I’m sorry you’re having to navigate this transition.

I will offer that I work with elderly clients and will just reinforce your instinct about memory care that is “built into” a larger assisted living community—-which is that in most cases (not always but more often than not), the communities that specialize in memory care only are just far superior in providing training and therefor appropriate care for the needs of residents who require a memory care unit.
In the larger assisted living communities where memory care is only part of what they do, I’ve found that caregivers float in and out of the memory care unit, are not as familiar/well-trained about the different types of dementia and various intervention and communication strategies, and may not be aware of or implement latest research when it comes to cueing or therapeutic communication or making connections and encouraging mental and physical stimulation and promoting social engagement in appropriate ways among residents. Instead, they just treat them like other assisted living residents or sometimes even grow frustrated or impatient with having to repeat instructions or information when they interact.
I would recommend touring memory care communities now without your mom there, and asking primarily about their caregivers, the ratio, what is expected of the caregivers (do they do all the events/activities in addition to caregiving or is there a special team whose focus is design and execution of dementia-appropriate engagement and activities?)
What is the morale among the staff? Do you see a lot of sitting around? Or are caregivers and other staff members actively searching for ways to be proactive and engaged with the residents?
Are large numbers of residents parked in front of the tv?
If there is a posted calendar of activities/events, are they following it when you visit? (Take note of the calendar is actually filled with meaningless repetitive daily fillers like “walking club” or “exercise” or “movie of the day” because it’s fine to have these items, but if they are just on the calendar to make it appear full, that probably mean not much is going on and that says a lot!)
Also look for the inclusion of lots of MUSIC, rhythm, and art therapy! There should be some type of music activity every day or every other day (research shows that music is essential part of brain stimulation and helps connect emotionally to our past) —and the schedule of events should be on a predictable routine in a memory care facility. Some sort of physical activity should be a routine part of the day as well. Chair yoga or seated stretching is fine…but every resident needs to be encouraged to connect and to be physically active in some way.

Also do not place your loved one in a community that neglects showers or allows residents to take all their meals in their rooms.

For memory care—the facility should be able to clearly articulate a plan to overcome objections by residents and get them to do things that are in the best interest of their health and well being, even when the resident voices otherwise. So ask the tough questions.

Communities that embrace the mission of caring for those with impaired cognition and memory decline will have a can-do “we got this” approach. When you find that one, embrace it.

OP here, this is extremely helpful. thank you so much. I have a few visits set up in the coming weeks. There are not many memory care only facilities near me (we are in central va/richmond area) but I'll be visiting a few that have small "cottage" like separate facilities for MC as well as those that have memory care units within larger facilities. Your list of questions to ask and observations to make is really helpful.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My mom fell overnight at assisted living and they didn’t find her until they went to give her meds in the morning. She’d broken her pelvis and ended up in the hospital. She’d been slipping and her assisted living place was abysmal (shiny, expensive and new, good reviews online which I found out later were staff members). I moved her stuff when she was recovering in rehab, and explained to her that her assisted living place wasn’t equipped to assist her recovery but once she was strong enough she could go back. She absolutely loves her memory care and has never mentioned the assisted living place.

Is it in the dc metro area? Which one?

And…which assisted living facility was this? (Was it in Montgomery County?)

It was Tribute at One Loudoun in Ashburn. Place is beautiful but it was awful for my mom.

If you can afford a memory care only facility—try to choose one that groups residents by severity of condition.
If you are in DMV, I know The Kensington in falls church and in Reston area I think both have memory care with two sides: one for mild to moderate and other for moderate to severe.
If you have mild dementia, it’s extraordinarily depressing to be in a unit where you have some cognitive concerns but are aware enough to be bothered by the moaning or screaming or constant crying of a more-severely affected resident (who cannot help their whining and/or screaming). And having separation like this is helpful for programming and care as well.

Two great ones on the Virginia side of DMV is Silverado and Renaissance. Very high end and super at training of entire staff!

