Home > Caregivers, Long-term care > Choosing a Dementia Care Unit

Choosing a Dementia Care Unit

Often, family members and other caregivers of persons with dementia are faced with what can be an agonizing decision.  Sometimes, as hard as you try, and as much as you want to, you just can’t provide everything that your loved one needs — either from a physical standpoint, or a cognitive one, or both.  Or, perhaps your loved one is exhibiting problem behaviors that you just aren’t equipped to deal with.  Now comes the time when you realize that the best place for your loved one is a long-term care facility, specifically one that has a unit specifically designed for those who have dementia.

These special care units have many things to offer that can enhance the physical well-being, as well as the quality of life, of a person with dementia.  Perhaps one of the most readily apparent features, to the casual visitor, is the locked door.  Often there is some kind of an alarm, as well, that will be triggered when a person attempts to leave the unit.  This feature addresses the problem of wandering, or the tendency of some persons with dementia to go off in search of some person or place from their memory, leading to a very real danger of their becoming lost.  That said, there are a number of different ways this can be accomplished, and some of them are better than others.

Other advantages to these special care units is that staff is usually given additional training in how to care for persons who have dementia, the types of group and individual activities that the residents can take part in, and the overall structure of the unit itself.  I have had the privilege to work in some units who accomplish these things exceptionally well, and have observed that those who live there exhibit a greatly enhanced quality of life.  But I have also seen units that don’t do such a good job.

When giving consideration to placing a loved one in one of these special care units, take time to learn about the unit.  Spend some time there, watching what goes on, and talking to the people who work there.  Watch how they interact with the residents, and see what kind of quality of life these residents have.  Do they look happy and fulfilled, or do they spend the bulk of their time sleeping or demonstrating undesirable behaviors?  Here are some things you can look for as you evaluate the unit.

1.  The unit should have a mission statement unique to the unit itself, and understood by everyone who works there.  For example, Our mission is to live in the residents’ world, and to hear what they are not saying.

2.  Residency in the unit should be restricted to those who have Alzheimer’s disease or another form of dementia.  Too many time, I have seen persons with psychiatric disorders placed in the special care unit, simply because of the locked door.  Often these persons are cognitively intact (or nearly so), and do not interact well with the other residents.

3.  A thorough preadmission assessment and social history should be taken, and used to develop a specialized plan of care for each resident.

4.  The unit should have physical, occupational, and speech therapists on call and able to consult with the residents and staff as needed.

5.  All staff should receive special training in how to work with persons who have dementia.

6.  Staff should be assigned to the special care unit only, instead of being rotated in and out of the general population of the facility.  Adequate staff should be on duty around the clock, and on all days of the week, with a consistent staff-to-resident ratio.

7.  In addition to the nursing staff, there should be activity staff assigned exclusively to the special care unit.

8.  There should be an outside area reserved for exclusive use by residents of the special care unit.

9.  A quality assurance committee should exist in order to recognize, evaluate, and deal with problems that may occur.

10.  There should be a network of community volunteers who regularly visit the unit to put on special music programs, bring in pets for visits, spend one-on-one time with the residents, and so on.

11.  There should be a program director who oversees the philosophy, training, and support of not only the residents, but also the staff and families.

12.  A behavior team should meet regularly, to ensure that any problems that occur are dealt with appropriately, through non-pharmacological means.

13.  Use of medications for the control of maladaptive behaviors (antidepressants, mood elevators, antipsychotics, etc.) should be kept to a minimum.  Some sources say that less than 10% of residents in such units should be taking such medications at any given time, and then only for short periods.

14.  Counseling services for residents and family members, and possibly for staff members, should be made available as needed.

15.  Residents should be re-assessed regularly, with changes made in their individual care plans as appropriate.

16.  Team meetings should be held on a regular basis to discuss any changes in residents’ behavior or care.

17.  Families should be encouraged to participate in community recreational activities and family council meetings, where they can provide input as to their own concerns as well as those of the residents.

18.  Environmental design should be given careful consideration, to ensure that the residents are not overly stimulated, and also to give the appearance of home-like surroundings.

19.  Residents should be provided with a finger-food menu, to enable those who are losing the ability to use utensils to feed themselves.

20.  The unit should have secured doors, monitored by a non-intrusive alarm system.  (In other words, alarms should not be so loud that they are upsetting to the residents.)

21.  Most importantly, the residents should be seen to be happy and well-fulfilled, and interacting successfully with each other and with the staff.

(The above list was inspired by one found in “Learning to Speak Alzheimer’s:  A Groundbreaking Approach for Everyone Dealing with the Disease,” by Joanne Koenig Coste.  This is an excellent book for anyone working with folks who have dementia, and I recommend it whole-heartedly.)

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