About Memory Care
Memory care is a great option for senior loved ones who have been diagnosed with disorders such as dementia or Alzheimer's disease. Memory care services are similar to those that are available in standard nursing homes, but they also provide availability to a nursing staff that specializes in memory disorders, and who can provide individuals with the care that they need to live comfortably despite their disease. These facilities benefit from additional security to help ensure the safety of residents and to prevent them from wandering or otherwise harming themselves.
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More About Memory and Alzheimer's Care
Memory care is a great option for senior loved ones diagnosed with disorders such as dementia or Alzheimer's disease. Memory care facilities are similar to nursing homes, but they also provide nursing staff that specialize in memory disorders. An additional benefit is more robust security to keep residents from wandering or otherwise harming themselves.
What is Memory Care?
Memory care, sometimes called dementia care or Alzheimer's care, is offered in state-licensed assisted living residences or in nursing homes, often housed in a special wing with additional security, cueing devices, and other special services. Memory care units ensure that staff is trained to monitor residents and prevent them from becoming disoriented and wandering off the premises. Like other long-term care, typical memory care services include:
- A private or semi-private room
- Assistance with activities of daily living
- Social, leisure, exercise and religious activities
- 24-hour staff and security
- Laundry and housekeeping
- Dining and meal preparation
- Medication reminders
- Transportation to doctor's visits or social activities
In addition, many of the communities with memory care services offer cognitive therapies and programs meant to keep the brain active and engaged. These facilities are designed to accommodate older adults with progressive cognitive disorders. Although memory care is often located in a separate unit of a larger facility, specialized social and therapeutic programming ensures that residents are kept engaged and happy. Here are some examples:
- Snoezelen Rooms - Created by Dutch psychologists in the 1970s, these are controlled environments that residents will find relaxing, safe and stress-free. They are often designed with soothing colors, relaxing sounds, aromatherapy, and comfortable chairs and blankets.
- Music and Memory - These are personalized playlists using iPods that enable residents with Alzheimer's, dementia and other cognitive and physical challenges to reconnect with the world through music-triggered memories.
- Companion Pets - These are designed to bring comfort, companionship and fun to elder loved ones. They have realistic fur and pet-like sounds as well as sensors that respond to petting and hugs with familiar pet-like actions.
Memory Care vs. Assisted Living
Assisted living facilities are residences offering personal assistance and hospitality services to seniors who are still able to live independently. Memory care, on the other hand, is a distinct form of long-term skilled nursing that specifically caters to patients with Alzheimer's disease, dementia and other types of memory problems. While assisted living communities may be able to offer care to people with early to moderate dementia, they are usually not equipped to care for people in the advanced stages.
Memory Care vs. Nursing Home
Nursing homes provide extended senior care, meals, and medical assistance to those who cannot live independently and perform daily living activities like bathing due to disabling medical issues, or other physical or mental conditions that require continuous supervision. Many nursing homes have a specific wing dedicated to residents who have late stage dementia or Alzheimer's. If your loved one has a cognitive impairment as well as other medical issues, a nursing home can handle all these needs, as they have skilled nurses on staff.
Memory Care vs. Adult Day Care
For those needing memory care, adult day care provides a chance to be social and to participate in staffed activities such as art, leisure, support and exercise programs. Some centers even offer therapy and basic health services. Like memory care in a nursing home or an assisted living facility, day care can provide a nice daily break from 24-7 family caregiving. As with all senior care facilities, not all adult day care centers cater to those with dementia, so it is important to research. Adult day care may be paid for completely or in part by Medicaid, long-term care insurance, out-of-pocket or via Veterans benefits. In contrast, Medicare does not typically pay for adult day care services.
Types of Memory Care Facilities
Memory Care Units Inside Larger Facility
If you anticipate your loved one may need memory care services in the future, but he or she does not yet require that level of care, you might consider looking for a facility that offers assisted living, skilled nursing, and memory care options. Residents can move from one section of the facility to another as their needs arise. Also, the wait time is likely to be shorter if your loved one is already a resident at the facility.
Dedicated Memory Care
There are also smaller facilities completely dedicated to providing memory care. These provide a more personalized approach to care with a higher caregiver-to-resident ratio. Smaller facilities may feel less overwhelming to your senior loved one, especially if this is his/her first time moving away from their own residence. They are also more affordable overall but may not have as robust security systems as a larger facility.
Adult/Foster Care Homes
If you're seeking a homier environment, an adult/foster care home might be an option. These typically have just a handful of residents, which provides excellent one-on-one care, but may not have all the amenities and security of a larger facility.
