ann ellettby: Anne Ellett, Nurse Practitioner, M.S.N., Gerontology Consultant, has worked in the arena of elder care and gerontology for more than 2 decades. Most recently, she held the position of Senior Vice President at a national company that was a recognized leader in caring for elderly, specializing in dementia care.

It was good news to read that at the Assisted Living Federation of America’s (ALFA) most recent national conference in May, setting standards for dementia care was identified as a critical issue for their organization.  Studies indicate that up to 60-70% of residents living in assisted living are affected by memory changes such as MCI (mild cognitive impairment), Alzheimer’s disease, vascular dementia or some other type of dementia. Current types of care programs often fall far short of meeting the unique needs of these residents.

Providing compassionate and life-affirming care for people living with dementia is complex. The pervasive culture of “person-centeredness”, providing care that is individualized and respects the “whole” person, needs passionate leadership, adequate staff training and engagements that are stimulating and interactive. This type of care is not easy to deliver. We can hope that ALFA’s focus on setting standards for dementia care will provide the “top down” support for dementia care providers to assess their programs and improve as needed.

Consumers shopping for senior housing may assume there are already standards in place for dementia care. Almost every assisted living sells itself as providing “memory care” for their residents. Unfortunately, not every assisted living community has done its “homework” and prepared a safe and life-affirming environment for their residents affected by dementia.

Each state has its own regulations defining which type of assisted living can provide care for people with dementia. There are no national standards. Most states have regulations that require some additional training, but it varies from 6 hours up to 40 hours of training. Some states require that there is nursing on-site, other states may only require a nurse available “on-call”, or no nurse at all. Most states don’t specify staff ratios for caring for individuals with dementia, but will write something vague like “staff must be adequate to provide for the health and safety of the resident” – interpretation is left to the dementia-care provider..

As consumers of dementia care services, it behooves you to ask questions of potential providers: If you’re moving your loved one into a memory-care assisted living, what are their standards?  Can they explain those standards to you and also explain how they operationalize them – how many hours of training does their staff receive?  What is the ratio of direct care staff to the residents?  How do they handle emotional outbursts (behavioral expressions) by residents?  Do they have a medical director or other health care providers who visit the residents on-site?  What is their system for handling a resident who becomes ill?

It’s not enough to pour all our national resources into finding a cure for dementia. The national crisis is in the immediate need for developing better models of care. As customers of dementia care, you can help improve standards of care by asking questions of assisted living providers and showing them that you expect trained personnel, adequate

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