Recently, I have noticed more senior care facilities offering what I shall call “mixed care,” which means they are caring for seniors both with and without dementia in the same environment. Some of these facilities seem to imply that their ability to offer this option suggests that they are more capable and flexible, and therefore providing better care.
First, let’s clarify the different standards of care that may be involved. Facilities that provide care for seniors without dementia are typically called Assisted Living Communities. They are served by Certified Nurse Assistants (CNAs) who are professionally trained, and Resident Assistants (RAs) who have on-site training, but neither of these rises to the standards required for proper dementia care.
Facilities that specialize in dementia care are typically called Memory Care Communities, and their staff are required to have eight hours of dementia-specific training, which they can do by watching videos within their first nine months on the job. So, their being “on the job” does not necessarily mean that they have completed dementia care training.
I see two areas of concern with facilities that mix these two populations. The first is the staff/resident relationship. In most cases, the population with dementia will be a minority population. If most of the residents are assisted living clients without dementia, will all of the staff be trained to the higher standards required for dementia care? In my experience, in most cases they are not. Levels of training should be clarified before you admit your loved one to a “mixed community.”
In addition, higher standards of dementia care require more attention to the environment than we find in most Assisted Living Communities. People with dementia react adversely to over-stimulation, and this can include visual and auditory stimulation. To really address their needs, a lot of attention should be given to floor coverings, wall color, furniture, lighting, sound, and window design, placement, and covering. Assisted Living Communities need only imitate apartments or hotels in their design and decoration. Any community offering “mixed care” would need to adhere to the higher and more costly standards of design necessary for good memory care. If clients with dementia remain the minority of the population, I doubt this extra attention to environment will be provided.
My second area of concern is the resident-to-resident relationship. Attempting to serve a mixed community will raise many challenges in finding ways that dementia residents will not be considered “disruptive” by residents without dementia; and, conversely in assuring that non-dementia residents will not be impatient, rude, and confrontational toward patients with dementia. Frankly, I think mixing populations is a sure recipe for conflict.
I am all for innovation and experimentation in the development of better dementia care. Those who have read my columns know how much I have praised the fresh ideas coming out of the so-called “dementia villages” in Europe. But I suspect trying to pass off “mixed care” as effective and innovative in our culture, where standards of care remain minimal, is a bridge too far.
I fear that in our profit-based system of senior care, mixed care is just another way to cut corners and reduce expense. I think we all deserve the best, which I believe cannot be provided through mixed care.
Debbie Selsavage is a Certified Trainer and Consultant in the Positie Approach to Care®, and a Certified Dementia Practitioner. Her company, Coping with Dementia LLC, is dedicated to making life better for individuals living with dementia. Contact Debbie at deb@coping.today to learn about free support groups on line.
Until next time remember: “We all deserve the Best”
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