Would my mom with Alzheimer's benefit from moving to a smaller facility?

2 answers | Last updated: Sep 25, 2016
A fellow caregiver asked...

My mother, whose dementia and agitation have increased noticeably in the past year, is in an assisted living facility that houses about 40 people. She often thinks she is in a hotel or hospital. Would there be any benefit in moving her to a smaller facility with only 12 residents, or would the move just add to her confusion and agitation? She has been in the current facility for 3 years. They have a few activities, but she seldom participates. She spends most of her time in her room alone. The smaller facility offers more one-on-one attention.

Expert Answers

A social worker and geriatric consultant who specializes in dementia care, Joyce Simard is based in Land O' Lakes, Florida, and in Prague. She is a well-known speaker and has written two books, one focusing on end-of-life care and the other, entitled The Magic Tape Recorder, explaining aging, memory loss, and how children can be helpers to their elders.

Your mother needs to be in a facility that has a good activity program designed for people with dementia as they rarely if ever self initiate activities. The facility must be aware of this and offer appropriate "meaningful activities" for her. Sitting in her room is isolating and can lead to depression while doing nothing to keep her brain active. Television is the only activity that does nothing to stimulate the brain. I don't think the size of the facility is as important the programming they offer. I have two articles on programming on my web site www.joycesimard.com One is the Memory Enhancement Program for people with mild dementia the other is The Club for those with moderate dementia. They may help you assess programming in any facility you are looking at for your mother.

Community Answers

A fellow caregiver answered...

I just moved my mother from an assisted living facility with 60 units much like you described. She was severely self-isolating. I hired a private-pay geriatric counselor (at $95 an hour) to help assess Mom and advise our family. She was a godsend. I also signed Mom up for hospice palliative care (it's free) who send in a team of an RN, social worker, and doctor to also assess Mom. ALL recommended a smaller environment for Mom. We found a beautiful facility with four large "homes"--they have 15 units in each. (The homes look like real houses on the outside--about 5000sf?) The "apartments" are studios. Mom has the single one-bedroom but, truthfully, now that I've seen the positive effects of "smaller-is-better" for the dementia patient, I don't even feel she needs that. Mom has always been reclusive--even before dementia. But the way the home is structured, the residents are helped to get dressed each AM and escorted to breakfast. Even THAT small routine has given Mom some focus. Bear in mind, three years ago she was working at 81 years of age and totally independent before she broke her hip and hit her head on the job catapulting her into fullblown dementia. So, for a season we were in total dementia-denial. No longer. We've seen the effects of the smaller unit for our mother. She's not nearly so isolated and she seems to be responding to that in a positive way--in SPITE of her introverted ways. I think AL simply fueled her decline into dementia and have even asked myself if it didn't--in and of itself--almost make her crazy--even withOUT the added component of the dementia? Call around. Ask social workers what is the BEST dementia care unit in your area. (We drive a little farther to the best one, but it's worth it.) Take a full tour. Smell urine? Cross it off your list. Taste the food and look at the presentation of it. Mom's is quite good. Chat up the staff. Find out how long they've worked there. Find out how many staff to residents. 1 to 7 residents is the norm in Mom's "home". Look at the furnishings and decor. Are they shabby and outdated? (Mom's got granite countertops, glass subway backsplashes, floor-to-ceiling fireplace, etc. All this for the same price as the crummy out-dated AL we "thought" was nice but which was actually financially gouging us. Mom's top-of-the-line care is about $5100 a mo.)