What Does “Memory Care” Really Mean?

“We are looking at Shady Acres for Mom – it is a Memory Care facility.”  This is something usually said by a family member with a certain level of satisfaction. Now, in this story, Shady Acres is a fictional place, at least that is my intention. But because Shady Acres is a Memory Care facility, the family is convinced it is going to be the perfect place for their mother with early stage dementia, and that she will receive better care there.

I steel myself. It is time to stick the pin in the balloon. I’m sorry, I really don’t mean to let the air out, but I have to tell you something important. You need to know the truth. I can tell you are trying to do the best thing for your loved one so you need to know this.

“There is something very important you need to understand about memory care,” I start.

“It doesn’t mean anything. It is a marketing term.”

Then I have to explain what this means, since the family has been convinced that “memory care” is something specific, and they are usually shocked at the words that just came out of my mouth.

The first part of the explanation goes something like this: “The kinds of assisted living facilities you are looking into for your mom all have a certain level of licensing from the state. The kind of licensing is based on the level of care they provide. This facility is licensed as a Community Based Residential Facility, or CBRF for short.”

This is true of most facilities that hold themselves out as “memory care” in Wisconsin, where my elder law firm is located. The level of care in a CBRF is one level below that which is required to be provided in a nursing home. My clients usually use these names interchangeably. Most of my families generically refer to the places they are looking at as “nursing homes” or “assisted living” without really understanding the differences.

Those differences are important. Nursing homes have a higher level of care, with strict requirements for the number of nursing staff hours required to be provided per patient.  A CBRF has a much more generic staffing requirement, essentially one person on staff at all times in most cases, regardless of whether there are 3 residents or 30. An additional requirement states that the CBRF needs to have “sufficient” staff to care for the residents. During a client meeting, I help families understand more about what this might mean for their loved one by going into more detail than I can do here.

And how does “memory care” fit into these requirements? It doesn’t. So I launch into the second part of my explanation: “Memory care is not a recognized level of care like nursing home or CBRF. There is no additional staffing, licensing, or training required in Wisconsin for a facility to call itself ‘memory care.’ That bears repeating. In Wisconsin, a facility does not have to complete any special training or certification to say it is ‘memory care,’ and it does not have to have any more staffing than any other place of the same licensing classification.” 

So what it boils down to is that “memory care” is a marketing term chosen by the facility itself to hold itself out to people with Alzheimer’s, Dementia and other cognitive issues. You cannot assume it means anything. You need to do your homework.

Don’t get me wrong – I don’t mean to say that memory care facilities are bad. Possibly, in calling itself “memory care”, the facility is giving you information that it truly wants to provide  special services to people with dementia. There are “memory care” facilities that genuinely pride themselves on the quality of care they provide for this population. You will be able to figure this out by asking a lot of questions:

  • What do you mean by “memory care?”
  • What training do you provide your staff for caring for patients with dementia?
  • What training do you provide your staff for dealing with people who are agitated or aggressive?
  • Do your staff have any special licencing or certifications related to “Memory Care?”
  • What activities do you provide for people with memory loss? Why do you believe they are appropriate?
  • What is your caregiver/resident staffing ratio?
  • How many times have you terminated a resident’s tenancy for behavior related issues?
  • How many times have you contacted police or adult protective services or a crisis team to respond to behavior related issues?
  • How many times have you terminated a tenant’s stay because you could not provide sufficient care for their needs?

For more tips, there is a detailed list of questions available on the Alzheimer’s Association website. You can find it here.

Once you dig deeper into what the facility can actually provide, you will understand which facilities genuinely are dedicated to serving people with memory issues, and which are simply trying to get your business. I recommend to my clients that they explore a variety of places, not only the ones that call themselves “Memory Care.”

An example from my own caregiving experience is on point. The first place I moved my mother into was one of the highly recognized “memory care” facilities in the area. It had a good reputation from what I could dig up. After Mom had been there for awhile, I noticed she was losing a lot of weight. I asked the staff about it and they said that often she stayed in her room during mealtimes and did not eat. My next question was “Well, what kind of things do you do to encourage her to eat?” Eating had never been a problem when she was living with me. In fact, it was the opposite, because she would often take a snack and fifteen minutes later, take another since she forgot she ate the first one. The response to my question was, “well, when it is mealtime, our activities director comes and knocks on the resident’s door, and if they come out, they come out. If they choose not to, that is up to them.” I followed up: “What if the person was busy in the bathroom when they knocked, or maybe did not hear, is there a follow up?” Answer: “No, we don’t have the staffing to do that. The residents make their own choices.” OH COME ON. These are people with Alzheimer’s. In five minutes they will forget that someone knocked, it doesn’t mean they shouldn’t eat! How can a person make a “choice” not to eat when they forget that eating was offered in the first place? I ended up spending several weeks bringing mom food and sitting with her while she gladly ate every bite, until she gained weight back.

It did not take a long time before I decided to move Mom out of that “memory care” facility, and into a very nice, smaller facility that did not call itself “memory care.” It just called itself a CBRF. Exactly like the first facility in terms of licensing. But the care was more personal and attentive. The staff there were well trained in working with people with dementia. Mom never skipped a meal there, because she was encouraged to join the mealtime crowd. It wasn’t the branding that mattered. It was the training and care.

Don’t hesitate to ask all the questions you need to before making decisions, and now that you know what “memory care” really means – and does not mean – you can focus on the services and training instead of the name. Because it is the service, training and care, not the name, that will make the difference for your loved one.

I hope that someday soon there will be regulations in place that require a facility holding itself out as Memory Care to meet certain requirements of training and staffing. If you would like to see this too, let your legislator know.

About Carol J. Wessels

I am an Elder Law Attorney practicing in Wisconsin. I am the owner of Wessels & LIebau LLC in Mequon, WI. I handle Medicaid, Long Term Care planning, special needs trusts, guardianship, advance directives, elder abuse and other related issues for elderly and disabled clients and their families. My Mother Velma lived with Alzheimer's for fifteen years until she died on Jan. 24, 2015, which has given me a personal perspective on elder law issues as well.
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