memory care unit placement from a geriatric care manager’s perspective

                                                                                           By Dawn Elledge, RN-CCM Geriatric Care Mgr.

All MCU’s (Memory Care Units) are not all alike, nor are the MCD’s (Memory Care Directors) who are supposed to manage them. And perspective is everything! Depending on what perspective you have, makes a difference in what your own assessment of a good memory care unit should, would and could possibly be. Typically, a memory care unit is a secured or locked unit in a long-term care facility that houses persons with memory impairment or who suffer cognitive impairment. Especially, those individuals who may deemed at risk for certain behaviors requiring 24/7 monitoring. Risk of elopement or poor self-care decision making skills along with memory decline are most evident in these residents.

While a prospective “move-in” family with an aging loved one looking for memory care placement may have certain opinions about a particular memory care unit, the perspectiveof the loved one to be placed, is on another level entirely. It’s never easy when a family faces having to choose where to go when mom or dad can’t. Then there is peer perspective-reviews of local memory care units, and that is where I enter in, writing this to you today. If you or someone you know is actively looking, or will be on the lookout for a great long term care community with a memory care unit, then read on…

For many families, the decision on where and when “to place or not to place” is money driven. That’s a fact. For others, it’s not a money matter as much as it is a matter of sanity for the family who is unprepared for caring for someone who is not only unable to care for themselves but is calling out for help as they slowly fade into a mysterious place with faces unrecognizable, while defending themselves in whatever mental capacity they are experiencing. And I coach caregivers regularly in regard to this; what a confused person thinks is real-is, in fact. To them. Talk about perspective. That’s why when it comes time “to place” someone somewhere, we must think in terms of what is the actual and the potential perspective of the person we love and join them in their journey. So, lets.

What to look for from any perspective in regard to a quality care environment for a loved one suffering cognitive decline hinges on the loved one’s function, interaction, and symptom management in any case. Let’s examine these three important memory care placement factors more closely:

1. Function

Lighting

Cleanliness

Orderliness

Décor

Restful

Stations

Warmth

Sensorium

Supports

Tools

Safety

Care-level

2. Interaction

Music

Children

Plants

Animals

Safety

Activities

Organized

Planned

Structured

Setting

Routine

Rounded

Ratio

Engaging

Supportive

Lighthearted

Easy

Friendly

Integration

Supervision

3. Symptom-Management Expected

Results

Sufficient

Gentle

Firm

Confident

Experienced

Diversion

Triggers

Removal

Assessments

Evaluations

Patterns

Staffing

Education

Monitoring

Reporting

Supportive

Positive

Approaches

As you look at these one words, I use in my work, as a sort of backboard or template, if you will when I enter in a memory care unit, I hope you can see the meaning behind each word. If not, let me help. Let’s look at one or two of the one word’s in each category to help find more meaning for each word used. Starting with 1. Function. It’s vital that you try to see a loved one’s functional capacity within a prospective new environment. As you begin to “visualize” your loved one there, think of their happiness and safety and well being in terms of daily living which includes all of the different kinds of activities throughout each day. And never assume! Go with “what you do know.” What you know about your loved one will make a difference in choosing the right place to be. Try to think in terms of “lighting” as a key safety feature as it relates to how someone with Alzheimer’s or impaired aging will also suffer visual impairments, visual disturbances and visual (or sensory) loss. Research indicates that not only peripheral vision is disturbed in persons with Alzheimer’s disease, but depth perception is one of the leading causes of persons with moderate to severe dementia accidentally falling. “Stations” refers to the areas in the unit that are conducive to “triggering” long term memory in persons with short term memory loss. In some memory care units, there may be a “hardware” station that has lightweight and safe tools or work benches to remind someone of the work they know. This is visually comforting. Likewise, some units may have a lady’s “boutique” with jewelry, vintage clothing, shoes and other beauty apparel that delights the long-term memory receptors in the brain. 

Moving along to 2. Interaction, it is imperative to see routine activities being implemented in the unit. These activities should also be posted on a large wall so that family members can readily see and plan to participate on any given day as they so choose. There have been cases in the past where I have judged how well a memory care director is doing based solely on her activity board. If the activity board is displayed in bright, bold colors with eye-catching seasonal embellishment, or it is obvious that the board itself took more than an hour to prepare and put up, that tells me so much already about the unit. In this case I am speaking of, the MCD (memory unit director) was also so proud to give me a colorful copy of all of the routine daily activities happening in the unit before I was ushered into a room of happy demented persons all singing songs they knew. It was one of the happiest times in my work as I recall. (Happy tears!) You may notice that some of the one word in this category such as “plants,” or “children,” refer to what is known as the “Eden Alternative.” 

“About the Eden Alternative®

The Eden Alternative® is an international, non-profit 501(c)3 organization dedicated to creating quality of life for Elders and their care partners, wherever they may live. Through education, consultation, and outreach, we offer person-directed principles and practices that support the unique needs of different living environments, ranging from the nursing home to the neighborhood street.” 2016 The Eden Alternative. Find out more at: https://www.edenalt.org/

With 3. Symptom management is a category that every family member must be profoundly serious about when approaching a new environment for their loved one. It is very possible that a loved one’s defensive posturing or negative “triggers” are engaged when moving or transitioning into a brand-new environment. In some cases, a loved one improves vastly as they no longer sense they have to put on a show of defending dignity to loved ones. This is readily seen when caregivers enter the caregiving picture and a parent tells them everything they ask as well as laugh and tell stories, and when a family member shows up, they revert to a defensive posture and become easily indifferent or even hostile. One must understand that such behaviors are a deep and psychologically rooted phenomena in reference to a loved one suffering cognitive decline who defends what they think they are experiencing with others who cross the dignity barrier. This sort of detail is exceedingly difficult to try and sort out, so the best thing to do is assess what is working and what is not. In other words, will a parent do better with someone else? Sometimes this has to be trial and error influenced to see wat works best for each family. “Triggers” are important to “monitor” and “report” if at all possible. I suppose one of the saddest things to see in a memory care unit is a loved one who stands at the entrance begging to go home. Often times, the same person in a unit will display this sad gesture repeatedly. Often times I will grade a unit base don this alone, just as I have the activity board. Along with a gut feeling about the unit as a whole, of course. I tell families to plan on visiting each place (outside of the pandemic) and see the activities, watch behaviors, and observe how the staff intervenes with poor social behaviors. Look, listen, and sense what’s going on in there before you place a loved one in a place you may think you know. Or do you?

                                                          Dawn Elledge is a passionate Board-Certified RN-CCM-GCM

                                                          You may e-mail Dawn to: delledge23@gmail.com

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