Also, the Annandale location of Arden Courts does an exceptional job as well (even though the residents aren’t grouped by severity of condition). They have nursing staff and many members of their team that have been there for over ten years, and they seem to have very high morale! In terms of setup, the four-wing model of Arden Courts allows for a more individualized approach where residents eat in smaller dining areas and caregivers really get to know the residents in their wing very well. Also love that residents can wander and go in and out 18+ doors at any time that lead to the outside grounds but is still fully enclosed in the property. Great for exit-seekers! Some Arden Courts are better than others though and it largely depends on the work culture to dictate whether team members are actively engaged or spend hours on their phones. Just ask questions and pay attention to more than the sales pitch while on your tour!

Anonymous wrote:

Anonymous wrote:My mom fell overnight at assisted living and they didn’t find her until they went to give her meds in the morning. She’d broken her pelvis and ended up in the hospital. She’d been slipping and her assisted living place was abysmal (shiny, expensive and new, good reviews online which I found out later were staff members). I moved her stuff when she was recovering in rehab, and explained to her that her assisted living place wasn’t equipped to assist her recovery but once she was strong enough she could go back. She absolutely loves her memory care and has never mentioned the assisted living place.

Is it in the dc metro area? Which one?

And…which assisted living facility was this? (Was it in Montgomery County?)

Anonymous wrote:What prompted the love of you were in this situation?

My mom’s been noticeably declining in cognition,’language and memory. She had Alzheimer’s but it’s been fairly manageable in assisted living though recently she seems much more out of it.

Took my mom to the doctor to check for uti and they did a cognitive screen (6 question She got a 25 (anything above a 10 is cognitive decline/issues and highest/worst score is 28. She scored 15 last year.

Questions included
What year is it (2022?)
What month is it? (No idea no one know what month it is)
Count backward from 20 (she did this fine)
Say the months backward (she got lost after October)
What’s your address? (With prompting she recalled the name of her assisted living but not anything else).

I’m guessing we will be in memory care by years end but so far her assisted living hasn’t said anything (she doesn’t wander and isn’t aggressive, just confused and loses things constantly). I do not think the memory care where she is living is good so I’ll have to move her which will be very difficult for her.

I’m sorry you’re having to navigate this transition.

I will offer that I work with elderly clients and will just reinforce your instinct about memory care that is “built into” a larger assisted living community—-which is that in most cases (not always but more often than not), the communities that specialize in memory care only are just far superior in providing training and therefor appropriate care for the needs of residents who require a memory care unit.
In the larger assisted living communities where memory care is only part of what they do, I’ve found that caregivers float in and out of the memory care unit, are not as familiar/well-trained about the different types of dementia and various intervention and communication strategies, and may not be aware of or implement latest research when it comes to cueing or therapeutic communication or making connections and encouraging mental and physical stimulation and promoting social engagement in appropriate ways among residents. Instead, they just treat them like other assisted living residents or sometimes even grow frustrated or impatient with having to repeat instructions or information when they interact.
I would recommend touring memory care communities now without your mom there, and asking primarily about their caregivers, the ratio, what is expected of the caregivers (do they do all the events/activities in addition to caregiving or is there a special team whose focus is design and execution of dementia-appropriate engagement and activities?)
What is the morale among the staff? Do you see a lot of sitting around? Or are caregivers and other staff members actively searching for ways to be proactive and engaged with the residents?
Are large numbers of residents parked in front of the tv?
If there is a posted calendar of activities/events, are they following it when you visit? (Take note of the calendar is actually filled with meaningless repetitive daily fillers like “walking club” or “exercise” or “movie of the day” because it’s fine to have these items, but if they are just on the calendar to make it appear full, that probably mean not much is going on and that says a lot!)
Also look for the inclusion of lots of MUSIC, rhythm, and art therapy! There should be some type of music activity every day or every other day (research shows that music is essential part of brain stimulation and helps connect emotionally to our past) —and the schedule of events should be on a predictable routine in a memory care facility. Some sort of physical activity should be a routine part of the day as well. Chair yoga or seated stretching is fine…but every resident needs to be encouraged to connect and to be physically active in some way.

