Choosing an Alzheimer's special care unit

By BARBARA BEAN-MELLINGER

Feeling Fit Correspondent

Many Alzheimer's patients who are cared for at home eventually become too much for their caregivers to handle. But where to place the loved one becomes the next big dilemma.

Almost 60 percent of patients in nursing homes have Alzheimer's disease or another form of dementia, according to the Alzheimer's Association (www.alz.org). So if a nursing home is the chosen placement, the loved one will surely be among other patients with the same disorienting disease, and staff that are trained to care for them.

There are problems inherent in placing Alzheimer's patients in the general nursing home patient population, however. Traditional floors of nursing homes are not typically laid out in the best way for dementia patients.

With open corridors and crossing hallways, it's easy for patients to become disoriented, frustrated and lost. Even well-meaning and well-trained staff can have difficulty focusing on the specialized, sometimes intense needs of Alzheimer's patients when they are also caring for patients with other needs.

Another option that has grown in recent years is the Alzheimer's disease special care unit (ADSCU). These are dedicated areas of a nursing home or other facility where Alzheimer's patients are cared for together by one staff dedicated to the unit.

When ADSCUs were first started 20 or so years ago, they were not regulated and one facility could be far different from another in its level of specialty care. Sometimes, they were not much more than a marketing mechanism to attract patients, with few accommodations made for their special needs.

Today, however, thanks to Alzheimer advocates, state disclosure laws require facilities to inform the families of prospective patients exactly what the ADSCU's special services include, and if the cost for the ADSCU is higher than the cost elsewhere in the facility.

This way, families can make informed decisions when choosing between facilities in the difficult decision of where to place their loved one.

In his article, "Alzheimer's Disease Special Care Units," social worker Daniel L. Paris, MSW, highly recommends these specialized units for Alzheimer's patients. Although each family will have special considerations for their loved one, Paris suggests some criteria to look for in an ADSCU:

•A physical layout that has been designed or modified for Alzheimer's patients; one that maximizes safety while minimizing confusion, including methods for preventing wandering.

•Constant lighting, color-coded walls, signs and memory aides visible.

•Staff that is trained to manage symptoms with "techniques like distraction, reminiscence and successful non-verbal communication," and that receives continuing education annually.

•Patient activities that are modified with Alzheimer's disease in mind.

•Programs for families, such as education seminars or support groups.

"In evaluating an ADSCU, caregivers should ask very clear questions about facility design and staff training," Paris writes.

Sometimes it isn't possible to find a facility that has everything you want, that is affordable and close enough for the family to visit. In these cases, Paris recommends choosing well-trained, caring staff over the facility.