How to Determine When It Is Time for Memory Care
It can be easy to notice the symptoms of memory loss and dementia, but the choice to seek help from a memory care facility can be a sensitive topic between families and elders. It is a choice that is essential for the well-being of the loved one and for the safety of others. If several of these situations apply to your loved one, then it may be time to consider a memory care facility:
- Forgotten, misplaced or incorrect dose of medications or supplements
- Forgotten alarm or gate codes, or forgetting to lock doors at home - being susceptible to crime
- Getting lost on a familiar route such as a nearby walk or while running usual errands
- Declining in daily care activities such as bathing, meals, grooming or chores
- Important information is forgotten such as phone numbers, addresses, bank passwords or other account security information
- Appliances like a stove or oven have been left on, or running water is left on
- Personality changes like mistrusting others, confusion, anger, withdrawal or depression
- Care for the loved one is becoming too involved and interfering with other important responsibilities that the family members have
Just a few of the situations above can be enough to spark the process of looking at memory care centers and deciding whether a nursing home, adult daycare or assisted living option has the right amenities for the loved one. Not all facilities offer memory care, so it is important to keep in mind when exploring these options.
How Much Does Memory Care Cost?
Being one of the most expensive health conditions experienced later in life, most individuals pay for memory care via Medicare, Medicaid and out-of-pocket, among other methods. According to a report released in March 2017 by the Alzheimer's Association, despite support from Medicare, Medicaid and other sources of financial assistance, individuals with Alzheimer's or other dementias still incur very high out-of-pocket costs.
The annual average per person out-of-pocket costs for Alzheimer's and other dementias are almost five times higher than average per-person payments for seniors without the need for memory care ($10,315 versus $2,232 per year). The total costs including out-of-pocket and other sources of pay is equal to approximately $341,840 for the total cost of care for an individual living with dementia or Alzheimer's in 2018.
How to Pay for Memory Care
Medicare covers inpatient hospital care, some of the doctors' fees, some prescriptions and other medical needs for people with Alzheimer's or dementia who are age 65 or older. Medicare will pay for up to 100 days of skilled nursing home care in conjunction with memory care under limited circumstances. There are Medicare Special Needs Plans (SNPs) available for individuals with dementia, including Alzheimer's disease. SNPs are Medicare Advantage plans that specialize in care and coverage for those with dementia. To learn more information about these services, visit Medicare SNP online.
If the individual needing memory care is eligible for Supplemental Security Income (SSI), he or she usually is eligible for Medicaid. Those not on SSI must have limited income and assets. Eligibility and benefits are determined by each state. Most people with Alzheimer's or other dementias will eventually need long-term or nursing home care. Medicaid covers all or a portion of nursing home costs, however not all nursing homes accept Medicaid. Most states have home care and community care options for people who qualify. Unlike Medicare, Medicaid has strict eligibility requirements.
Aid and Attendance Benefit for Veterans
According to the VA website, the Aid and Attendance benefit (A&A) benefit is a special benefit for war era veterans and their surviving spouses. It is a tax-free benefit designed to provide financial assistance to help cover the cost of long-term care in the home, in an assisted living facility or in a nursing home with memory care. This benefit is for those who live in a nursing home or are mentally or physically incapacitated or require the regular attendance of another person or caregiver in at least two of the daily activities of living. To learn more about the eligibility requirements and to apply for these veteran benefits visit VeteransAid.org online.
Long-term Care Insurance
Long-term care insurance is a policy that is purchased through a private insurance company. Like health insurance policies, the price varies greatly depending on age, general health and amount of coverage. Coverage could be denied for people with pre-existing conditions such as Alzheimer's disease or Parkinson's disease. Not all insurance will deny based on these conditions, so it is important to explore different insurance companies.
It's also wise to look at how your life insurance could be a source of funds for memory care. These options greatly depend on the type of life insurance policy so it's best to discuss with an insurance broker or financial advisor.
- Life Settlement - You can sell your life insurance policy to a third party for market value and use the proceeds to fund memory care services.
- Surrender Policy - You give up ownership and the death benefit. If the policy has accumulated cash, the insurance company writes you a check for the full amount of cash value, which is often taxed.
- Policy Loan - You can take a loan from your life insurance policy, which means you won't pay taxes. However, you can't take it all or the policy will lapse.
- 1035 transaction - This allows you to exchange cash value from an existing life insurance policy into a new life insurance policy with memory care insurance benefits tax-free.
Reverse Mortgage Loans
The Home Equity Conversion Mortgage (HECM) is a reverse mortgage that seniors take against their home's equity. Insured by the federal government, it is only accessible via lenders approved by the Federal Housing Administration (FHA). Once finalized, the lender makes payments in a single lump sum, monthly installments, or as a line of credit. The loan does not have to be paid back until the last borrower passes away or moves from the home for one full year. The home is usually sold, and the lender is paid back the full loan amount plus interest. If you want to use a reverse mortgage to pay for memory care, know that one of the co-borrowers must remain living in the home to qualify for a reverse mortgage loan. Once the surviving homeowner permanently moves out or passes away, the loan is due.
