At some point, most Alzheimer's patients will spend time in a nursing home or assisted living facility. Whether, the stay is a temporary or permanent in nature, the special needs of Alzheimer's patients must be recognized and evaluated before the person is placed into a nursing home environment. There are no specific nursing home regulations in place for people with Alzheimer's and dementia.
Consequently, the burden of selecting an appropriate facility falls squarely on the shoulders of the family or close friends. The following is general 'game plan' that can be used by families of people with Alzheimer's, dementia or traumatic brain injury to aid in the selection of a temporary or permanent nursing home.
Before any change in living arrangements is contemplated, a complete physical and mental assessment of you loved one should be completed. A candid discussion of the individuals needs should be done in the presence of the family and caregivers. Try to decide what the person is really capable of an in what areas the person needs assistance. Honesty is crucial. An open and honest discussion will help with the selection of a facility, but will also help the staff at the facility a baseline get an idea of your loved one's needs.
Initial selection of a nursing home or long-term care facility for an Alzheimer's patient is no different from the selection of a nursing home for a non-Alzheimer's patient. The first step is to do some research about the facilities via friends or on the internet. I suggest the Medicare website as a starting point. You can see on-line where the facilities are located and what services they offer.
After conducting some initial fact gathering about the facilities, a visit to the facility is a must. Do not risk the safety and happiness of your loved one at a facility without physically visiting the facility. Before deciding on a facility at least two visits are in order. The first visit should be a scheduled visit to get a tour from the staff. If the initial visit passes muster, a second unannounced visit should be made. The second visit will likely be more telling than a carefully coordinately tour. Do not hesitate to talk with the staff during your visits. You can learn a lot about the facility depending on their attitude and demeanor. Unhappy staff is usually indicative of unhappy residents.
Unlike most nursing homes that care for the elderly, nursing homes that care for Alzheimer's patients and those suffering from a brain injury needs to take precaution to reduce the risk of residents harming themselves and others. Nursing homes for Alzheimer's patients should have specialized design considerations to help ensure the individual's safety and happiness. Facilities should:
- Place restrictions on in-and-out privileges for residents. Safeguards to prevent elopement and wandering --common sources of injury to Alzheimer's residents.
- Require each visitor to sign in. Mentally impaired residents are disproportionately physically and sexually abused compared with the general nursing home population.
- Bracelets and alarms. Does the facility have a tracking system or alarm for residents who have a tendency to wander? Depending on the mobility of the individual, a surveillance bracelet should be used to keep track of the person.
- The facility should have clearly marked walkways inside and outsides the facilities. The walkways should be well lit, have directional signage with diagrams as opposed to written diagrams.
- Have a circular configuration. Alzheimer's patients get particularly frustrated when encountered by dead-ends and right angles.
Staffing Is The #1 Consideration
'Does the facility regularly handle people with Alzheimer's?' This is an important question to ask, because the most important factor in your loved ones happiness and safety will be dependent on how much experience the facility has in dealing with Alzheimer's patients. Seek out a facility that focuses exclusively on Alzheimer's care or has a specialized unit for residents with Alzheimer's. If the facility houses both Alzheimer's and non-Alzheimer's patients, precautions should be in place to control both groups access to the other. Though it may seem segregationalist, depending on the level of functionality, most Alzheimer's patients should be kept together for their own safety.
Most incidents involving nursing home injury occur due to staffing problems. Don't be afraid to ask some or all of the following:
- Does the facility require / provide any specialized Alzheimer's training for the staff?
- Does the facility do backgrounds checks on all employees?
- What is the policy for alerting a family member to an incident?
- What is the policy for physical and / or drug restraints?
- What is the facilities toileting policy? Are diapers changed regularly or does the facility only change on a schedule?
- How does the facility ensure that resident's eat? Do they have staff to monitor what is and is not eaten?
- What is the resident / staff ratio? A general rule is 1:6 for staffing during the day.
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