When to Move From Assisted Living to Memory Care: 5 Signs

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

While it may be a stressful choice, you may be considering getting ready to move a loved one from assisted living to memory care. Your loved one may have made friends in assisted living and is familiar with the staff and routine, and sadly, they may not understand why they have to move.

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Moving to memory care can also mean acknowledging the fact that your family member is declining. The idea of placing your loved one into an environment with other impaired people can be distressing. Some families prefer to wait as long as possible before making a move.

If your loved one is in assisted living with memory care attached, the transition may be easier. If, however, you have to choose another memory care community, it may take more time. Finding care for aging adults can be overwhelming if you have lots of places to choose from. 

Main Differences Between Assisted Living and Memory Care

Although different from assisted living in some significant ways, memory care is often housed in assisted living communities. The reason for this is primarily financial in that senior living companies want to take advantage of and provide a range of senior living options for families. There are advantages to this arrangement. It is easier to move from assisted living to memory care in the same building, or in the case of a Continuing Care Retirement Community, moving within the same location. There are other differences as well. 

  • Memory Care communities have dedicated staff to that particular unit. Presumably, staff who work in memory care are trained to help people with memory and behavioral problems. Also, the regular, consistent staff is comforting to loved ones with dementia. They become familiar with and close to the caretakers who see them each day.
  • Memory Care units are typically smaller than assisted living. In newer communities, there might be an emphasis on a less confusing design by color-coding hallways or having clearly accessible common rooms. 
  • Many people with dementia can feel confined and claustrophobic in memory care since the unit is locked. Outdoor patio or garden space helps to alleviate this problem. 
  • Residents in memory care may exhibit disturbing and unusual behaviors such as crying, shouting, striking out, and trying to leave through the locked door. These behaviors are highly unlikely in assisted living, and if noticed, they are usually a sign it might be time to suggest memory care.
  • More intensive care is standard in memory care with additional nursing services and 24-hour supervision. Assisted living will vary in terms of the level of nursing and overnight support. The assumption in assisted living is that residents, although needing some help, have varying degrees of independence and freedom.
  • In assisted living, residents are invited to attend activities but given the freedom to decline and decide for themselves what they want to participate in. There is a concerted effort to keep residents from isolating too much in memory care, so they will be encouraged to attend as many activities as possible.

What to Consider Before Moving a Loved One to Memory Care

Considering whether to move a loved one to memory care is fraught with doubt, guilt, and worry. The best, most caring approach is to think things through and then plan everything to the smallest detail. Despite all of your efforts, things might go awry, but try and be flexible and keep a calm demeanor. Some things to consider and plan for are the following.

  • Are there any alternatives or additional support that could keep your loved one in assisted living? Consulting with your loved one’s physician about the progression of dementia might help you decide. There is always the chance that a move will worsen your loved one’s condition- something you want to avoid. Talk with others about the possibility of delaying a move to memory care for as long as feasible. 
  • Have you factored in the additional cost of memory care and any other expenses associated with the care of your loved one? Many families augment the care provided by memory care staff with private caregiving. 
  • Moving is incredibly disruptive for anyone, but for someone with dementia, it can be overwhelming and distressing. There are steps you can take to minimize the disruption caused by a move. 
    • You might find it helpful to plan the move well in advance. Packing belongings with your loved one present could be emotionally upsetting. Most moving companies will pack all belongings on moving day. This service is well worth consideration.
    • On the day of the move, take your loved one away for several hours. Go to the park, to a friend or relative’s house until everything has been moved—station someone else in the new room to unpack and place personal items and hang pictures. Walking into an inviting and organized space is far better than being in a chaotic atmosphere with unpacked boxes.
    • Plan on staying for a meal with your loved one in memory care so they don’t feel abandon.

Signs You May Be Ready to Move a Loved One to Memory Care

In most cases, a gradual decline in mental and or physical function leads to a move to memory care. That’s why it can be so hard to know when the right time is. In the end, safety is the deciding factor in making a move. If assisted living staff are unable to keep your loved one safe, it might be time for memory care. These are some of the common signs to watch for.

1. Wandering

Many assisted living communities are open for residents to come and go as they please. Although many residents don’t have cars, the front doors are usually open during daytime hours. Most assisted living communities require residents to sign in and out when they leave.

If someone wanders out the front door without knowing exactly where they are going and not informing anyone, this could present a safety hazard. There are lots of stories of assisted living residents leaving the premises during dangerous weather, with some resulting in the death of a resident

Why did this happen? Because these residents were in assisted or independent care where they were free to leave. Memory care communities are locked and require a special code to access and exit, making “escape” much less likely.

2. Confusion and disorientation

At first glance, you may wonder why confusion and disorientation may be signs requiring a move to memory care. If someone is so confused and disoriented that they need assistance with getting to meals, or taking care of hygiene, there may not be enough staff to accommodate those needs. 

The ratio of staff to residents tends to be higher in memory care. In addition to sheer numbers, staff in memory care are trained to provide hands-on care and cueing to confused or disoriented residents. Helping people to meals or assisting with hygiene needs is routine in memory care.  Memory care staff help confused and disoriented residents by redirecting and repeated orientation to place and time. 

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3. Inappropriate behavior

Unfortunately, inappropriate behavior can be a symptom of dementia. Inappropriate behavior includes sexual acting out, aggressiveness towards other residents or staff, and self-harming behavior.

If these behaviors are not controlled in assisted living, it may be time for memory care. Although it is not always the case, most memory care communities are smaller than assisted living communities. Smaller facilities allow for greater supervision and monitoring of residents. More immediate action is taken to redirect and minimize inappropriate or disruptive behavior.

