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When to Move From Assisted Living to Memory Care

By Merritt WhitleyMarch 31, 2022
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The right time for transitioning from assisted living to memory care varies from family to family. Some common indicators to look for in your loved one include wandering, aggression, frequent forgetfulness, poor hygiene, and difficulty socializing.

Fortunately, the decision-making process and transition are usually collaborative, says Niki Gewirtz, a former Senior Living Advisor at A Place for Mom and former executive director at a senior living community that offered both 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, the best questions to ask, and ways to prepare for the transition. Plus, read one family’s story of their loved one’s move to memory care.


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What signs indicate it’s time for memory care?

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

Signs it’s time to move from assisted living to memory care include:

  • Wandering
  • Getting lost
  • Aggression
  • Frequent forgetfulness
  • Poor hygiene
  • Difficulty socializing
  • Changed eating habits
  • Trouble participating in scheduled activities

Elopement — when a dementia patient wanders away from a safe area — is often the driving factor in moving a senior from assisted living to memory care, according to Tina Crissman, a registered nurse, certified dementia practitioner, and divisional vice president of care services at Enlivant. “This is a very need-based scenario, as safety and security are of utmost importance.”

“There are often warning signs when residents are at a higher risk of elopement,” Crissman says. These can include:

  • Packing their belongings
  • Saying they want to leave
  • Seeking exits

“The signs of dementia really become an issue when a person is getting lost frequently in the community,” Gewirtz says. “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.”

Noticing memory care needs early

To avoid safety risks, Crissman emphasizes the importance of catching memory care needs early.  “The sooner placement happens, the longer the resident can benefit from the routine environment, allowing them the opportunity for more structure and direction throughout their day.”

But subtle behavior changes can make it difficult to know when someone is on the path to requiring memory care. “The need for reminders or redirection throughout the day, or getting up mid-meal or mid-activity, are often behaviors we see but tend to normalize,” Crissman says.

Often, assisted living staff members notice subtle signs of dementia before families do. This is because families may prefer to think of their loved ones as they were before the dementia diagnosis. But if someone isn’t brushing their teeth, or is wearing mismatched or inappropriate clothing, these behaviors may reveal that they’re having cognitive difficulties that could put them in danger.

“You can’t underestimate the role of caregivers in a community,” says Rachel Levy, a national account manager at A Place for Mom. “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 your family or the staff members caring for your loved one notice dementia signs 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?

Community staff, doctors, and the senior’s legal decision maker decide when it’s best to move from assisted living to memory 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,” Gewirtz says. “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 less restrictive environments have been tried and have 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.

Legal requirements to transition from assisted living to memory care vary by state. Some states, like Colorado, are strict, while others may only require a simple cognitive test or health evaluation.

If you’re uncertain whether your loved one needs memory care, an evaluation by a neurologist or geriatric care managercan be helpful, Levy says. These professionals can provide expert, 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 members communicate with families about health changes?

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

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

After a resident moves in, community staff perform a 30-day evaluation, Gewirtz says. 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 plan meetings to evaluate each resident’s needs and determine 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, the results of this assessment may lead to a transition 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,” Levy says.

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

Memory care facilities provide personalized care for people with dementia, with the goal of helping to 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,” Levy says. “They fit in better, and they 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 members are available day and night for 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, many memory care communities incorporate custom building designs that include:

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

Dementia activities are specifically designed to comfort and stimulate people experiencing cognitive decline. These include pet therapy, reminiscence activities, aromatherapy, and more. Music therapy, a common memory care activity, has been shown to improve cognition, lower stress, and boost the moods of people with dementia.

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 the decision: Sally and Joan’s story

For four years, Sally’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 place to live. 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,” Sally says.

Fast forward several months, and Sally is glad her mom moved to memory care. “They had activities at assisted living, but she wasn’t really able to participate.” Sally explains that there’s more enrichment in Joan’s life as a result of memory care’s tailored environment. “There are secure outdoor areas if she wants to go outside and there are more activities for her.”

She also notes how Joan’s interpersonal skills and relationships improved after moving to memory care. “My brother recently had a conversation with my mom, and that hasn’t happened for a long while,” she says.

Deciding on memory care: Community features and resources

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

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.

“It’s important for families to come to a unanimous decision about their loved one’s care,” Gewirtz says. “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.”

How A Place for Mom can help

At no cost to you or your family, A Place for Mom can provide a personalized assessment for your loved one’s care based on their needs. If you have a relative in assisted living and you’re worried about their memory, speak with one of A Place for Mom’s Senior Living Advisors to see if it’s time to move them to memory care.

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal, or financial advice or to create a professional relationship between A Place for Mom and the reader. Always seek the advice of your health care provider, attorney, or financial advisor with respect to any particular matter, and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not endorse the contents of the third-party sites.

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Author
Merritt Whitley

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