Different residents need different approaches for dementia care.


Picking a facility for dementia care shouldn't be trial and error

  • September 1, 2014 - 2:00 PM

Doing your homework before deciding on a care facility for a loved one will make things easier for both of you.

It took three tries before Leslie Reid-Green found a suitable nursing home for her 88-year-old mother, Bella Solomon, who has advanced dementia.

The first home her mother moved into “was dreary and gray, in an old hospital,” Reid-Green said. “The staff wasn’t very nice; my mother hated it, and it was far from where I live.”

The second home was “a newer and much nicer facility, though still more like a hospital than a home.” But the staff was unable to deal with her mother’s aggressive behavior.

After multiple hospitalizations and 18 months on a waiting list, a spot became available at a facility closer to Reid-Green’s home in New Jersey. Despite costing significantly less, it offered “a homier atmosphere, an attentive and pleasant staff and a more serene environment,” she said.

“The take-home message: More expensive is not necessarily better,” she said.

Her experience and similar ones reported by other families emphasize the importance of thorough footwork well in advance of the need to place a loved one in a nursing home.

(While the term “nursing home” has a specific meaning within the industry and for Medicaid, it typically is used by the public as a generic reference for several forms of senior housing that offer varying levels of care options, not all of which technically qualify as nursing homes.)

Nearly half of the residents in nursing homes are there because their dementia, primarily Alzheimer’s disease, has reached a point where caring for them at home has become unsustainable. They may wander from home, not knowing how to return or even who they are, or awaken many times a night, causing mayhem and exhausting their caregivers. Falls, fires, poisonings, self-injuries and physical aggression often are ever-present dangers.

It’s not a sign of weakness to move a loved one with advancing dementia to a nursing home, counselors insist. But it isn’t easy to find a place that offers the services and environment that the patient needs.

Study the programs

Simply having a specialized dementia unit is not enough: The quality and extent of services may vary widely.

“There are different levels of dementia, and people with it have different needs,” said Joanna Leefer, author of “Almost Like Home,” a guide to choosing a nursing home.

She recommends looking for a place with different levels of care. As dementia progresses, a resident’s needs will change. The facility must be able to adapt to those changes.

Different residents need different approaches, too. Some people with dementia benefit from stimulation, but overstimulation, such as a noisy environment, can make others agitated and aggressive.

She lists six crucial questions to ask when assessing a nursing home for someone with dementia:

• Is the dementia unit large enough that the resident will not feel confined?

• Does it offer activities appropriate for the person’s intellectual abilities?

• Is the environment positive — colorful, but not too stimulating or confusing?

• Are there music and singing? “Many residents with advanced dementia still sing or play musical instruments, even if they can no longer express themselves in other ways,” Leefer said.

• Is the staff trained to handle patients with dementia and Alzheimer’s? How does the staff deal with patients who act out?

• Are residents kept clean and well dressed, and are they treated with the same respect as those in other parts of the facility?

The Alzheimer’s Association offers a checklist for finding a nursing home at The list describes desirable characteristics of the building and its environment, including the facility’s services, room designs, meal arrangements and recreational activities.

But no matter how good a facility might be, experts say that continued family support and involvement are critical to ensuring good patient care. Plan to spend several hours with the patient on the day of admission, when anger, hurt and acting out are likely. Visit often on different days and times, and get to know the staff.

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