How To Choose a Memory Care Community

If you have a loved one who has been diagnosed with Alzheimer's disease or dementia, you may be considering looking into a memory care facility. There are thousands of memory care communities across the United States, and you're likely to have a choice of several within your own hometown.

Finding the right community for your loved one takes a bit of research and legwork. Of course, you want to make the right choice. While your loved one's physician or your friends may have suggestions, don't rush your decision.

You can start with online research, but you'll quickly realize that you need to see the various memory care facilities and communities available to make a wise decision. After all, you wouldn't buy a home based on a few photos online.

The following will help you to evaluate memory care communities, along with a comprehensive list of questions to ask as you do your research and make your initial memory care assessment .

Planning your tour of memory care communities

Start with your online research to narrow down your options and make a short list of communities to visit. You should plan on visiting at least three memory care communities, and you may want to take a look at several more.

Once you visit your first memory care community, you'll see immediately how important it is to go in person. Your visits will give you a peek into what it would be like for your loved one to live in the right memory care community. Change and transitions are very hard for people with dementia. Making sure the community is a good fit for your senior is very important. Visiting memory care communities and asking detailed questions can minimize the possibility that you might have to move your loved one to a new place later.

Should you bring your loved one on a tour of the memory care community? That probably depends on the stage of dementia and their fear of transition. If you sense that touring multiple memory care communities would be confusing or frightening to them, you may want to conduct your in-person research on your own.

When should you visit?

The vibe of a memory care community can vary greatly depending on the staff member and when you visit.

• Morning: Residents will most likely be the most active and engaged in various social activities.
• Afternoon: Visiting during lunchtime will offer you insight into the types of food being served and how residents are treated and cared for during meal times. You may also observe more social activities during this time.
• Evening: Prioritize the morning or afternoon hours for your tour. However, since older adults with dementia have disturbed sleeping cycles, consider asking for a follow-up nighttime visit to witness how incidents of wakefulness are handled.

What to look for on your tour

Each memory care community is unique, and you'll get a feeling for the personality of each place as you visit. Some key characteristics to look out for are: 

• Cleanliness of the facility (and rooms, if room tours are provided)
• Overall satisfaction of the residents and staff
• Staff’s ability to answer questions easily 
• Physical and cognitive engagement programming

Questions to ask at memory care communities

As you tour prospective memory care communities, feel free to ask as many questions as you can think of on your tour. You may want to print off a list of questions or carry a list on your phone so you don't forget something important.

Here are some valuable questions to get you started:

What medical staff are available?

Are nurses on duty 24/7? If not, what medical staff are on duty during nighttime hours and weekends? Does the community have visiting physicians? How often do they visit? What other types of medical staff are regularly involved with the community (nurse practitioners, podiatrists, physical therapists, etc.)? How are the medical staff trained? Do they receive ongoing training? Do they receive specific training on dealing with residents with Alzheimer's disease and dementia? What is the policy for handling medical emergencies? What onsite medical services are provided? What types of other care services can your community NOT provide?

What is the nursing staff composition and rotation? 

At some time in our lives, we're all likely to experience the important role that nurses and nursing staff play in patient health. For patients with memory care issues like dementia or Alzheimer's, this role is even more crucial.  

In fact, the role that skilled nursing and staff plays in providing palliative care and spotting changes in health status is critical for a patient's well-being. While touring, make sure to spend time talking to and understanding the credentials of the nursing staff.

What happens if a resident becomes physically aggressive?

Sometimes, Alzheimer's and dementia residents who have always been gentle and calm become unexpectedly aggressive, hostile, or disruptive. When you ask this question, think about it from both sides of the issue. If it's your loved one who becomes aggressive, what steps will the memory care community take to calm them down? Will psychotropic drugs be used? Will their freedom to move about the community be restricted? And think about the issue from the other point of view as well. If other memory care residents become physically aggressive, what steps are taken to protect your loved one?

How is the facility secured?

At times residents may wander or lose sight of where they are. Some question to think about is doing the facility have the doors locked in case your loved one wander. Is the building standalone, or is it attached to another assisted living facility? Are there outside grounds that your loved one can visit safely?

What specialized care is offered?

Some memory care communities offer therapy and treatment for specific types of memory loss, such as vascular dementia. They may offer treatment or accommodations for people with other disabling diseases or conditions, such as Parkinson's disease or blindness. If your loved one requires any such specialized care, make sure you ask specific questions about it. You can also ask what level of personal assistance can your loved one expect. Does the facility accommodate special care needs, such as diabetic care, mobility issues, physical aggressiveness, or wandering?

