What is the most suitable type of aged care facility for those living with dementia? A user guide.
The landscape of aged care facilities is growing exponentially. It is easy to lose yourself in the endless options and variables in an already complex and confusing system. This article aims to simplify the task of selecting the most suitable aged care facility for a loved one living with dementia. We will run through the different types of aged care facilities, as well as the generalized factors to look for in all of them.
As of 30th June 2016 (release date of most recent government aged care data), 52% of those living in permanent aged care had a diagnosis of dementia. Of this sub-group, 81% fell into a ‘high’ category for the domain of “cognition and behavior” care needs. This compares to half (42%) of those without dementia in the same category. Therefor aged care facilities have been caring for residents with dementia for a long time. But this doesn’t mean they are all suitable for that purpose.
Care services are provided by different categories of organization. Two thirds of them (65%) are not-for-profit organizations, 20% are private, and the rest (15%) are government run. The location of these services varies. In the inner city regions, the majority of places are provided by the not-for-profit and private sectors. However, as you move more rural, government run facilities can make up over half of the options available. I would take each care facility on a case by case basis. Try not to make preconceptions based on the organisation type. My one piece of advice however would be if affordable, privately run (including not-for-profit) generally have increased funds available to create a more stimulating environment than government run facilities.
The size of these organizations varies too. 22% of government run facilities are <20 beds in size. Compare this to not-for-profit, where 50% of sites are 100+ bed facilities. Dementia units within a facility are often smaller in size, around the 20 bed mark. I believe this is preferable, where residents see familiar faces day to day both in terms of other residents and the staff looking after them. This creates a more family feel and reduces potential confusion.
Care services are categorized by the level of care they can provide:
· Low Care
· High Care
· Dementia-Unit
Low care facilities are those that provide the less intrusive assistance, such as for meals, cleaning, washing, as well as a small amount of personal care. High care facilities provide a higher level of personal and nursing care, administering treatments and medication as is needed. Within certain facilities you will find a dementia-specific unit that is in one area, with a set number of beds usually around 10–30 in number.
Which of the aged care facility types is most suitable?
The obvious answer is dementia-specific units, which in my experience is the right one. It goes without saying, however, that quality within each category of care facility varies significantly. The second part of the article regarding general points to look for will assist with this further.
From my experience families have concerns over choosing a dementia-unit for their loved ones- i can understand why. But I’d like to correct some common misconceptions. The largest of these is the concept of controlled areas that are usually swipe access and separate from the rest of the site. This creates an image of an enclosed area, much like a prison. What this actually allows is quite the opposite. With a secure area comes no risk of residents wandering to unsafe and unknown places; they are able to move around at free will. No situation will occur where a resident has to be restrained to limit wandering tendencies.
This is not to say that low/high care facilities cannot accommodate those living with dementia. But with limited freedom to move around, reduced autonomy and quality of life can result. For example, lack of a secure space means an increased risk of wandering tendencies, resulting in risk of harm. Consequently some facilities implement restraint based tactics to limit these risks.
Another key advantage of dementia-units is specially trained staff. Dementia training is crucial for effective interaction between staff and residents to create an inclusive and relaxed environment. Interaction with those living with dementia can be testing and requires appropriate training. Any stimulus that upsets residents can cause unnecessary distress. Well trained staff can limit these occurrences.
What general factors create a dementia friendly environment?
The core theme surrounding dementia friendly spaces is to create a home like environment that is warm and welcoming. The link below provides a useful checklist of preferable characteristics for a dementia friendly setting. I would recommend referring to such a list when viewing any facility.
I will now highlight some specific characteristics I believe are essential to great dementia-friendly homes.
- Personalized bedrooms
Many facilities limit personalizing of bedrooms to preferred furniture and wall paintings, due to the cost of alteration once the room is vacated. But this is crucial to the concept of creating a home like environment for the resident. It is also very important as a safety feature, by highlighting certain objects in the foreground using bold colors which can contrast other objects in the room. The following link provides a great info-graphic on some common principles to abide by.
Another key point to bedroom space is that it is private (not shared) and has an en suite bathroom. When possible keeping the bathroom door open or even removed can limit confusion and any difficulty moving in and out.
2. Garden
A large and stimulating outside space is vital to the enjoyment of residents as well as a regulatory effect on sleeping patterns. The garden should be easily accessible and converge into one with the inside space. It is well documented that regular exposure to sunlight regulates the brains sleeping pattern and will reduce daytime dozes, replacing it with deeper sleeping at night. This will have a positive effect on residents mood- think how grumpy you can be after a bad nights sleep! The following info-graphic provides some key characteristics to look for in a good dementia friendly garden.
3. Animals/pets
The companionship of pets is well known and this is no different for those living with dementia. This can be especially true for those residents experiencing loneliness, which can be fulfilled by the unconditional love of a pet. I have personally experienced resident cats and dogs, who all have a lasting impression on residents- and rarely fail to bring a smile to their faces. A chicken pen is also a great idea. On a point of caution, resident response can vary from day to day, so it is important to supervise such interactions, in particular in the initial phases. The link below summarizes succinctly the benefit of pets to those with dementia.
There are many other points listed in the first link to also look for. But they all revolve around the main point of creating home like environments. A good example of a visually ideal facility is linked below. Note the homely and open layout as you browse through the photos.
Conclusion
Due to the large variation in facility provision and the ever growing number to choose from, selecting the appropriate dementia friendly facility can seem daunting. However, you can narrow the field by abiding to a specific criteria of key characteristics that are essential to comfortable living. My suggestion would be to find (if possible in you region) a dementia-specific unit within an aged care facility. Visiting sites is essential to then gauge whether they fit the criteria of general dementia friendly characteristics. In particular, I would look for beautiful personalized bedroom spaces, expansive gardens full of color and visual stimulus and the inclusion/visits of pets. Other key factors to include are staffing levels and specific-training, as well as level of input from diversional therapy and allied health.
I hope this provides you with some useful information in your quest to find the most caring and appropriate home for your loved one living with dementia.