4. Social isolation

For someone with dementia, depression, or other mental health problems, increasing social isolation is common. The reasons for this are complex, but someone may not feel comfortable in social situations that require organized conversation and participation. Other residents might notice that your loved one has memory problems or is constantly repeating themselves. Unfortunately, it is all too common for other people to shun residents who have these problems.

In memory care, activities are designed to accommodate people with cognitive impairment. They may be more concrete and time-limited. Residents are encouraged to come out of their rooms even if they don’t want to participate in organized activities. For some, this means only observing or one to one tasks with a staff member like folding laundry or creating a memory box.

5. The assisted living community requires it

You might be shocked to get a call from the assisted living director, informing you that your family member needs to move to memory care. You may assume that they seem to be doing fine. It is well within an assisted living community’s right to recommend a move. But before leaping to a decision, find out what the real issues are. Depending on the situation, you might be able to solve the problem without a move. Here are some suggested solutions to problems.

  • Your loved one needs more help with hygiene and dressing
    • Solution: Hire caregivers to take some of the stress away from assisted living staff. If cost is a concern, talk to your family about taking shifts to help with some of these tasks.
  • Social isolation 
    • Solution: Hire caregivers to accompany your loved one to activities or on outings. Discuss as a family visiting more often. Activities directors may be willing to offer one-on-one attention to people who are anxious about participation. 
  • Inappropriate behaviors
    • Solution: Talk to your family member’s doctor about possible medications that could bring relief. In some cases, inappropriate behavior is a sign of distress or pain. Do what you can to identify the causes of the behavior.
  • Wandering
    • Solution: GPS systems are becoming more sophisticated all of the time. Some will allow programming of a pre-set boundary that will notify the caregiver if the wearer goes outside that boundary.

It can’t hurt to negotiate additional time to try some interventions. Most assisted living directors welcome family involvement and will be open to suggestions. Assisted living staff often don’t have the time to identify and resolve specific problems. You can help with that.

Frequently Asked Questions: Moving From Assisted Living to Memory Care

Having uncertainty about moving a loved one from assisted living to memory care is reasonable and expected. Moving your loved one from assisted living to memory care is unlikely to be appreciated or understood. Your loved one could become angry, resentful, and resistant.

Remember that their cognition is disturbed, so rational thought may not be possible. Sometimes it is better to take an emotionally supportive approach rather than one that tries to explain the reasons.

What’s the main difference between assisted living and memory care?

The main difference between assisted living and memory care lies in safety features and programming. Most memory care facilities are locked and secure. Assisted living communities allow people the freedom to leave the building when they want.

Both memory care and assisted living offer all meals, transportation, activities, medication management, and housekeeping. Both also sometimes offer in house physician services. Many assisted living communities allow residents the flexibility to schedule meal times. Memory care meal times are scheduled at the same time every day to reinforce structure and routine.

The higher staff-to-resident ratio in memory care allows staff to monitor residents more easily. Innovative changes in memory care design seek to accommodate people who like to wander by giving them circular pathways, as people with dementia often are frustrated by dead-end hallways.

Other design elements include pictures and artifacts in hallways for residents to stop, look, and interact with. The focus of these design features is to ultimately reduce any agitation or anxious feelings.

Memory care recreational activities focus on music, art, and smaller groups. Many residents feel less anxious in smaller, more contained groups. One-on-one activities are not unusual if a resident needs that.

Staff in memory care are also specifically trained to deal with people who have dementia. They understand the unique behaviors and needs of memory care residents. 

How long do you usually stay in a memory care unit?

People can stay in memory care until the end of life unless their nursing needs exceed what staff can accommodate. It is not unusual for people to be on hospice in memory care.

The length of stay in memory care until death depends on several factors. If your loved one has multiple medical issues including dementia, their stay may not be as long as someone who is physically healthier. According to the Alzheimer’s Association, the average length of time someone lives after diagnosis is four to eight years, but people can live up to even 20 years with Alzheimer’s.

How do you talk to a parent or another aging loved one about moving to memory care?

This can be one of the hardest conversations to have. The loss of memory and reasoning makes it very difficult for your loved one to understand why they need to move. They might get very agitated and angry by the suggestion.

The best approach is to stay calm and explain in simple terms why this change needs to happen. Be careful not to use derogatory or condescending language. Explain clearly to your loved one that they need more care, and this is the best option to get that care.

Visiting memory care with your loved one can help. It might take several visits, but connecting with staff and becoming more familiar with the environment might make the transition easier.

Once the move is made, give your loved one plenty of time to adjust. Things might be rocky at first, but hang in there and let the situation settle in its own time.

Moving from Assisted Living to Memory Care

A move from assisted living to memory care can be difficult, but necessary. Even with the steps we have listed, you could be unsure about such a move. It is normal to want to wait until the last minute to decide. A supportive, caring, and loving approach will help your loved one make the transition.

If you're looking for more help with long-term care planning, read our guides to the best alternatives to assisted living and our moving to assisted living checklist.


Sources

  1. Michel, Lou. “After Wandering Senior Nearly Froze to Death, Amherst is Fined $1000.” The Buffalo News, 23 June 2020, buffalonews.com
  2. Burling, Stacey. “His Elderly Mother Wandered Out Into The Snow and Died: Whose Fault Was it?” The Philadelphia Enquirer, 9 February 2018, inquirer.com
  3. “Stages of Alzheimer’s.” The Alzheimer’s Association, alz.org
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