In situations when costs aren't covered through other means, paying via private funds is an option. Sources of private funds for memory care include retirement accounts and 401Ks, savings accounts, annuities and insurance plans (including life settlements), trusts and stock market investments. Home equity and bridge loans can also be used when transitioning to an assisted living facility or increasing to memory care services. Social Security can be an ideal solution for those who are receiving most of their care through a facility that offers memory care.
Evaluating Memory Care Facilities
As you begin to tour memory care facilities, you'll want to document information in five key areas.
- Make sure emergency and nurse call systems are working in all public and private areas. Are the call systems accessible from multiple points in their room? Ideally bedsides, bathrooms (toilet and shower) and living room areas.
- Does the facility provide a wearable safety monitoring system for your loved one, along with an identification bracelet?
- Check to see if there are security cameras throughout hallways and common areas.
- Are outside doors properly locked and attended? Do the windows have safety locks? There should be ample emergency exits with alarms. Check for locks and peepholes on resident doors.
- Check for smoke, fire and carbon monoxide alarms as well as sprinklers. Find out how often they're tested.
- Ask about emergency drills and procedures. Are there emergency plans in writing? Are there emergency supply kits? Power generators? Where do residents evacuate to and how will families be notified? How will medication and care be handled in the event of an evacuation?
- Ask how staff members are trained and their qualifications. Find out about staff turnover, as this could indicate a problem.
- Make sure there's a nurse on the premises 24/7.
- Confirm what medical care they provide. Be sure to understand whether they'll be able to continue caring for your loved one if he or she becomes bedridden or needs to use a wheelchair. What is their procedure in case of a medical emergency? Can they provide end-of-life/hospice care?
- Do they have a visiting physician? This can make life easier by eliminating the patient's need for transportation to a clinic.
- Memory care costs more than standard nursing home care partly because a higher ratio of staff to residents is needed for safety and comfort. Make sure this is adequate. Ask about the staff-to-resident ratio and whether it is different at night.
- Do they manage and administer medications and prescriptions? What steps do they take to monitor changing medical needs?
- Be sure to understand whether they'll be able to continue caring for your loved one if he or she becomes bedridden or needs to use a wheelchair. Can they provide end-of-life/hospice care?
- Find out the details about room size, whether they're private and have their own bathrooms.
- Learn about their meal plan, see if it looks appetizing and nutritious, and if they can accommodate dietary restrictions.
- Are there opportunities for seniors to get physical exercise? Memory care homes need to guard against exiting, but ideally the residents have a secure outdoor area for getting fresh air and recreation.
- What amenities and daily activities make this facility special? Structured activities led by skilled nurses and therapists can greatly improve a person's quality of life. In the best facilities each day has a full programming calendar. The facilitated activities are designed to help keep residents' minds active and lessen symptoms of decline.
- Study the fees and the contract. Make sure you understand what services are included in the monthly fee. Find out what is available for extra costs. Take the contract home to look at it thoroughly or to have an elder law attorney look at it.
- Ask if there are move-in fees and if you'll need to hire a mover.
- If you're loved one isn't ready for memory care yet, make sure they are able to move residents from assisted living to memory care when needed.
- Find out if there is a waiting list.
- Alzheimer's and related diseases develop differently for everyone, so the best care for dementia patients is personalized. Be sure to ask how they customize the care plans and continually assess the resident. How do they update you? Will you have regular meetings to discuss the effectiveness of the care plan and any changes?
- Your loved one may transition better if they have familiar belongings in their new residence. Ask if they can bring their own furniture and hang things on the wall.
- Make sure you can stay engaged with your family member. Ask if family members welcome at mealtimes and during scheduled activities. If the situation warrants, find out if a spouse who doesn't require memory care live with the resident?
- Pets are family too. If this is important, find out if pets are permitted (either to live at the facility or periodic visits.
Memory Care Regulations
Memory care facilities are not regulated nationally like nursing homes. Each state has its own laws, regulations and licensing standards. While all states require senior care facilities to be licensed, only 23 states have specific laws regulating memory care.
If you're selecting a nursing home with a memory care unit, there is oversight by the Joint Commission (which is a nonprofit organization that manages accreditation of health care organizations and programs in the United States). They've established a set of memory care requirements for accredited nursing care centers and have a certification program.
However, for all other types of long-term senior living communities, it's important to understand your state's laws for oversight and see if there are any specific laws related to memory care. The National Center for Assisted Living (NCAL) maintains a summary of all state regulations, updated each year. Be sure to review this when it comes time to decide about assisted living communities.
Additional Memory Care Resources
- Checklist for Finding the Right Memory Care Community
- Treatments for Alzheimer's
- Understanding Alzheimer's Symptoms
- Starting With Assisted Living or Memory Care- Making the Right Care Choice
- Selecting the Right Memory Care Community
- Signs it May be Time for Memory Care
- What is Alzheimer's and Memory Care