Dementia Care Options: Choosing the Right Type of Care

There is no single right way to care for someone with dementia. The Alzheimer's Association stresses that there's no one-size-fits-all approach: needs change as the disease progresses, and every family's situation is different. It notes that around-the-clock supervision often becomes necessary in the middle stages, and care needs become more intensive in the late stage. This guide explains the main types of care in the US, the signs that it may be time for more help, and how to choose a place.

Care at home

In-home care lets the person stay in familiar surroundings, and it can also support the family members who care for them. Services range from help with everyday tasks to personal and medical care, so ask providers exactly what they offer.

Adult day centers offer social activities and a safe setting during the day, giving the person company and structure while caregivers work or take a break.

Respite care gives caregivers a short-term break. The Alzheimer's Association says "everyone needs a break," and that these services can strengthen a caregiver's ability to keep going.

Many families combine these for as long as the person is safe at home and the caregiver can manage. See how to support someone with dementia for day-to-day tips.

Residential care

A few things to know, according to the Alzheimer's Association:

• Assisted living isn't federally regulated. Definitions and rules vary by state, and not every assisted living community offers dementia-specific services, so ask.
• Nursing homes are licensed by the state and regulated by the federal government, but staffing ratios and training still vary.
• Memory care units are often part of a larger building. Some states require them to disclose their fees and the specialized services they offer.

Signs it may be time for more care

The Alzheimer's Association lists these signs that a move to residential care may be needed:

• the person is becoming unsafe in their current home
• the health of the person or the caregiver is at risk
• the person's care needs are beyond what the caregiver can physically manage
• the caregiver is becoming stressed, irritable or neglecting work, family or their own health
• the person might do better in a structured setting with more social contact

Feeling guilty about this decision is common. The Association suggests gathering information and moving forward, keeping the focus on the care the person needs.

How to choose a care facility

The National Institute on Aging (NIA) and the Alzheimer's Association suggest these steps:

1. List needs and preferences. Think about help with daily activities, nursing care, a dementia unit and hospice, and about what matters to the person, such as food, activities, faith and being near family. Ask their doctor if you're unsure what level of care they need.
2. Ask people you trust for recommendations: friends, health care providers, social workers, faith groups and support groups.
3. Call several places. Ask how many people live there, what it costs and whether there's a waiting list. It can be worth joining a waiting list before you're ready.
4. Visit at least twice. Make one visit unannounced, at a different time of day, and include a mealtime. Talk with staff, residents and families.
5. Check inspection records. For nursing homes, use Medicare's Care Compare tool. For other communities, ask for the latest inspection survey and, where your state requires one, the special care unit disclosure form.
6. Read the contract carefully before signing, and ask about anything unclear.

Questions to ask

• What is the resident-to-staff ratio, and is a registered nurse on site at all times?
• How long have staff and managers worked here, and how often do staff leave?
• Are staff trained in dementia care? What does the training cover, and does the state require it?
• How do staff handle challenging behaviors?
• What activities are offered, including evenings and weekends? Is there a safe outdoor space?
• How often does a doctor see residents, and how do residents get to appointments?
• When would a resident have to leave (the discharge policy)? Can they "age in place," and is hospice care available here?
• Does the community accept Medicare or Medicaid? What happens if private funds run out?
• Can the person bring familiar things, such as photos, bedding or a chair? What are visiting hours, and can family join in care planning and mealtimes?

The Alzheimer's Association also suggests looking for The Joint Commission's Memory Care Certification when comparing nursing homes and assisted living communities.

Paying for care

Most families pay for residential care out of pocket. According to the Alzheimer's Association, assisted living averages about $74,400 a year for basic services and a private nursing home room about $129,575 a year. Medicare does not pay for long-term residential care; it covers only short-term skilled care after a hospital stay. Long-term care insurance, veterans benefits and Medicaid may help. If Medicaid may be needed later, the Alzheimer's Association suggests talking to an elder care attorney early. See paying for dementia care, dementia benefits and power of attorney.

Where to get help

• Eldercare Locator: 800-677-1116, to find local services, including your Area Agency on Aging.
• Alzheimer's Association 24/7 Helpline: 800-272-3900.
• Medicare: 800-633-4227. Medicaid: 877-267-2323.

UK readers: care homes, home care and funding work differently in the UK. See paying for dementia care in England.