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Monday, September 1, 2014
The diagnosis of Alzheimer's disease and related dementia presents families with a complex set of difficult decisions related to the care and well being of their loved-one. One of the most difficult of these decisions involves the placement of the person with Alzheimer's disease in an assisted living facility (ALF) or skilled nursing facility (SNF). Families often struggle to find just the right facility for their loved-one, one that will care for that person diligently and with respect for dignity. It is important to everyone that the decision be based upon a thorough search for options and alternatives, and a thoughtful comparison of those options given the needs and unique characteristics of the memory-impaired person.
This article is meant to help family caregivers sift through the increasing number of specialized care programs and facilities designed to meet the needs of people with Alzheimer's disease and related dementia. It provides a set of questions and issues that should be addressed when visiting and selecting a facility. In doing so, we are assuming that the decision for placement has already been made, and that other more basic issues of nursing facility selection (for example, questions related to financing care, visiting hours, physical appearance of the facility, etc.) are being addressed as well.
Be aware of the differences between skilled nursing facilities and assisted living facilities. For example, for families in Ohio, if you select a skilled nursing facility, your first request should be to review the last inspection by the Ohio Department of Health (ODH). This will list all the citations, which would indicate the areas of weakness. Assisted living facilities are not subject to mandated ODH inspections. Also, note that a position of medical director is mandated for skilled nursing facilities, but there is no such requirement for assisted living facilities.
It must be emphasized that it is crucial for anyone considering this type of placement for a loved-one to actually tour the facilities being compared, talk with staff, and ask questions and make observations related to the following issues. You may wish to go prepared with a list of questions important to you, and make note of answers and observations for comparing facilities later. Following are some examples:
In making this important and difficult decision, families often consider the location of the facility as high on the list of priorities. You will find this criterion on many checklists for assisted living and nursing facility selection. However, our experience indicates that the closest facility is not necessarily the most qualified. When a family affected by Alzheimer's is comfortable and confident with the quality and focus of the specialized care unit or program, geographical location becomes secondary to knowing that their loved-one is receiving knowledgeable, compassionate care from experienced staff.
Whatever your stage in this decision-making process, taking the time to tour facilities and compare them thoughtfully based upon the above considerations is a good way to gain confidence in your decision. You may want to try walking in unannounced, preferably during mealtime and observe. If your presence makes anyone in the facility nervous, cross it off your list. It is important to select the facility that best fits the needs for care, comfort and dignity of a loved-one affected by Alzheimer's disease or a related form of dementia.
Last Reviewed: May 01, 2001
Susan D Gilster, PhD, RN, NHA
Volunteer Professor, Preceptor
College of Nursing
University of Cincinnati