Put yourself in the shoes of your loved one. If you found yourself in a situation where you needed around the clock care, would you want to move from the comfort of your home to a medical facility that feels more like a hospital than your home? If memory loss and confusion are growing issues, wouldn’t you feel more at ease in a facility that has the feel of a home?
Residential care homes feel like home. They have a kitchen, shared or private bedrooms, often shared bathrooms, a few public rooms such as a living room, and typically a garden or deck outside the door all within easy distance for most seniors. Because of this single family home layout, it is my experience that seniors with more advanced memory loss believe they are in their own home. This helps increase feelings of comfort and relaxation and eases their transition from their own home or apartment to moving into a residential care home.
Due to the single family home size and generally short hallways residents tend to be able to move about the house more easily and find rooms, people and objects they are looking for. This leads to less confusion and agitation.
Residential care homes generally have quieter, calmer environments than larger settings, again contributing to a calmer state of mind for all in the home.
Open kitchens are common in residential care homes. Residents are encouraged to spend time in the kitchen, helping to prepare food or sort through recipes – family members typically can help themselves to beverages or get beverage or snack for their loved one.
The smell of a roast, turkey or chicken noodle soup cooking all day helps to stimulate appetite in seniors with decreased appetite and is also a comforting, familiar “home” smell. Dogs and cats roaming around also provide for a homey atmosphere, companionship and an opportunity for residents to care for something.
Residents of care homes typically spend most of their time in the common areas, rather than in their room. They spend most of their time interacting with other people in the house or engaged in various activities which helps boost their mood and feel like a vital part of their household … their new extended family.
5 Basic Needs of People with Dementia
- Need to be useful
- Need to be able to still care, for self and others
- Need to have self-esteem boosted
- Need to give and receive love
- Need to experience joy and laughter
People with dementia generally want to contribute to the household they live in in. Due to the smaller size of residential care homes and increased staff time per resident daily chores become a possibility. Many residents in residential care homes have various chores such as picking up the mail, helping to prep dinner, caring for plants and sweeping sidewalks. Daily chores fulfill their need to be useful, help care for themselves and others, and have their self-esteem boosted. Due to the physical nature of household chores, they also move their bodies, which is an added bonus.
The relationships residents have with each other are often like between siblings because they live in the same house. They provide comfort to each other, celebrate each other’s birthdays, get to know each other’s family members and sometimes squabble over the TV. This is like “normal” life at home which is comforting.
The staff and family members of residents tend to have close relationships due to the small size of residential care homes. Staff and family can more easily brainstorm problems together because they see each other regularly and get issues get taken care of as they occur. This reduces the need for formal care conferences and keeps the resident with dementia safer and happier.
Small Staff to Resident Ratios
The staff to resident ratio (number of caregivers on duty at one time per number of residents requiring assistance) is typically lower in residential care homes than in larger facilities. A standard in the Minneapolis-St. Paul metropolitan area is 1 direct caregiver per 3-4 residents in residential care homes. Often the direct caregiver ratio in larger facilities is 1 direct caregiver per 7 residents. Lower staff to resident ratio = more time spent caring or socializing with each resident.
According to Mayo Clinic staff, “Alzheimer’s Stages How the Disease Progresses,” three of the common changes in personality and behavior that persons affected by Alzheimers experience are “social withdrawal, increased stubbornness, distrust in others, and depression”
So, the first thing out of an elderly person’s mouth affected by dementia is usually “no,” especially if it involves any type of movement. They will often naturally want to lie in their bed or remain seated in their recliner or perhaps engage in some other type of non-beneficial activity such as hoarding.
Staff in residential care homes generally go beyond the “no” and say something to the effect of, “Pearl I know you are the best at baking cookies your family told me so and we really need your help. Let me help you into your wheelchair in bring you in the kitchen now.” This process of encouraging, cajoling, bargaining, transferring and assisting takes a lot of staff time. The worse the dementia or physical condition of a person, the longer this process is likely to take. Staff in residential care homes simply have more time to “go beyond the no” due to favorable staffing ratios. Symptoms of dementia such as calling out repeatedly or trying to get out of a chair without assistance can stem from lack of personal attention. Because residents in residential care homes generally receive more personal attention, it is common for these symptoms to diminish once they are settled into their new home.
Symptoms of dementia can also rise from pain or discomfort, boredom, or underlying illness. Because staff in residential care homes generally have more time to devote to each resident, they may have the time to be able to investigate the root causes of symptoms and develop and plan to decrease them. Alternatively, when direct care providers are squeezed for time, it is easier and less time consuming to administer a drug to medicate and mask the symptoms.
Caring for elderly people affected by dementia is very personal. They often need help changing their clothes, showering, and touch to their private parts to help get them clean.
Due to the small size of residential care homes it is typically a small number of staff members caring for a household of residents. So residents see the same faces day after day. They may not remember the staff’s name, but they likely will recognize them and trust them, making it much easier for staff to work with residents who need help with these very personal cares.
In my care home Grace Homes, I have 9 Certified Nursing Assistants who provide direct care for 7 residents. Most of my staff are full time so they spend around 40 hours per week with the same 7 residents – in many cases they spend more time with the residents than their own families. My staff know each of our residents intimately.
Staff members in residential care homes can easily remember routines, preferences and personal histories of residents as they only have 3 – 4 residents to care for. Routine following keeps persons with memory care feeling happy and safe. People with dementia don’t like surprises or changes in their routines. Just as we are all getting older and have our own daily routines. For example, you might routinely wake up in the morning and drink a cup of coffee. If you miss your morning cup of coffee, you might be crabby all day. Same with our seniors with memory care, only their displeasure at a disrupted routine might lead to an angry outburst or refusal to participate in any other activities of the day.
Caregiver continuity also helps staff be more effective at getting residents involved with exercise and various other activities because they know what makes them tick. This becomes of great importance when dealing with the resident with dementia. Caregiver continuity also helps reduce hospitalizations. Hospitalizations are especially disorienting and harmful for folks with dementia since they are out of their home environments and familiar faces and routines. Staff in residential care homes often know their residents well so they might pick up on symptoms of illness in their beginning stages. Also, because residents generally have a positive familiarity with their caregivers they are more likely to report a discomfort they are experiencing. A illness, such as a pneumonia, can be more easily treated in its early stages while the resident remains in the care home, rather than a trip to the hospital.
In my residential care home, we have not sent a resident to the hospital in over 2 years as of October 2012. Yes, we have been lucky no one needed stitches or broke a bone that required surgery. However, our staff along with our provider team have been able to treat a multitude of illnesses while keeping our residents in the care home.
Other memory care options include a skilled nursing facility or nursing home, or a large 50+ bed assisted living facility. Seniors with high level medical needs requiring a 24/7 nurse on site to provide skilled nursing may need to be in a skilled nursing facility. Seniors without advancing dementia and still able to walk or propel themselves in a wheelchair may thrive in a 50+ bed assisted living facility as they offer a much wider variety of activities, programs and people than the residential care homes.
In conclusion, residential care homes are the best setting for those elderly with advancing dementia who need caregiver continuity, lots of personal attention, and an environment that feels like home.