Alzheimer’s disease and other dementias are brain disorders that typically progress over many years through early, middle and late stages of the disease. The Alzheimer’s Association says that on average, people live for 8 to 10 years after diagnosis, although some people with Alzheimer’s may live longer. This poses a challenge to families in terms of the personal effort, life modifications, and the costs to care for their loved one.

People with cognitive impairment (CI) of varying degrees are able to live comfortably and safely in their own homes. Some families will seek support by choosing to have their loved one with CI live in an assisted living community. A cognitively impaired resident can be able to live quite functionally and happily in an assisted living community for quite a long time. This can help a resident stay more highly functional in a more active environment with enriching opportunities for social interaction and activities, and it can help to save costs.

The decision to move from assisted living to a specialized memory care unit is not based on the simple fact of cognitive impairment. It is based on three primary factors:

1. What is the best care environment for the resident’s comfort in her own skin;
2. Does the behavior of the resident allow her to function within the community without disruption to the other residents;
3. Whether the assisted living environment is able to meet the needs of the resident within their normal model of operation.

It can be difficult to think about your loved one having to move into a specialized memory care facility, even when it is recognized as the best decision. We all want to end our days in our home, with our family and familiar things surrounding us. Sometimes that is not possible – when mom starts to wander or leave the stove on or get so anxious when alone at night that she calls at all hours.

So then, how do we choose the best place? Do we make an earlier decision for assisted living placement, or wait until later stages of the disease when specialized memory care is clearly required?

Speaking for Elm Street Assisted Living and the Lincoln Home because we know these organizations best, we care for cognitively impaired residents in our assisted living environments very nicely, and we always hope to be able to meet the care needs of our residents through the end-of-life.

At the Lincoln Home, residents will move from assisted living to Harbor View Cottage for specialized memory care, where they most often have their end-of-life care with hospice. It is rare for a resident to have to move to nursing home care.

At Elm Street, residents with progressive cognitive impairment will at some point move to a specialized memory care facility.

When choosing a memory care community, the key is to visit and ask questions, and most importantly, get a feel for the different places that are available. Most specialized memory care communities will also have an adult day care/respite program. It can be very helpful to have your loved one participate for several days to see how it goes, which also helps them (and you) transition to the new environment.

A few questions to ask are:
• What is the cost? Are you constrained by needing MaineCare, either now or in two or three years?
• What types of activities and programming occur during typical days?
• What is mom’s personality? Is she an introvert who will be intimidated by lots of choices, a large facility, and many people? Or is she an extrovert who is naturally more comfortable around lots of people?
• Will mom be able to navigate a large dining room or long corridors or a complex facility floor plan? Is the community structurally designed to be easiest for the residents?
• Will the specialized memory care facility accommodate higher degrees of physical care needs, or do residents tend to move to nursing home care?
• What is the ratio of direct care staff to residents, and is there other staff that helps with guidance and activities?
• And most importantly, what is the atmosphere? Whatever physical structure you prefer, take a discerning look at the way the staff and direct caregivers interact with the residents.

We think the key element in choosing a care facility for your loved one is to get a solid feel for the atmosphere. Are the caregivers cheerful and kind? Do they use the “Best Friends” approach? Do they pause and connect with love and kindness? Or are they harried and just getting through their shift? What do you feel as you walk into the building? It is likely that it is something akin to what your loved one will feel living there.

We all respond to the feeling vibe in a room full of people, or to a particular person who is happy or kind or angry or loud. This is especially true for people who have any kind of dementia. They are struggling to make sense of the world around them, and they do not have access to the intellectual or theoretical or conceptual anymore.

The energetic and emotional vibration and body language that others are putting out impacts them very directly, and has a constant influence upon their sense of well-being. And this is what is most important … to the greatest extent possible, we want our loved ones with cognitive impairment to experience well-being wherever it is that they are living.

Jill Wallace is the owner and director of Elm Street Assisted Living in Topsham. Steve Raymond is director of community outreach at the Lincoln Home in Newcastle, and the producer and host of the television show “Spotlight on Seniors.”