Selecting a Dementia Care Unit

When selecting a dementia care unit, remember:

• The primary goal of a dedicated dementia care unit is to help the patient achieve the best possible quality of life.
  
• Care should be patient-centered, and offer residents
  • Safety
  • Security
  • Medical care
  • Emotional support
  • Reasonable privacy
  • Access to appropriate activities
  • Assistance with the activities of daily living

• The state of Nebraska has not established uniform guidelines for dementia units. However, Nebraska does have a statute relating to the Alzheimer's Special Care Disclosure Act. Any facility which offers to provide care for persons with dementia/AD must disclose "the form of care or treatment provided that distinguishes such form as being especially applicable to or suitable for such persons." This disclosure is filed at the Department of Health and Human Services Regulation and Licensure office and is available for viewing by the public. The disclosed information explains the additional care provided in each of the following areas:
  
  • The special care unit's written statement of its overall philosophy and mission which reflects the needs of residents afflicted with Alzheimer's disease, dementia, or related disorder;
  • The process and criteria for placement in, transfer to, or discharge from the unit;
  • The process used for assessment and establishment of the plan of care and its implementation, including the method by which the plan of care evolves and is responsive to changes in condition;
  • Staff training and continuing education practices;
  • The physical environment and design features appropriate to support the functioning of cognitively impaired adult residents;
  • The frequency and types of resident activities;
  • The involvement of families and the availability of family support programs; and
  • The costs of care and any additional fees.
    
• Families may find substantial differences in the units. In most cases, families have to rely on their own judgment when making their final selection.
  
  

Philosophy and Criteria for Admission to the Unit

One of the first things for a family to decide is if a dedicated special care dementia unit would be right for their loved one. A unit is only "special" if it offers a service that is "special" and needed by their family member. Pre-admission assessments should include the family's input regarding the patient's ability level. Management of difficult behaviors should be possible without the use of restraints. Matters like cost, unit security and medical services available may not seem important now, but will have long range importance to the family.

• How does unit care differ from care in the regular facility?
  (Request written materials from the facility relative to philosophy of care, services provided for dementia patients and cost per day. Ask what this charge includes and are there additional costs?)
  
• Does the unit accept Medicaid?
  
• What is the unit's policy regarding medical and physical restraints?
  (Federal law requires that the facility use the least amount of medical and physical restraints possible to insure the resident's quality of life.)
  
  
• How often does the staff monitor the necessary restraints?
  
• What type of security system is used in the unit?
  
• Are there special policies written for unit residents?
  
• Are medical specialists available to serve residents in the unit?
  (For example, Dentist, Podiatrist, Ophthalmologist, Audiologist.)
  
  
• Are skilled rehabilitation services available for unit residents?
  (For example, Physical, Occupational, Speech, Recreation.)
  
• Can residents' private physicians be retained in the facility?
  (Federal law requires that a resident be seen by a physician every 30 days for the first three months. After this period of time, they must be seen by a physician every 60 days.)
  
• Does the facility do a pre-admission assessment personally or by telephone?

Family Related Area

Residents in a unit need a familiar, secure environment. The value of having personal and treasured items in their rooms is important. The possibility of theft and breakage is present, but the worth of having these items far outweighs the disadvantages. Maintenance of family relationships with the resident and staff should be an important goal of the unit and facility.

• Is the resident allowed personal items to furnish his/her room?
  
• What is the policy on home visits outside the unit?
  
• Is there a policy on family visits within the unit?
  
• Is there a quiet, private area for residents to entertain visitors?

Services of the Facility

Staffing on units varies greatly. There should be enough staff on day and evening shifts so that residents can be assisted to do tasks for themselves rather than have the tasks done for them. Ongoing dementia behavior training is essential to the staff and residents. Activities are vital for a good unit. These activities should support remaining abilities, minimize failure, enhance dignity and enable pleasure. A beautiful environment does not necessarily insure quality care for the resident.

• Is the environment clean (odor free), comfortable, and well lit?
  
• How many people as staff are scheduled on each shift?
  
• How is the staff selected and trained for the unit?
  
• Is there an ongoing training program for staff working on the unit?
  
• Do the residents seem to interact well with the staff?
  
• Does the staff appear to display respect to the residents?
  
• What is the availability of the beauty salon and barber shop for residents?
  
• How often are snacks made available with finger food offered for self-feeding?
  
• Are activity programs personalized to meet the needs of individual residents?
  
• Who plans and carries out the activity programs and what are some examples of personalized actives?
  
• What pharmacy does the nursing facility use?
  
• Are unit residents included in social outings?
  
• Is there a courtyard connected to the unit for the residents and how is it monitored?
  
• Are the residents allowed to go out of the unit to take part in the facility's activities?
  
• Is smoking allowed and is it supervised?

Tips for Families

Selecting a nursing facility for your loved one is a difficult procedure. Below are several tips you might want to consider before the final decision is made.

• Make an appointment for a formal tour of the facility with the unit director.
  
• Return to the facility at a different time of day and make an informal tour.
  
• Consider the location of the facility in relationship to that of the family.
  
• Talk to families with loved ones currently residing in the unit.
  
• Check to see if your private physician will make calls to the facility you select. Find out if all pharmacy costs are billed directly to the family, or included in the monthly facility charges.
  

Telephone numbers to know:

• (402) 471-2306, Nebraska Long-Term Care Ombudsman, advocate for nursing facility residents.
• (402) 595-3356, Nebraska Department of Social Services - answers questions on Medicaid and spousal impoverishment.

Source material: "Selecting a Nursing Home with a Dedicated Dementia Care Unit," by Nancy L. Mace, M.A., and Lisa P. Gwyther, A.C.S.W.

Compiled by the Lincoln/Greater Nebraska Chapter of the Alzheimer's Association, 1999.