Also do not place your loved one in a community that neglects showers or allows residents to take all their meals in their rooms.

For memory care—the facility should be able to clearly articulate a plan to overcome objections by residents and get them to do things that are in the best interest of their health and well being, even when the resident voices otherwise. So ask the tough questions.

Communities that embrace the mission of caring for those with impaired cognition and memory decline will have a can-do “we got this” approach. When you find that one, embrace it.

Anonymous wrote:My mom fell overnight at assisted living and they didn’t find her until they went to give her meds in the morning. She’d broken her pelvis and ended up in the hospital. She’d been slipping and her assisted living place was abysmal (shiny, expensive and new, good reviews online which I found out later were staff members). I moved her stuff when she was recovering in rehab, and explained to her that her assisted living place wasn’t equipped to assist her recovery but once she was strong enough she could go back. She absolutely loves her memory care and has never mentioned the assisted living place.

Is it in the dc metro area? Which one?

My mom fell overnight at assisted living and they didn’t find her until they went to give her meds in the morning. She’d broken her pelvis and ended up in the hospital. She’d been slipping and her assisted living place was abysmal (shiny, expensive and new, good reviews online which I found out later were staff members). I moved her stuff when she was recovering in rehab, and explained to her that her assisted living place wasn’t equipped to assist her recovery but once she was strong enough she could go back. She absolutely loves her memory care and has never mentioned the assisted living place.

The director of nursing called and told us it was time to move. That’s basically how. I think some people can stay in assisted living indefinitely with dementia if they are quiet and well behaved, just confused. This seems preferable to me if the person can handle it. But when the person needs a secure unit, they will tell you.

My sense is unless she's a danger of elpoping or hurting herself, she can stay in assisted living for quite some time. I wouldn't be in a rush to move to memory care, and I wouldn't bring it up with the staff - they'll should let you know when they start being concerned about her there.

My mom's CCRC has regular meetings for residents and their families once someone has moved out of independent living. Does your mom's place have this?

I know that when my dad met the guidelines to be moved into memory care, the staff in AL was in no hurry to move him because they liked him and his issues weren't causing problems, at least not major ones.

He had mobility issues, so he wasn't going to making a break for it, unlike PP's mom.

My mother was in assisted living until an incident where she broke out of the facility at night and had delusions. They weren't equipped to handle that kind of behavior and said she needed to transfer to a memory care facility. I was shocked because the shift in behavior seemed sudden.

If you're questioning/concerned, you can always talk to the nurses at assisted living. I ended up having my mom move to another location within their system. She was miserable wherever she was that wasn't her home, doing exactly what she wanted, so it didn't much matter.

I accept that I might one day end up in memory care, but I’d like to spend as little time aware that I am there as possible. I wouldn’t jump the gun on this, personally.

What prompted the love of you were in this situation?

My mom’s been noticeably declining in cognition,’language and memory. She had Alzheimer’s but it’s been fairly manageable in assisted living though recently she seems much more out of it.

Took my mom to the doctor to check for uti and they did a cognitive screen (6 question She got a 25 (anything above a 10 is cognitive decline/issues and highest/worst score is 28. She scored 15 last year.

Questions included
What year is it (2022?)
What month is it? (No idea no one know what month it is)
Count backward from 20 (she did this fine)
Say the months backward (she got lost after October)
What’s your address? (With prompting she recalled the name of her assisted living but not anything else).

I’m guessing we will be in memory care by years end but so far her assisted living hasn’t said anything (she doesn’t wander and isn’t aggressive, just confused and loses things constantly). I do not think the memory care where she is living is good so I’ll have to move her which will be very difficult for her.