Choices can be a true double-edged sword, and no one knows that better than an individual looking for a memory care facility for someone they love. There are so many options out there—and so many criteria to consider—that the decision can feel impossible.

In this recent article by Theresa Sullivan Barger, an independent journalist writing for NextAvenue, the author gives a very practical list of tips to consider —based on her own experience— when choosing a memory care facility for a loved one. Here’s what she suggests to keep the process from seeming completely out of reach. 

Don’t Be Afraid to Talk to Everyone

Safety is, of course, highest on the list of priorities for most people when they’re looking for a facility for their loved one with dementia. You want your loved one to be more secure and comfortable in a facility than they ever could be at home, otherwise you wouldn’t be looking elsewhere. Barger suggests beginning the journey by asking around, and not being shy! Ask for recommendations from as many trusted friends and resources as you can.

“I also called the staff at both the home health aide agency and adult day care facility we’d used and asked for their insights,” Barger writes. While she warns that many of these places aren’t exactly allowed to give official recommendations, staff will occasionally subtly hint that one location might be better than another, or that their own loved ones are at certain facilities. It helps to read between the lines.  

Visit Several Communities and Compare Amenities

As you might expect, you can’t get a lot of certainty about a place unless you see it in person. Visiting a handful of facilities can give you a better sense of what you’re looking for, and help you to catch the unique differences—both good and bad—between places.

Barger asked Dr. Carolyn Fredericks, a neurologist at the Yale School of Medicine, what to look out for as far as amenities go. Fredericks responded, “If your loved one has Alzheimer’s disease or another type of dementia, research shows that following a daily routine while providing a mix of activities is best for emotional well-being and intellectual engagement. If it’s social, it’s good for brain health.” To this end, Barger suggests looking for places with a variety of engaging social activities, such as art, exercise, entertainment, games, and even pet visits. People in later stages of dementia benefit remarkably from social interaction of all kinds.

When You Visit, Use All of Your Senses

A huge benefit of visiting a facility in person is the ability to use all of your senses to investigate. Watch how the staff interact with each other and the residents; does the staff ratio seem appropriate? Listen how the residents interact with each other, or if they’re not engaging at all. But Barger says, “keep in mind, some with dementia get their nights and days mixed up, so if you see a few sleeping, that’s normal; others may take medications that might make them drowsy.”

Yale’s Dr. Fredericks adds, “Alzheimer’s patients like to wander, so if someone is walking alone while you visit, that’s a good sign that residents are safe and given autonomy.”

Hygiene also becomes obvious when you stay alert. Unpleasant smells—urine, for example—shouldn’t be ignored, and can be an indication that staff ratios don’t allow for prompt changing for the residents, or thorough enough cleaning. Keep note of all these things, and trust your gut. If something seems—or smells—off, it probably is.

Plan On Visiting More Than Once

Through the visiting process you’ll probably narrow your list down to a few key places. Once you’ve done that, Barger suggests visiting as many times as you can, on both weekends and weekdays, to get a more well-rounded feel for the place. It also helps to go with someone else, at least the first time, so that one person can listen to the official guide through the facility and the other can observe the surroundings more closely.

Barger advises taking note of how residents are treated, even in subtle ways. Do the staff know the residents by name and seem to know them on a deeper level than just their diagnosis? This is a sign of real respect, and should signal that the staff is interested in forming true relationships with residents, not just treating them as patients.

It’s Okay to Peek Behind the Scenes

In her own search for a memory care facility for her mother, Barger admits to being as nosy as possible—even dropping into a facility unannounced to see how welcoming the staff are—and she advises you do the same.

“At one of our visits,” she writes, “I excused myself to use the restroom, while my sister met with the marketing staff. I checked for cleanliness, then I snooped even further: I asked an independent living resident waiting for an elevator how she liked living there and whether it offered what was promised.”

Barger went on to ask a Certified Nursing Assistant on a shift change about how she liked working there, and even a waitress at a restaurant nearby whether the residents were ever brought there and how they were treated. She received glowing feedback from all of these disparate sources, which gave her a much better picture of the place.

It’s Essential to Ask About Staffing and Retention

Some of these questions may feel uncomfortable or pushy, but Barger insists that asking about staff compensation and turnover can have a huge impact on how your loved one may end up being treated. For this topic, Barger quotes Crystal West Edwards, an elder law attorney in New Jersey: “The question about staff retention and salaries speaks to the business viability and the values of the business. If they value their employees, they likely will value their customers.”

According to PHI National, a nonprofit in the elderly and disability care field, the national average hourly wage for direct care workers in residential care facilities was $12.67 in 2019. As for the ideal staffing ratio, according to U.S. News and World Report, it should be about five residents to one care staff member.  Having these numbers and stats in your back pocket can help you get a sense of whether a particular facility is meeting or exceeding standards.

Families of Residents Will Tell You How They Really Feel

Relationships are key in any place where your loved one will be living. Barger suggests talking with families visiting with their loved ones to get real feedback on how they feel their experience has been. Ask open-ended questions, like, “Could you tell me about how this place has been for your loved one?”

If a facility seems wary of letting you wander and talk to people without the marketing people within earshot, that could be a red flag, or at least something to note. 

Some Specific Questions for You to Ask:

Barger gives a more extensive list of questions in her article, but here are a few to give you an idea for your own list:

• What kind of dementia and/or caregiving training does the staff receive?
• When, and how often, does the staff receive training?
• What behaviors are tolerated and what types of behaviors could lead to a residents’ eviction?
• How are meals served? Are residents given choices? Are visiting family members allowed to eat with their loved ones?
• What kind of vaccinations are required for staff (flu, COVID-19)? What percentage of staff has been vaccinated for COVID-19?

With questions like these at the ready, you can be armed with the right information to find a facility that works best for both you and your loved one. Visit a place a handful of times, be willing to ask lots of questions—get nosy, if necessary—and always trust your instincts. Planning ahead will help you make the right memory care decision for your loved one.

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(originally reported at www.nextavenue.org)