How are mealtimes handled?

Food is a great source of enjoyment and comfort for just about everyone, so of course, it makes a difference for those in a memory care community. Take a look at menus to see if your loved one will be happy with the food served. Can residents eat whenever and wherever they want, or must they come together in a dining hall at specified times? How frequently is the menu changed? Are there options at each meal, or does everyone eat the same thing? What accommodations are made for special diets (kosher, gluten-free, vegetarian, etc.?) What accommodations are made if a resident refuses to eat? What if a resident wants to eat outside standard mealtimes?

Can residents personalize their own accommodations?

Familiarity makes a big difference in the happiness of dementia residents, so find out what lengths you can go to in making your loved one feel comfortable. Can they bring in their own furniture? Hang pictures on the walls? Use their own linens? Are they allowed to bring in a pet? If so, what restrictions are there on the size of the pet (and is there an extra charge?

What amenities are provided in the accommodations?

Do residents have private bathrooms, or do they have to share bathrooms with the same staff members other residents? Are there TVs in every room, and is cable or satellite service provided? Is there an emergency response system provided in each room?

What exercise programs are available?

AARP has outlined the benefits that exercise offers for patients with memory care diagnoses. While exercise regimens may look different in a memory care community - for example, dancing, chair-based programs, or even working with a ball - you'll want to look for the daily programs that support the movement.

How are memory care patients kept engaged?

Daily engagement is one of the most important pieces of programming that a memory care community can provide. This 2021 study illustrates that while building cognitive reserve (CR) is important to prevent Alzheimer's and dementia,  supporting CR is equally important to slow the progression of the disease.

While on your tour, look for activities like painting, coloring, working with puzzles, or listening to music, as the depth and breadth of this programming will be a litmus test for the quality of care.

Can residents leave the community?

Will you be allowed to take your loved one out for the afternoon if you choose? What's involved in arranging for such a visit? Is transportation available for medical appointments? Does anyone from the community accompany residents or family members on these appointments? Are residents ever taken out of the community for other reasons, such as a slow walk around the neighborhood?

Are individualized care plans created for each resident?

The Alzheimer's Association has put together a comprehensive guide to help families understand the stages of Alzheimer's, and the care plan developed for each resident should strongly correspond with the unique stage and experience of each resident.

If the memory care staff doesn't give you an unequivocal answer, maybe it's time to move on to look at other communities. Once you hear the "Yes," don't drop the subject. Ask who puts together this plan. Are physicians involved? Nutritionists? Therapists? 

Can my loved ones stay here through the end of life, or do they have to move if their care becomes too extensive?

If something should happen to your loved one, you need to make sure what the facility is able to do for them. You might also want to find out what the discharge policy is and if your loved one can return to the facility should they require outside rehab. Another good question is what happens if your loved one is no longer ambulatory? Also, can a resident go into hospice in your facility? 

How does the memory care community communicate with the family?

Will the memory care community provide you with regular reports (oral or written) on your loved one? Will you have a single contact person who keeps you apprised of your loved one? Will the dementia care community contact you in case of an emergency? What types of emergencies?

What's the community's philosophy of care?

This may sound a bit abstract, but each memory care community's philosophy of care underlies every decision made affecting your loved one. If the philosophy of memory care unit stresses kindness and encouragement, you'll see it reflected in the attitudes and actions of the staff. If the philosophy of care is focused on schedules and checklists, you'll see a different set of behaviors from staff. Take a look at the written philosophy of care and ask questions to see if the community is living up to its ideals.

How does the community support cultural diversity?

Does the memory care community celebrate a variety of holidays and events? Will the community be able to cook and provide cultural foods for your loved one? Maintaining a sense of familiarity, such as practices and beliefs associated with cultural identity, will help your loved one adjust to -and feel more comfortable in- their new home at a memory care facility.  To learn more about cultural competence in memory care communities, The Crisis Prevention Institute provides an overview of the advantages of personalized care for patients and cultural competence training for staff. 

If you decide to tour assisted living facilities, you can find more questions to ask here. Keep adding to your list and keep track of the answers you receive on your tour.

Evaluating what you saw on your tour

Once you're home from your tours of memory care communities, you have a lot to think about. Try to pick up some printed materials while you're there to help keep different communities straight in your mind.

Pick up floor plans, brochures, and activity calendars to make it easy to remember what you saw in each community. In addition, taking photos as your tour can help you evaluate your experience.

Asking the right questions and considering the answers and your own observations carefully can help you make a wise decision when deciding for your loved one.