A study in the Journal of Clinical Psychiatry.
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Memory care and child day care -- two sides of the same coin
Are we at the crossroads of care? We are at an interesting and somewhat ominous crossroads in the care of those with dementia. AARP (and the media that quote them endlessly) repeat that adults want to remain in their own home as they age. Nice goal, but, not such a good fit for everybody. So combine the growing longevity of middle class adults with the beginnings of a multi-year revival in home sales and perhaps home prices, seniors may have an easier time selling and moving that will shift the average age of residents below today's age 89. To families searching for options, expensive assisted living memory units may look like good care options for those with serious functional memory loss. But are they really good care?
Memory care generates profit assisted living today. Assisted Living communities can charge top dollar for their memory units, which have the highest revenue-to-resident ratio – although they may also have the highest ratio of staff to resident. Like the rest of so many AL communities, often the decorating is top tier and augmented with cheerful colors and eye-catching artwork. Stuffed animals are prevalent, easy puzzles and a regular set of activities are offered at a few specific times of the day, typically led by an activities coordinator. These may include exercises, current events, games, snack, music, movies. Is that good care?
What exactly is 'good' care? Years ago, when working mothers were relatively rare (and I was a working mother), we could read multiple books and magazine articles about what was excellent day care and – and what wasn’t. The goal was to help guilty working mothers assess (beyond word of mouth) whether ‘ABCD-Quality-Childcare’ was the place for their baby or toddler. Since then, there has been an explosion of guides to helping working moms and dads find great child care. This is not so with the decision-making process of finding memory care for aging family members. As a sign that some guidance might be in order for memory care units in assisted living, the Alzheimer’s Association offered a 2009 booklet to help train their managers. And it is good advice, but, what it reveals is the immature state of the art. Mostly about physical assessment, fall risk, and environment, less about social aspects, it is a first step guide, but does it define good care?
Use the Memory Walk money to fund a study of what is great. Instead of all the money and hype going to find a cure for Alzheimer's, let’s see a landmark study that identifies what great memory care looks like. Hint, that does not mean offering a checklist for finding care – that's useful, but insufficient. How will you know if you’ve found great care? Forget Amazon – the search for ‘finding adult memory care’ how-to books found nothing. Caring.com offers a breakdown of the types of long-term care and adds its own checklist, but also sidesteps the question of what exactly is great memory care. It’s easy to correlate goodness with cost, with circular hallways, with a 'specially trained staff' or a full list of activities. But when all is said and done, next time you visit a memory care unit, look around. Are the residents slumped in their too-soft couches and rocker-dangerous chairs? Are they listlessly awaiting the next activity while staff members chat with each other and do their paperwork, often behind privacy-protecting glass barriers? Is that good care? Shouldn't we expect more and what exactly should we expect? Thoughts welcome.