My neighbor’s elderly father suffers from dementia. However, it’s not the memory loss that makes caring for her father so challenging—it’s the behaviors that have erupted alongside it. His dementia, she says, has reached a point where she is no longer willing to care for him. He yells. He hits. He’s mean. The stress of spending time with him has become completely overwhelming. Moving him into a memory care facility has become her only option.
My neighbor is just one of 16 million family members caring for someone with dementia or Alzheimer’s disease today. A staggering 1 in 3 people will die with some form of dementia, and the number of people with Alzheimer’s will top nearly 14 million by 2050. It makes sense, then, that memory care communities are the fastest-growing sub-segment of senior housing. But is “memory care” the right solution to the problem? One expert, Paul Nussbaum, Ph.D., a board-certified clinical and geropsychologist focused on brain health in aging, says it may not be enough.
While research is scant, reports have shown up to 68% of long-term care residents have experienced cognitive impairment, with more than 40% experiencing impairment that is moderate or severe. And though many reports link dementia and aggression, 90% of dementia patients are also believed to experience psychiatric co-morbidities that increase the potential for problem behavior. It’s no wonder that behavioral health and aging are starting to get some attention.
Aggression, especially, is taking its toll on memory care workers and residents alike. AARP says some 10-20% of long-term-care residents have been bullied by an aggressive resident, and an unknown number of dementia sufferers has been abused by frustrated staff members. An increased focus on behavioral care may prove a better solution for both resident outcomes and worker satisfaction. But what does behavioral health in senior care look like?
Creating a New Definition of Memory Care
There is no universal definition of memory care in the United States. Services vary widely from state to state. While families may assume that memory care units offer a higher staff-to-resident ratio than standard assisted living communities, just seven states specify minimum staffing levels in dementia care units. Further, just 14 states describe the types of staff that dementia care units must employ. On the upside, there is tremendous latitude in redefining what dementia care looks like for senior living and home care operators.
One possibility, Nussbaum says, is to add dedicated Behavioral Intensive Care (BIC) units to the continuum of care already provided in assisted living. BIC units would provide seamless care—both short and long-term—for those experiencing behavioral episodes that may cause risk to themselves or others. Much like the dedicated memory care wing of an assisted living community, a BIC would maintain the same quality and atmosphere as the overall community but would be staffed by behavioral health experts.
“Those experiencing behavior issues are the first to be discharged from senior care communities,” Nussbaum says. “But sending an aging dementia patient to a psychiatric hospital is the worst thing you can do because those facilities are not set up to care for the aging.”
David Cole, executive director of Welbrook of Santa Monica – Memory Care (Santa Monica, Calif.) agrees that the options open to those suffering from behavioral health issues in today’s care market are limited. Still, as a memory care administrator, he acknowledges there could be challenges to establishing BICs or increasing the options available for behavioral care. First, he says, state regulations often prevent care communities from accepting patients with behavioral health issues. Meanwhile, the pool of trained professionals who deal with geriatric psychology remains incredibly limited, and the costs of employing them, especially on a 1:1 basis, would be high. Still, there are some things the industry can do to help bring behavioral issues to the forefront.
- Make early, ongoing screening a priority. “The problem in our industry is that we don’t mention cognitive function until something goes wrong,” Nussbaum says. “We need to start tracking cognitive function regularly while people are healthy so that we can better sense and support cognitive decline.”
- Mandate training and education. Research shows that providing staff with mental health training improves resident outcomes. “There is training out there regarding the subject,” Cole says. “Practical experience is the number one teacher.” According to Cole, that also includes educating the greater care community on the important role medication can play in treating behavioral concerns and accepting that there is still a place for medications.
- Reduce the stigma surrounding mental health. “State regulatory agencies don’t understand aggression and acting out, so they tend to prohibit us from serving residents with those issues,” Cole says. “Each state needs to develop regulations for a new type of facility that addresses these issues more fully with an understanding that when many residents are aggressive, increased liability may be unavoidable.”
Regardless of whether a new type of facility is created in the long term, it’s essential that regulatory and healthcare professionals begin to work more closely with providers to better understand the realities in assisted living communities unique to cognitive impairment.
“At the end of the day, we [operators] need to be trusted to care for residents with challenging behavioral issues,” Cole says. “We need to be supported by the state and medical community when we do so.”