The Many Faces of Dementia: Choosing a care home |

The Many Faces of Dementia: Choosing a care home

Editors note: This column is Part 1 of 2 in which the author looks at choosing a care home. In Choosing a Care Home Part II, he will address the questions that should be asked and how to make the decision based on answers and a methodical process.

The decision to place a family member with dementia in a home can be hard for the family and may be accompanied by feelings of guilt, sadness and anger. In making that decision, there are some clear ideas and directions that most health care professionals agree with, but then there is the subjective side, intuition, referrals and just plain liking a place because “it just seems right.” Here’s some practical advice and thoughts to help you make the right choice.


Many families have made promises to never put a parent or spouse in “one of those places.” In wrestling with that issue, it’s good to remember that family caregivers can get so stressed and over-worked that they can statistically pass away before the person who they are caring for. One of the many choices is to have a caregiver come to the person’s residence. This type of home care can vary from minimal time perhaps a couple of hours providing relief for a spouse, to full-time 24-hour care. There are a number of very good companies that provide home care. Costs can range up to $30 or more per hour. On a 24-hour basis, it can be very expensive.

Finding an individual through a referral — not working for a company, is one way to reduce at-home care costs but has risks; lack of appropriate experience and training and issues of dependability and who will cover the caregiver on days off. One the other side of the cost spectrum, it is not unusual for some facilities to charge more than $11,000 per month for a high level of care of a person with end- or late-stage dementia. Skilled nursing facilities may be even more expensive, but in some cases, costs can be offset by state medical insurance such as Medicaid or Medical.

Weighing the cost of care at a facility versus cost of care at home, it may be well worth the decision to place a loved one in a care facility if the need is moving toward 24-hour care. For unlicensed care, there are senior care complexes. These facilities generally provide for a room, housekeeping, laundry and meals but make no provision for skilled medical care as part of their business. Most of these communities allow you to hire your own caregiving person or other health care professional. However, the combined costs may be substantially more expensive than a care home. In the next stage of care, there are licensed independent living facilities. Many of these facilities combine independent living, assisted care and memory care all in the same community.

In the case of someone diagnosed with a dementia such as Alzheimer’s disease, there are homes, large and small that specialize in dementia or larger facilities that have secured facilities within the property. The next step in increased care is licensed convalescent hospitals or skilled nursing facilities. Then there are full-service life care (continuing care) communities, where in one community, care can be provided from independent living to the final stages of full-service skilled nursing facility, palliative care and hospice. The choices are many but all have some common evaluation points.

Check points, questions and issues

Once the heart-wrenching decision is made, one of the first steps toward finding a good facility is to talk to as many people as possible. Most communities have Alzheimer’s Support Groups that are excellent sources not only to discuss your own issues but to get ideas of what the options for care are. Also, talk with the person’s doctor and friends who have a family member in local facilities.

Check to make sure that the facility meets basic safety requirements. All facilities and administrators should have current licenses from the state, and the facility should meet state and local fire regulations, which may include sprinkler systems, egress alarms, smoke detectors, fire doors, etc.

Consider asking to see the latest state survey and/or monitoring report. These reports, which comes from the state licensing agency, should be kept in a public place at the facility.

State agencies generally post on their websites facility violations. But violations, unless there are many serious ones can be as simple as a disgruntled and/or terminated employee filing a fallacious report of an incident that didn’t actually happen. Read the report and look for the disposition and corrective actions taken. Don’t overlook this resource but look carefully and then ask questions at the facility.

This article was submitted by Tor Eckert with permission from Eckert has been involved all facets of Alzheimer’s disease since the 2005 including owning a Alzheimer’s Care Home. His public speaking forums — The Many Faces of Dementia have provided health care professionals, adult children, caregivers and families with a better of understanding of Alzheimer’s and the other dementias. For more information, please call Eckert at 530-432-8308 or email

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