Board and Care Homes: The X Factor for Dementia Care

As a professional placement agent, I work with families who have an aging family member in need of senior care. Many of the clients I work with have memory challenges. Some have been diagnosed with dementia and some have not been formally diagnosed, but their family knows that mom or dad just can’t remember things like she or he used to and it is starting to impact their safety at home.

In these situations, I understand why families don’t force their parent’s to move into a senior living community with dementia care until something bad happens. A common reason for this is that many seniors want to age at home. However when a loved one falls and ends up in the hospital, alternative care options must be explored.  

The top priority should be a safe place to live where a parent’s 24-hour personal care will be tended to. A hospital stay, though not the desired path, often proves an easier way to convince a parent to move into housing with professional senior care. Yet, while the obvious option to seniors with dementia may be a memory care community, it isn’t the only choice available.

Depending on your loved one’s needs, a board and care home may present a better fit. Unlike most memory care communities, board and care homes tend to be smaller, have lower employee turnover rates and are, relatively, more cost-friendly. However to understand which option would best meet your needs it’s important to understand what each type of care offers and how they differ from one another.

Memory care communities

This is often the first option families consider when looking for dementia care as many people are familiar with assisted living facilities with secure memory care units. These facilities are not board and care homes. Instead, they provide resources and staff that can care for residents with various forms of dementia.

Some of these communities provide a unique approach for people with Alzheimer’s, Lewy body, vascular, or frontotemporal dementia, to name a few. For example, the use of Montessori-based activities encourages residents to get involved and take ownership in activities versus merely participating. Also, these memory care facilities provide security for those residents who have shown “exit-seeking” tendencies.

Is a memory care community right for you?

Large memory care communities provide many benefits. Still, there are some things to consider that might lead you to think of an alternative senior living option:

1. Cost – In large communities, memory care rooms are usually offered at a higher cost than assisted living rooms within the same community because of the additional services and higher level of care provided by staff members. Additionally, most communities charge a community fee. This is a one-time fee like an initiation fee at a gym. In Sacramento, these fees typically range from $2,000 to $8,000. Lastly, most communities calculate the cost of care using levels of care or a point system. This can result in a never-ending escalation of care costs as the months and years go by.
    
2. Employee Turnover –  I often hear that mom has finally bonded with her caregiver.  Then a few months later that caregiver has gone to work at another community and mom doesn’t want the new guy to give her a shower.  It’s important to find out about the staff turnover rate at any memory care community you are considering.
    
3. Caregiver to Resident Ratio – Ask yourself, “How long will it take before someone comes to help mom go to the bathroom?” In large communities, I have seen anywhere from 1 caregiver for 10 residents to 1 caregiver to 30 residents.  This can result in a long wait at times, causing mom to try to transfer herself. That is when accidents happen.
    
4. Care – Most assisted living communities have med techs who can dispense medication and caregivers who help with activities of daily living (eating, bathing, dressing, toileting  continence and transferring). Some offer additional services provided by a nurse or CNA, but all follow rules set by the state for assisted living communities and do not provide medical care unless they have a special waiver to do so.
    

The alternative: board and care homes

As an alternative to a memory care community, there are board and care homes. These are residential care homes in a suburban setting with only a handful of residents under one roof. A majority of these board and care homes cater to residents with Alzheimer’s disease or other dementia related illnesses.  However, you should always consider the following things when touring board and care homes:

1. “Exit-seeking” – Is your loved one prone to leaving the premise, running away or similar physical urge that requires more attention? Board and care homes are not equipped to handle this.
    
2. Socialization – Is your loved one anti-social or aggressive? Though this can be a natural part of aging, board and care homes are very small environments.  Residents share walls, the TV, and the dinner table. A larger senior living community is probably the better choice.
    

Why choose a board and care home?

1. Cost – In parts of the country, like Sacramento, board and care homes usually charge the same for a resident with or without alzheimer’s disease or dementia. Most board and care homes raise monthly fees at a much slower rate than their larger community counterparts giving families better confidence with their finances.
    
2. Employee turnover – Most board and care homes are owner operated, with just a few caregivers to take care of 6 residents. With one caregiver always permanent, there tends to be more employee stability than larger communities.
    
3. Caregiver to resident ratio – With most board and care homes licensed for 6 residents, and most having two caregivers during the day and 1 at night, the ratio is typically 1:3 or at worst, 1:6 which is at a minimum double the ratio in most larger communities.  For people who are at risk for falling, a smaller environment with a higher caregiver ratio means more eyeballs on your loved one.
    
4. Care – Most metropolitan areas have hundreds of board and care homes to choose from.  Their prices tend to be more reasonable. Some can provide services by acquiring a special waiver that only skilled nursing facilities can offer. This includes changing catheters or caring for someone who is a diabetic that cannot inject herself with insulin.     

One more thought about board and care homes

One thing I know for sure is that every family I work with is unique. I urge them to explore various options for their loved one before making any decision. Placing someone with a cognitive impairment is especially challenging because people with dementia don’t experience their illness the same way. Different types of dementia are manifested in different ways, at different times.

The most difficult attribute to identify in the best board and care homes is what I call “The X Factor.” This is the feeling you get when you walk in, the warmth and love that only exists in a caring environment, the smell (or lack of smell) of a comfortable home, and the positive sound of people living their best lives. This is the kind of home I would have wanted my parents to live in, and the kind of home that I try to find for my clients every day.