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My 94-year-old dad has advanced Alzheimer’s. After my mom passed away, we kept him at home and had different people caring for him through the day and night. But we had to move him due to the house not being conducive for a walker in too many trip hazards. He also became more combative when anyone tried to get him to do something he didn’t want to do. He has been living in an assisted living facility for almost 9 months. He fell a few times at night in the beginning, so we have hired a private person to stay with him overnights when the staff does not check on him that often. He is in continent now and uses depends. He is now at the point where he wants to just sit and sleep in his recliner and very seldom get up to use the bathroom, even with help and go to dinner. He now uses adult Depends and gets aggressive at times when they try to get him up to go change him so the staff does not force him to do anything, and he may sit in his recliner in a wet depends for many hours at a time. We have been fortunate that he doesn’t have any sores. We kids are very involved, and at least one of us goes by every day and spend a few hours with him, usually at a mealtime when they are just bringing his food in to the room and setting it on a TV tray when he refuses to go to the dining room. We help him eat. He’s not verbal but does interact through different sounds and expressions. We are lucky if they can get him to allow them to give him take a shower at least once a week. But we still we can enjoy him and laugh with him, and he seems to be happy.


My question is, with his declining abilities. I’m thinking they will soon want us to move him into a true memory care facility. They haven’t said anything yet, but I’m thinking a memory care may have more staff to check on him, be more equipped on handling him and keep him from sitting in wet depends for so long. Does a memory care force the resident to get up so they can change him and shower him, even if they are combative? Do they use more medication to pretty much drug them, so they are more acceptable? What have you guys seen in the difference between a memory care and assisted living? Up to now we have really liked the assisted living facility. I just think dad is going to need more care soon. And then I’m wondering if we are still going to need to keep the private person overnight in the memory care Because dad likes to get up and walk around and we’re afraid he will fall? Or do they keep a better eye on the residents? What has your experience been between assisted living and memory care? Thank you so much.

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I can tell you from a long experience working in caregiving that the only real differences that memory care offers and assisted living doesn't is a locked door and memory care costs a lot more.

The residents don't normally get any better care then they do in AL. They definitely use more drugs in memory care because it's often necessary when dementia worsens and someone gets more violent, aggressive, and combative.

If you've never been to a memory care (formerly known as a dementia unit) be prepared for the experience.

For starters memory care facilities, wings, units, whatever they're calling them are going to smell. I have never seen one that didn't stink of pee, crap, soiled bedding/clothing, and unwashed people.
They're usually very dingy looking if not downright dirty even when they are located within a rehab, nursing, or AL facility and the other areas are very clean and well maintained. The memory care parts usually aren't.

The residents in memory care usually smell and look like their hygiene isn't kept up on as well as it should be because it isn't. They also don't offer the level of baby-sitting services you may be expecting for people with dementia either. Residents wander into each others' rooms. They take each other's belongings. It is not uncommon for a resident to be wearing clothes that aren't theirs too.
Be prepared for what you will see and know that this is what memory care is.
If you have to place your father in one, keep that aide you hire privately for him.
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ventingisback Jul 2023
Great advice!
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My 90 year old mom with mid/late stage Alzheimer’s has been in MC for just over a year and it’s been a very positive experience. We kept her home as long as we could but eventually she needed more care than we could give. I’ve read some dreadful responses here and I’m sad that people have seen such horrible conditions in certain MC facilities (i know it exists) but it’s not fair to generalize. Our MC is extremely attentive, they toilet mom every two hours and check on her every hour through the night. There are activities happening all day and many of the residents participate and engage. There’s chair yoga, sing-alongs, arts and crafts, history lessons, etc. (The list goes on)… I have been very impressed, overall. I visit everyday and see it for myself. There are some amazing MC facilities out there; it’s just a matter of finding the right one. They’re not all terrible.
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salina95 Jul 2023
This is my same experience with my mom in memory care. I always stop by unannounced and I’m quite pleased with the facility. Yesterday they were meditating, it was very peaceful. Other times, they’re playing a game, singing, learning, therapy dog visits, guest musicians.
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My father passed away before needing memory care but I had toured a few and for people living in the SF Bay Area I can say I was very impressed by the memory care facility Carefield in Pleasanton CA. It was very spacious and bright with a large protected patio area for residents. The entire building was built in a circle so all the hallways led back to the large central gathering area so residents could never get lost. The food looked very good and the chef made fresh bread a few times a week. There seemed to be a good staff to resident ratio and the rooms did not look like institutional rooms. They looked like someone’s bedroom and bathroom at home or a nice hotel room. I toured a few others that were a hard pass right away so this one really stood out.
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I am amazed that an ALF will keep your Dad now that his needs are so advanced. Generally such a resident takes so much caregiver time from others who are more suited to ALF, and is disturbing for them to witness. I would imagine your Dad has also risen to a level 4+ care needs and there is a lot of expense, perhaps as much as memory care.

