You can also remain their primary caregiver while taking a break from time to time using respite memory care. Respite care offers family caregivers downtime to take care of themselves, tend to personal things, and even take vacations.
A senior with dementia can also continue living in their home and receive specialized in-home care for dementia. However, if their home environment isn’t safe, memory care facilities may be the best option. They vary in price, services, and amenities, but they all typically have built-in safety features, dementia care-trained staff, and memory-enhancing activities.
If your family decides in-home care or memory care is the best option, A Place for Mom’s Senior Living Advisors can provide a tailored list of care options in your area. Our advisors will also outline memory care costs that fit your budget. They can even help plan the logistics of a move — all at no cost to your family.
Original article by Chacour Koop
Key Takeaways
National Institute on Aging. National Institutes of Health. (2023). 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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