Determining When Memory Care Is Necessary

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Learn about the signs indicating it may be time for memory care, such as changes in memory, behavior and daily functioning, and understand the benefits of specialized memory care facilities.

When Memory Care Is Necessary

Say your aging mom, who’s living with dementia, has always been conscientious about opening her mail and paying her bills. You and other family members check on her regularly to see if she’s OK. Yet, over time, you notice she’s letting her mail accumulate unopened and forgetting to make her payments, or she’s paying the same bill multiple times. Or, what if she’s always cooked for herself, but lately she’s been unable to prepare meals?

There may come a time when a person living with Alzheimer’s disease, or another form of dementia, will need more care than can be provided at home. During the middle to late stages of Alzheimer’s, it becomes necessary to provide 24-hour supervision to keep them safe. In some cases, more specialized care is needed or individuals may need to move out of their home.

Overall, more than 6 million people in the U.S. have Alzheimer’s, which is the most common form of dementia, according to the Alzheimer’s Association. More than 11 million family members care for someone with dementia, and others live in assisted living communities, nursing homes or memory care units.

“When choosing a residential or long-term care setting for someone with Alzheimer’s or another dementia, it is really important to do your homework and understand the different levels of care these settings provide,” says Monica Moreno, senior director of care and support at the Alzheimer’s Association. “Assisted living facilities offer support for the person but do not provide full-time medical care. Nursing homes provide medical care but may not offer specialized dementia care. Knowing the levels of care these different facilities provide can help families make the best choice.”

People with dementia who exhibit certain behavioral changes that affect their day-to-day living may benefit from living in memory care units. These units provide specialized care from health care professionals trained to work with such patients, says Dr. Ardeshir Hashmi, section chief for the Center for Geriatric Medicine at Cleveland Clinic. Memory care units are residential facilities that provide additional training to staff members to care for individuals with memory loss.

Warning Signs That Someone Needs Memory Care
Here are six behaviors or circumstances that can indicate someone may need to move into residential memory care:
• Changes in behavior.
• Confusion and disorientation that imperils physical safety.
• A decline in physical health.
• A caregiver’s deterioration or death.
• Incontinence.
• Failed electronic and phone communications.

Changes in behavior
Some people with dementia may start acting in dramatically different ways. Consult with a medical provider to determine if these behavioral changes, such as difficulty concentrating or forgetting to cook meals, are appropriate for memory care, or if they are more severe (like difficulty speaking or swallowing) and require a higher level of care.

“Someone very independent may start to suddenly be apprehensive about driving, decline social invitations and become withdrawn,” says Dr. Elaine Healy, vice president of medical affairs and medical director of United Hebrew of New Rochelle in New York. “Someone meticulous about their appearance may suddenly forget daily hygiene or how to do basic tasks like bathing and hair styling, and (they) are too embarrassed to ask (for help).”

A person may also become more anxious or agitated. Agitation “is a behavioral syndrome characterized by increased, often undirected motor activity, restlessness, aggressiveness and emotional distress,” according to research published in the journal Frontiers in Neurology in 2021.

According to several observations, such agitation occurs in 30% to 50% of individuals with Alzheimer’s disease and, to a lesser extent, in people with other forms of dementia, researchers wrote. This type of behavior can be precipitated by time of day, low-lighted environments, hospitalization, admission to a nursing residence or changes in pharmacological regimens, according to the study.

Confusion and disorientation that imperils physical safety
Dementia can cause confusion and disorientation, which can lead to accidents. For example, someone with dementia could forget the rules of the road and run through a traffic light when driving. It’s also common for people with dementia to become confused and wander away from their homes, which can also put their safety at risk.

“Someone with dementia symptoms may forget where they’ve walked and end up somewhere they don’t recognize,” Healy says. “When your loved ones are putting their physical safety at risk, it’s time to consider memory care.”

A decline in physical health
“Changes in appearance and grooming are often the first noticeable differences when someone has dementia or Alzheimer’s,” Healy says. If someone becomes thin or frail, it may mean they are forgetting to shop for groceries or they may be forgetting to cook and forgoing eating.

Memory care is an appropriate level of care when a decline in physical health is not related to another chronic disease outside of Alzheimer’s disease or dementia. If health is wavering due to conditions like diabetes, heart failure or consistent infections, then it’s worth pursuing a higher level of care, like a skilled nursing facility.

A caregiver’s deterioration or death
Some people with dementia are cared for by relatives, often a spouse or significant other. When the caregiver dies or their health falters, that often means the spouse or significant other who is being cared for needs a higher level of attention, like memory care, says Dr. Rhonna Shatz, the Bob and Sandy Heimann Chair in Alzheimer’s Disease Research and Education at the University of Cincinnati’s College of Medicine. She is also the director of the college’s Brain Health Clinic.

Shatz says she had a patient with Alzheimer’s whose health seemed to be faltering rapidly. He’d lost weight and was increasingly confused. Shatz investigated and learned that this man’s wife had also developed dementia and was unable to shop and cook for him or make sure her husband took his medications. A daughter then arranged for the couple to move from their home into memory care.

Caregivers can handle a lot, but if incontinence gets to the point that adult undergarments are ineffective, it may be time to look for memory care, says Dr. Clifford Segil, a neurologist at Providence Saint John’s Health Center in Santa Monica, California.

This is because bladder or bowel incontinence can lead to potentially serious, and even fatal, infections. For example, a urinary tract infection can ascend and become a kidney infection or cause blood infections, he says. Such infections can also cause bacteremia or septicemia, which often causes septic shock. Bacteremia is the presence of bacteria in the bloodstream, and septicemia is also a bloodstream infection.

Bacterial infections that ascend into the blood and kidneys are often the product of neglect and poor care, Segil says. Patients in memory care units receive a level of care to help prevent small and easily-treated infections from progressing into life-threatening sicknesses. The higher level of attention provided in memory care could help prevent such infections.

Failed electronic and phone communications
If your loved one starts sending texts, emails or leaving voice messages that don’t make any sense, that may be a sign that it’s time for memory care, Segil says. You might read texts multiple times or listen to a voicemail more than once but still not figure out what your loved one is trying to communicate.

“When you contact them to ask them what they were trying to say, they’re unable to because they’ve forgotten,” adds Segil.

Should My Loved One Live in Memory Care?
When considering whether it’s time for a loved one to move into residential memory care, here are some questions to consider:
• Is it safe for the person to continue living in his or her current environment?
• Is the person’s behavior likely to cause harm to others?
• What does this person want, need and say about their situation?
• What do medical professionals and other family members suggest?
• Are there resources and support systems that can help the person to continue to age in place, or is a move necessary to provide care and protection?

If you’re worried that a loved one may need memory care, you can ask for a diagnosis from a primary care doctor, a geriatrician, a geriatric psychiatrist or a neurologist.