Daily Life in Memory Care: Routine, Activities and What to Look For

In California, memory care is provided in assisted living communities and board and care homes, licensed as residential care facilities for the elderly (RCFEs). The regulations do not set a timetable, so a six-bed home and a large community will run the day differently. Our guide to what memory care means in California explains the license behind the name.

The shape of the day is usually similar from home to home, because it follows what tends to work for a person living with dementia. The Alzheimer's Association publishes a sample daily plan for the early to middle stages of the disease. It is written for family caregivers at home, but it shows the rhythm a memory care day aims for:

The National Institute on Aging says people with Alzheimer's disease need to be active and do things they enjoy, and that activities they once enjoyed may become harder as the disease worsens. They may have trouble deciding what to do or getting started. That is the gap a memory care program is meant to fill.

The Alzheimer's Association says a person with Alzheimer's or another progressive dementia will eventually need help to organize the day, and that structured and pleasant activities can often reduce agitation and improve mood. It also says activities can reduce behaviors such as wandering. Regular times for waking up and going to bed are, in its words, especially helpful for a person who has sleep problems or late-day confusion. More on that is in sundowning and behavior changes.

Routine does not mean a full schedule. The Association says not to worry about filling every minute, because the person needs a balance of activity and rest and may need more frequent breaks and varied tasks.

Title 22, section 87219 applies to every RCFE, not only to those that offer memory care. It says residents shall be encouraged to maintain and develop their quality of life through a variety of planned activities, and that the activities made available shall include:

• Socialization, such as group conversation, reminiscence with photos and letters, cultural and religious activities, arts, crafts, games, gardening and pet care.
• Daily living skills that foster and maintain independent functioning.
• Cognitive and mental stimulation, such as reading, puzzles, and board and card games.
• Sensory stimulation, such as music therapy, aromatherapy or pet therapy.
• Leisure time that follows personal interests.
• Physical activities that promote balance, strength, coordination, flexibility and range of motion.
• Education through special classes or activities.
• Free time, so residents can do things of their own choosing.

The same section adds requirements that grow with the size of the home. A home licensed for seven or more people must post notices of planned activities where residents and relatives can see them. A home licensed for 16 to 49 must give one staff member primary responsibility for activities. A home licensed for 50 or more must have one staff member with full-time responsibility and a written program planned in advance. Every home must provide a comfortable living room area and outdoor space that is easy to reach, protected from traffic and has shade.

A home that advertises or promotes special care for people with dementia has a further duty under section 87706. Its plan of operation must describe its activity program for residents with dementia, with activities that support cognitive stimulation, physical activity and reminiscence. The regulations quote Health and Safety Code section 1569.628, which requires such a home to give each prospective resident an accurate written description of its programs and services before admission. You can ask for it.

A calendar tells you what is offered. It does not tell you whether a person who can no longer follow a card game will be included. The National Institute on Aging and the Alzheimer's Association both describe how an activity is adapted for a person with dementia, and their advice is a fair yardstick for what you see staff doing.

The National Institute on Aging suggests matching the activity to what the person can do, helping them get started, watching for frustration, and letting them simply watch if they enjoy that more. Its examples include simple household tasks such as setting the table or folding laundry, music and dancing, gardening, time with pets and gentle exercise.

The Alzheimer's Association adds that enjoyment matters more than achievement, that an activity linked to a person's former work can be satisfying, and that as the disease progresses more repetitive tasks may suit the person, who will eventually take a less active role. If attention fades or frustration rises, it says, it is likely time to end or change the activity. It also advises not criticizing or correcting the person. Family visits are part of the day too, and the same approach applies: see visiting a parent in memory care.

The Alzheimer's Association's questions for families choosing a care community include whether planned activities really take place, whether they run on weekends and evenings, and whether residents look comfortable, relaxed and involved. These checks follow from that list and from the state rules above. A longer set is in questions to ask a memory care home.

Size changes the picture. The staffing rules for activities differ for small and large homes, and so does the feel of the day. See board and care compared with a large memory care community.

Hamssa Benrekia is a senior living placement specialist in Torrance who helps families in the South Bay and Harbor area of Los Angeles County with memory care placement. She asks about your parent's routines and interests as well as their care needs, shortlists licensed homes she has toured herself, and goes on tours with you, where you can see the middle of a day for yourself. She does not run any home or its activities.

To talk about what kind of day would suit your parent, contact Hamssa. The rest of the series is in the California Assisted Living Placement Guide.