Board and Care Home or Large Memory Care Community for a Person With Dementia

No. A board and care home in a house on a residential street and a large memory care building are both licensed in California as residential care facilities for the elderly (RCFEs). Title 22, section 87705, on the care of persons with dementia, applies to both. So does section 87706 if the home advertises dementia care, whatever its size.

The Alzheimer's Association describes memory care units as dedicated areas, often a floor or wing of a larger residence, designed for people with dementia. It notes that such units may or may not be secured, and that not every assisted living provider offers dementia-specific services, so families need to ask. The same is true of small homes: some care mostly for residents with dementia and some do not take them.

Each home also decides for itself whom it can care for, so two licensed homes of the same size can answer differently about the same person.

Most of the rules are identical. A few depend on how many residents the home has or is licensed for:

The first row deserves attention. In a small home the night caregiver is not automatically awake. If your mother gets up and walks at night, raise it during the appraisal and ask the home to tell you plainly how it staffs the night.

A typical board and care home is a single-family house with a handful of residents, a shared living room and kitchen, and one or two caregivers on a shift. For many people with dementia that scale is the point.

Costs for this kind of home are covered in board and care cost in California.

• Fewer faces. The same few caregivers and housemates each day can be easier for a person who is confused by change.
• Less noise and less distance. The bedroom, bathroom and table are a few steps apart.
• Close observation. A caregiver in a small house tends to notice early when someone is eating less or sleeping badly.
• Limited room to walk. A person who paces for hours may run out of hallway, and the yard may be small.
• Thin staffing margins. When one caregiver is helping a resident in the bathroom, ask who is watching the door.
• Fewer organized activities. Ask what residents actually do between meals.

A large community usually places memory care in its own wing, floor or building, with its own dining room and staff. What that tends to bring:

1. 1

   More space built for walking

   Many have looped hallways and an enclosed courtyard. Health and Safety Code section 1569.699 ties delayed-egress exit doors to buildings with automatic sprinklers and smoke detection throughout. See wandering and exit-seeking.

2. 2

   More people on a shift

   There are more caregivers in the building and awake staff at night by rule. There are also more residents for each of them, so ask for the numbers on the memory care unit itself.

3. 3

   A planned activity calendar

   Larger communities often employ activity staff. Check that the posted schedule is what happens, on weekends and evenings too.

4. 4

   More stimulation

   A busy dining room, alarms and many unfamiliar faces can unsettle some people with dementia. Watch how residents look at the busiest time of day.

5. 5

   More staff turnover to ask about

   With a larger team, your father may see many different caregivers in a week. Ask how assignments are kept consistent.

Monthly costs and what drives them are in memory care cost in California.

There is no rule for this, only patterns to test against the person you know. Someone who is frail, quiet, easily overwhelmed or late in the disease may do well with the calm of a small home. Someone who is physically strong, walks constantly, tries the doors or enjoys a crowd may need the space, the secured exits and the activity of a larger community.

Think about the next two years as well as this month. Ask each home which changes in your parent's condition would lead it to say it can no longer provide care, and whether a move within the community is possible. A home that advertises dementia care must describe those conditions in its plan of operation.

Then tour both kinds in the late afternoon and ask identical questions. Our list of questions to ask a memory care home works for a six-bed house and a large building alike.

If you ever see a resident in immediate danger in any home, call 911. Complaints about a licensed home go to California's Community Care Licensing Division.

Hamssa Benrekia is a senior living placement specialist in Torrance. She knows many small homes and larger communities in the South Bay and Harbor area of Los Angeles County, and she refers families only to licensed homes she has toured herself. She can arrange tours of both kinds and go with you. To talk about board and care placement or memory care placement, contact Hamssa. The California Assisted Living Placement Guide covers the rest of the decision.