Moving a Parent With Dementia Into Memory Care: Planning the Day

The National Institute on Aging describes moving a person with Alzheimer's disease into a care home as a big change for the person and the caregiver alike, and says plainly that moving day can be very stressful. Its advice for the weeks before is short: get to know the staff before the person moves in, talk with them about ways to make the transition go well, and be an advocate for the person's needs and preferences.

In practice that means the staff should know your parent before they arrive: what they like to be called, when they wake and sleep, what they eat, what upsets them and what calms them. Write it down and hand it over. The home will also do its own appraisal and need medical paperwork, which our guide to move-in requirements explains.

The Institute also suggests talking to a social worker about your own feelings and about how to help your parent adjust. It notes that caregivers may feel loss, sadness, guilt or even relief, and that all of these are normal.

No rule or study cited here names a right hour. What the National Institute on Aging says about outings is a useful guide: plan them for the time of day when the person is at their best, and keep them from running so long that the person gets too tired.

Ask the home what time it prefers for a move-in and why, and tell the staff which part of the day is usually your parent's clearest. Then agree on an arrival time together.

Neither the National Institute on Aging nor the Alzheimer's Association offers a script, and neither says how far ahead to tell the person. Families handle this differently, and the staff at the home and your parent's doctor are the people to ask about your parent in particular. What both organizations do describe is how to talk.

On the move itself, the Institute's advice is to be supportive and listen to any concerns, but not to argue with the person about why they need to be there. On communication in general it suggests the following:

• Be aware of your tone, volume, facial expressions and body language, and aim for a warm, matter-of-fact manner.
• Be open to the person's concerns, even when they are hard to understand or to address.
• Ask questions that can be answered yes or no.
• If something is not understood the first time, try again with different words.
• Be patient with angry outbursts and try a distraction, such as a favorite snack or a walk outside.
• Do not talk about the person as if they were not there.

The Alzheimer's Association's advice for moments of confusion is similar: respond with a brief explanation, and do not overwhelm the person with lengthy statements or reasons.

A parent who says no clearly and consistently raises a different question, about rights and decision-making, which is covered in when a parent refuses assisted living.

Among the questions the Alzheimer's Association suggests asking a care community is whether residents may bring familiar items, and it gives photos, bedding and a chair as examples. It also suggests using photographs and other reminders to help a person recall important relationships and places.

California's regulations point the same way. For homes that advertise dementia care, Title 22, section 87706 calls for a safe, secure, familiar and consistent environment, and lists bedroom decor and memory boxes among the things a home may consider. Ask the home what it recommends, what will fit, and what it would prefer you leave out for safety.

Many memory care homes control their exits. Under Title 22, section 87705, a home that locks exterior doors or perimeter gates must keep one of two documents in the resident's record. For a resident who is not under conservatorship, it is a written statement signed by the resident saying they understand the home has locked exterior doors or gates and voluntarily consent to that on admission. For a resident who is conserved, it is the court order showing the conservator's authority to place the person in such a home.

This is a legal matter, and this page only describes the rule. If you are unsure whether your parent can give that consent, ask the home how it handles this and speak with an elder law attorney. How homes manage exits day to day is covered in wandering and exit-seeking.

The Alzheimer's Association says a change in care setting can cause temporary behavioral changes such as increased confusion, and that a person living with dementia will need time to adjust. The steps below pull the sourced advice into one order:

1. 1

   Arrive when your parent is at their best

   Use the time you agreed with the home.

2. 2

   Hand over to the staff you have already met

   The National Institute on Aging's point about knowing the staff beforehand pays off here. Give them your written notes on routines and preferences.

3. 3

   Listen, and do not argue

   If your parent objects or asks to leave, the Institute's advice is to be supportive and hear the concern without debating why they need to be there.

4. 4

   Ask staff how they will help with the transition

   The Alzheimer's Association suggests asking this directly. It says temporary sleep problems, wandering, falls and appetite changes may follow a move.

5. 5

   Check in regularly

   The Institute advises watching for signs that your parent needs more attention, is getting too much or too little medication, or is not getting the care they need. Our guide to visiting a parent in memory care covers the visits themselves.

6. 6

   Build a working relationship with staff

   The Institute describes the aim as working together as care partners. You know your parent, and they see the whole day.

If a change is sharp or sudden, do not put it down to the move without checking. The Alzheimer's Association advises a medical evaluation any time there is a sudden change in behavior, to rule out other causes. What the weeks after that usually hold is in the first month in assisted living.

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 goes on tours with families, which is one way to meet a home's staff before any decision, and she checks in after the move. She is not the home's staff and does not direct care.

If you are planning a move and want to talk it through, contact Hamssa. More topics are in the California Assisted Living Placement Guide.