When Is It Time to Move From Assisted Living to Memory Care?

Merritt Whitley
By Merritt WhitleyFebruary 3, 2021
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For four years, Sally Berlin’s mom, Joan, thrived in her assisted living community near Chicago. “We got close to the residents and staff,” Sally says. “It was my home away from home almost.”

But as Joan developed dementia and her symptoms worsened, it became clear she needed a new home. Prone to wandering, Joan went missing for four hours one night. Staff at Joan’s assisted living community told Sally her mother needed to go to a secure memory care unit. The call was heartbreaking. “My brother and I were so upset,” says Sally.

Fast forward several months, and Sally’s glad her mom moved to memory care. “There are secure outdoor areas if she wants to go outside and there are more activities for her,” says Sally. “They had activities at assisted living, but she wasn’t really able to participate.”

The right time to move from assisted living to memory care varies from family to family. Fortunately, the decision-making process and transition is usually collaborative, says Niki Gewirtz, a Senior Living Advisor for A Place for Mom and a former executive director at a community with memory care and assisted living. “If a community is actively managing a person’s care and communicating with families, there shouldn’t be any surprises.”

Learn more about the top dementia signs that may mean your loved one needs specialized care in a memory care community, who to talk to, best questions to ask, and ways to prepare.

What signs indicate it’s time for memory care?

When someone begins exhibiting dementia behaviors that compromise their safety, as well as the safety of others, it’s usually in their best interest to move to memory care, says Gewirtz.

Examples of concerning behaviors may include:

“When the signs of dementia really become an issue is when a person is getting lost frequently in the community,” says Gewirtz. “For example, if a person is riding up and down on the elevator because they’re not sure where to get off, or if they’re pacing the hallways, or accidentally going into other residents’ rooms, these are major red flags.”

Poor hygiene is another sign someone needs additional help, according to Rachel Levy, national account manager at A Place for Mom. If someone isn’t brushing their teeth, or is wearing mismatched or inappropriate clothes, it reveals that they’re having cognitive difficulties that may put them in danger.

Often, staff notice more subtle signs of dementia before families do. This is because families often prefer to think of their loved ones as they were. “You can’t underestimate the role of caregivers in a community,” says Levy. “This includes the housekeepers, servers, and bus drivers, because they see residents frequently and probably notice changes faster than anybody, including whether they’re eating their meals, socializing, or doing anything out of character.”

If you or staff notice dementia signs are becoming more frequent, concerning, or dangerous, it’s time to have a conversation about memory care.

Who decides if my loved one needs to transition from assisted living to memory care?

Changing a person’s living arrangements and care is typically a decision made by the community staff, doctor, and power of attorney, or legal decision-maker for the senior who needs care.

A community may try other supportive measures before deciding to transition a resident from assisted living to memory care. However, depending on the urgency of the situation, sometimes the transition happens quickly. Documentation is often required.

“In Colorado, for example, the health department really wants to look at whether or not a person needs a secured environment,” says Gewirtz. “Because a secured environment is more restrictive, there has to be a lot of documentation indicating a person is exit-seeking. You don’t want to put someone in a secured environment unless they can really benefit from it.”

Colorado also requires a doctor to sign a secured environment form in order for a move to take place. This document must state that other less-restrictive environments have been tried and failed. In general, a community must provide documentation to prove that a transition from assisted living to memory care is the most effective way to ensure safety and care.

If you’re uncertain whether your loved one needs memory care, an evaluation by a neurologist or geriatric care manager, also called aging life care specialist, can be helpful, says Levy. These professionals can provide professional and unbiased advice.

Ask these questions when talking to staff at your loved one’s community about a potential move to memory care:

  • What would prohibit my loved one from staying in assisted living?
  • What qualifies a person for memory care?
  • How do staff assist with the transition from assisted living to memory care?
  • What costs are involved in this transition?
  • How do staff communicate with families about health changes?

What documents and evaluations are required for my loved one to move?

Once a resident moves into a community, they’ll sign a residency agreement. This document is similar to a lease on an apartment, says Levy. It outlines the move-in process, how payments work, and discusses how families may be notified if more care is ever needed and costs change. It’s common for staff to walk families through all of this information one-on-one to help clarify and answer questions.

After a resident moves in, community staff perform a 30-day evaluation, says Gewirtz. The community is responsible for managing and monitoring a resident’s behavior, habits, and care.

Based on this assessment, staff can determine a resident’s needs and how to best manage them. After the initial evaluation, communities continue to have weekly care planning meetings to evaluate each resident’s needs and any potential changes to care. Community nurses will talk to the doctor to understand if there are any changes in health or medications that need to be addressed.

For some, this may mean transitioning from assisted living to memory care. If staff and medical professionals determine that the care needs of a resident have changed and may be better met in memory care, they’ll meet with family to address concerns and explore options.

If memory care is required, the family will be asked to sign an addendum to the original residency agreement confirming the transition from assisted living to memory care. Although the decision to move a resident with dementia typically happens as a person’s cognitive health worsens over time, this is not always the case. “Sometimes the community will have to make a decision fast because a resident is not safe where they’re currently living,” says Levy.

How can memory care improve the life of a senior with memory loss?

Memory care facilities provide personalized care for people with dementia to help reduce confusion and enhance quality of life.

“I’ve seen many residents who weren’t thriving in assisted living, but when they moved into memory care, it’s almost like you could see relief,” says Levy. “They fit in better, and can do more for themselves because the environment is more soothing and a better match.”

One major difference between assisted living and memory care is the staff-to-resident ratio. More staff are available day and night for more one-on-one support and direction. Staff members also have specialized dementia care training, which allows them to better communicate with residents and prevent challenging dementia responses.

Memory care facilities feature an abundance of protective and specialized features. For example, memory care communities incorporate a custom building design which includes:

  • Flowing floor plans to redirect wandering residents
  • Color-coded walls to assist with easier navigation
  • Enhanced safety features, like secured or alarmed doors

Meals and memory care activitiesare carefully planned out as well. For seniors with memory loss, mealtime can be particularly challenging, adds Levy. A person with dementia may not function well in a large dining area with lots of stimuli. Memory care communities may provide smaller, quieter environments, as well as specialized plates and devices to help make mealtime easier.

Dementia activities are specifically designed to comfort and stimulate people with dementia. These include pet therapy, reminiscence activities, aromatherapy, and more.

At Joan’s new memory care community, they play music every morning, says Sally. Music therapy, a common memory care activity, has been shown to improve cognition, lower stress, and improve the moods of people with dementia. “My brother recently had a conversation with my mom, and that hasn’t happened for a long while,” says Sally.

Additional safety benefits of memory care include:

  • 24/7 supervised care
  • Keypad entrances for staff and family
  • Emergency call systems
  • Clearly defined shared spaces

Making a decision: What resources are available for my family?

It can be helpful to tour a variety of communities to learn what kind of support is offered to families directly or locally. Some memory care communities may have in-person or virtual support groups, while others may bring in public speakers to provide ongoing education.

Additional memory care considerations to think about when touring or making a decision should include evaluating safety features, activities, staff experience, and more. Be sure to reference our 50 essential questions to ask when touring a memory care community.

“It’s important for families to come to a unanimous decision about their loved one’s care,” says Gewirtz. “At the end of the day, you need to prioritize your loved one’s safety. Memory care can cost more, but if it means that someone can receive the care, safety, and oversight they need — it’s necessary. And with the help of staff, the transition should be natural.”

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Merritt Whitley
Merritt Whitley

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