Doe his current ALF have a wing that is for MC patients? If not, then I can see why they are "hanging on to dad". But if they do have a facility for MC I would guess you are close to their asking you about this advancement.

You are so correct that they are much better staffed in MC for your Dad. He may also qualify for Hospice care help and that is a help to the facility.

I am so sorry you are at the place for these decisions. I wish you the very best of luck.
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Prayers to you, Dad & your family..A tough stage in The Circle of Life, exacerbated by this disease.

My Mom was in MC 3+ years, passed in 2021..A lot of experience here. Bottomline, I would move your Dad to MC, keep your private duty nurse, bring Hospice in & put a camera in the room..The more “hands-on-deck,” the better..

Mom’s facility was very clean, but always short-staffed, under-paid. The good aides almost always started in MC, then moved to AL side..So frustrating!

Lmk if you want me to expound..You/family are doing great with your Dad. He feels your care & presence. ❤️😇🙏🏻
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My father moved through independent living to assisted living to memory care in the same facility. I never noticed a smell in memory care but maybe there was odor in the rooms of the few bedbound residents. The cost was a bit more in memory care than in assisted living. There was a large man who was sometimes combative for awhile. The staff often had two people working with him to get him to move from one activity to another. I would suggest visiting all the memory care facilities close to your home. Have lunch with the residents if possible, You will get a feel for the staff.
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You are thinking about it in the right way. Memory care facilities have skilled staff who know how to care for and interact with residents that have all stages of dementia and declining abilities. They check in more often during the night and they know how to help with toileting, bathing and dressing, taking medications, also feeding. Some of them have male aides and nurses. They have a 24/7 nurse(s). The nurse can order equipment as needed. For example, when my mother had advanced dementia they got her a hospital bed with bars so she wouldn't get out of bed on her own (she also lost strength in her legs and kept falling). They also ordered her a safe and comfortable reclining chair (called a geri chair). They'd help transfer her from bed to wheel chair when she could no longer walk. Some men prefer to have male aides. It's still a good idea for the family to visit as much as possible. If it's more than they can handle (for example, if he is a big, heavy man) they may have to transfer him to a nursing facility, where they have equipment to lift people out of bed. But this should be a last resort. Try to keep him in memory care if they can handle it. All the best to your father and family.
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I got off the elevator at the wrong floor of my mom's assisted living and it was the memory care floor. It was nice and bright and had beautiful views of the grounds. No smells, quiet, smiling aides. Also I often saw patients from that floor out with aides, strolling the building or going in and out. I was impressed. This was in Florida. It was run by Brookdale.
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My wife and I moved to an ALF because of her dementia. One year later she developed incontinence and needed to be moved to MC … we live in San Francisco and our facility has both AL & MC in the same building. Both are bright, clean, with wonderful caregivers. Lots more help in MC than in AL. Lots of activities in both. Cost is roughly comparable in both. I still live in AL and see my wife whenever. I haven’t seen, heard, or smelled any of the things others have posted. Guess we've been very lucky!
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ElizabethAR37 Jul 2023
Yes, from what I read/hear, I think you have had good luck on your side. In addition, you probably have the financial resources for a top-of-the-line facility. I suppose there are good and not-so-good facilities at every price point, but yours sounds exceptionally well run.
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" Memory Care" is skilled care 24/7.
" ALF" Assisted Living Facility, has different level of care expectations defined; in other words , the patient is cognitively appropriate and can perform ADL needs etc.
Talk with the facility and they can give you the " level of care needs' description for each level of care. You may also want to go ahead and have the patient 's PCP provide an updated assessment of pt care needs so that you can be pro active instead of waiting for the facility to make the call. And, of course, start being prepared for the increased cost associated with " Memory Care" vs "ALF".

Practice good self care !
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