How to Choose an Aged Care Facility for a Person Living With Dementia

How to Choose an Aged Care Facility for a Person Living With Dementia

When it came time to find full time care for my aunt who is living with dementia, I was on the lookout only for a few factors. I knew she needed somewhere within the right price range for a pensioner, somewhere that provided regular activities, and that she would prefer not to share a room. I did not know that the size of the facility mattered, the types of activities mattered, that accessible outdoor spaces were important, or that different facilities have different arrangements for medical care. I did not know much at all.

Through my own experience visiting aged care homes, trawling through the latest scientific research and speaking directly to medical specialists, I’ve compiled a list of what’s truly needed for the highest quality dementia-specific care. This is the information that I wish I had known.

Before you start looking for aged care, remember that having your loved one stay in their own home for as long as possible is always best. You can contact My Aged Care for support with cooking, cleaning, bathing, shopping and other care needs. But of course, care needs are complex, and sometimes an aged care facility is absolutely the best option.

If full time care is needed, the first step is to contact My Aged Care for an assessment from ACAT (Aged Care Assessment Team). They will visit your family member at home, with you present, and ask you both questions to decide if they are ready for full time care. A couple of weeks later, if they agree that your loved one is ready, they will provide a referral number you will need before you start the search.

Here are some key questions worth asking to assist you in making the best choice when choosing an aged care facility.

1. Is there a dementia-specific unit? 

Not all aged care facilities have dementia units, so this is one of the first questions to ask. These units are generally more secure than a general unit, and since 60% of people living with dementia are prone to wander, security is an important factor.

2. Does the facility have a familiar home-style layout that accommodates only a small number of residents?

Studies have shown that the physical environment of small-scale living facilities (maximum 8 residents) can be highly beneficial for people with dementia. However, the same studies also emphasise the importance of these facilities providing residents with meaningful activities and using the physical environment to its full extent (in other words, small-scale alone isn’t enough).

Other factors to consider are if the environment is home-like, and how much privacy your loved one will have. In most facilities, residents will have their own room with a lockable door (although staff have keys). However, there are facilities where residents are required to share a room.

3. Does the facility routinely provide meaningful activities to slow cognitive decline and enhance wellbeing?

Nursing homes often employ staff such as diversional therapists or activity coordinators to give residents focused events throughout the day, but it is worthwhile finding out exactly what types of activities are provided. Ideally, the facility will prioritise activities that have beem shown to slow cognitive decline, such as cooking, craft, art therapy, singing and dancing.

When you visit the facility, you can always check the activities schedule for yourself (you’ll usually find it pinned up in a common area) and get a feel for what’s being offered. If the facility has only one full-time diversional therapist, it’s worth asking what happens on weekends, or when that person is sick or goes on leave.

4. Does the facility prioritise movement?

We have known for quite a while now how important regular physical activity is for maintaining good mental health, which should be a priority at any aged care facility. In addition, many geriatricians state that resistance exercise — like squats, resistance bands and lifting weights — is particularly important to slow the progress of Alzheimer’s disease.

Many aged care facilities offer physical therapy, however since it is usually done in groups, it’s often designed to cater to the residents with the poorest mobility (i.e. those in wheelchairs). Some aged care facilities also schedule regular walks with residents, which is highly beneficial – especially when it’s in green spaces.

5. Does the facility provide well-designed outdoor spaces?

These should be easily accessible, interesting, safe and secure. Residents should be free to come and go from these spaces, there should be fixed seating, and residents should have the ability to easily return indoors.

6. Does The Facility Employ Mostly Full Time And/Or Part Time Staff To Work In The Dementia Unit?  

Having consistent staff in the dementia unit, with the majority of employees being full time or part time, is very important. Regular staff are more likely to understand your loved one’s specific needs, frustrations and personality, and can therefore care for them better. A consistent care team also fosters a feeling of safety for a person with dementia, and facilitates improved communications between staff and families.

7. Will your family member be regularly seen by a GP? Are experienced registered nurses on site at all times?

Dementia affects the way people think, behave and perform everyday tasks. To improve care and better manage the needs of people living with dementia, there needs to be highly skilled registered nurses and care assistants to work collaboratively with the person, their family and their GP.

There are many different ways a facility can operate. I visited one where resident doctors attended the facility (that is, people who have graduated medical school and are in the process of completing a post-graduate training program). Others required residents to have their own GP, as long as the GP was willing to visit the facility.

It’s also important to ask about the nursing home’s communication strategy. How will they communicate any changes in the resident’s condition?

8. Can your loved one afford the facility?

Dementia care should be affordable for all. Unfortunately, many aged care homes only take residents who can pay considerable fees. Some require payment of a RAD (Refundable Accommodation Deposit) which is often around $500,000. Others have a smaller refundable deposit but high daily fees. One facility I contacted ticked all the boxes, with 8 residents per unit, easily accessed outdoor green spaces, and meaningful activities designed to slow cognitive decline. However the daily fees of $600 made the facility inaccessible for a pensioner.

For people with few assets and who are living solely or predominantly off the age pension, there are still many options, but so far I haven’t found any that tick all the boxes – so it’s a matter of visiting them and choosing which aspects are most important. These places will require you to complete income and asset calculations from Centrelink, and will usually charge the bulk of the pension payment for their fees.

Once you know the facility is in the right price range, don’t rely on the website information or online rating alone. Book a visit, bring a pen and checklist (perhaps summarising the above questions and anything else you’d like to know), and make notes based on the answers you’re given and importantly, from your own observations.

Denise Mills

Denise Mills is a writer and accountant based in Central West NSW. Her words have featured in The Guardian, Brevity, Epoch and more.

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