Questions to Ask on a Memory Care Tour in California

Start with paper. Health and Safety Code section 1569.627 requires any home that advertises or promotes special care for persons with dementia to disclose its special features in its plan of operation and to provide that information to the public on request. A related statute, quoted in the dementia care regulation, requires an accurate written description of the program to be given to each prospective resident before admission.

So you are entitled to ask for it, and the way a home responds tells you something. Under Title 22, section 87706, the description covers the program's philosophy, the areas of the building where dementia care is provided, staff training, activities, the physical environment, what happens when a resident's condition changes, and how the home judges whether its program works.

Do two more things first. Look up the home's public licensing record, using our guide on how to check an RCFE license. And bring the general assisted living tour checklist, which covers cleanliness, meals, contracts and fees. This page adds what is specific to dementia.

California allows several ways of keeping a resident from leaving unsupervised, each with its own conditions. Residents also keep the right to leave, so the answers here show how a home balances the two.

• Are your exterior doors alarmed, on a delay, or locked? What does your fire clearance approve?
• What would my mother or her conservator be asked to sign? A home with locked doors must keep a signed statement of voluntary consent, or a court order for a conserved resident.
• Do you use wristbands or tracking devices? These need prior written approval from the resident or conservator.
• When a resident wants to go outside and cannot be redirected, who goes with them?
• Where can residents walk freely, indoors and outdoors?
• How many times did a resident leave unsupervised in the past year, and what changed afterward?

California sets no staff ratio for memory care. It requires enough competent staff to meet residents' needs, and it sets training hours. Health and Safety Code section 1569.626 requires 12 hours of dementia care training for new direct care staff and 8 hours every year, in every licensed home.

The night rule is the one most worth asking about. In a home with fewer than 16 residents, the night caregiver must be awake and on duty only if a resident with dementia has been found to need awake night supervision.

• How many caregivers are on the memory care unit on each shift, and for how many residents?
• Is the night caregiver awake? If your home is small, how was that decided?
• Who provides your dementia training, and what does it cover?
• How long have the caregivers I am meeting today worked here?
• Will the same caregivers help my father most days?

The Alzheimer's Association suggests asking how a community handles challenging behaviors and what dementia training its staff receive. California's rules give you something concrete to ask for: when staff see behavior that could cause harm, the home must record what happened just before it and use the least restrictive response.

• What do caregivers do when a resident becomes agitated in the evening?
• May I see, with names removed, how you record a behavior and what led up to it?
• What do you try before calling the doctor about a behavior?
• If a doctor orders a new medication, when is the family told?
• What do caregivers do when a resident refuses a pill? Staff may not force medication or hide it in food without the resident's knowledge and consent.
• Who assists with medications on each shift?

A program description must include activities that support mental stimulation, physical activity and reminiscence. The Alzheimer's Association suggests checking whether the posted activity schedule is actually followed and whether there are activities on evenings and weekends. Our guide to daily life and activities in memory care explains why routine matters.

• What did residents do yesterday afternoon? Ask a caregiver, not only the marketing director.
• How do you help a resident who no longer joins group activities?
• Who helps residents who need assistance to eat, and how do you keep track of how much they eat and drink?
• Can meal and wake times bend around a resident's lifelong habits?
• Can families visit at any reasonable hour and join a meal?
• May my mother bring her own furniture and photographs?

Dementia progresses, and the home you choose today will be asked to do more later. The program description must explain when a reappraisal is done, at what point, if any, a licensed medical professional is involved in it, and the conditions that would require a resident to be relocated.

Each home decides what it can manage, so two licensed homes can give different answers about the same person. Write the answers down, with the date and the name of the person who gave them. What memory care costs and why is in memory care cost in California.

1. 1

   Ask what would make the home say it can no longer provide care

   Common examples to raise: needing two people to transfer, hitting or shouting, repeated exit attempts, no longer walking, or needing help to eat.

2. 2

   Ask what happens after a hospital stay

   Find out who reassesses the resident before they return and how quickly.

3. 3

   Ask whether hospice can come in

   Ask whether residents have stayed through the end of life, and how often.

4. 4

   Ask how the price changes as needs grow

   Ask what the care levels are, who decides a level has changed, and how much notice you get.

Watch more than you listen. The Alzheimer's Association suggests noticing whether residents appear comfortable, engaged and well groomed, whether personal care is done respectfully, and whether indoor and outdoor areas are safe and easy to find your way around. Visit in the late afternoon, and visit a second time unannounced. If you see a resident in immediate danger, 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 who holds an RCFE Administrator Certificate. She helps families in the South Bay and Harbor area of Los Angeles County shortlist licensed homes, schedules tours and goes on them with you. To talk about memory care placement, contact Hamssa. The rules behind these questions are in California's dementia care rules, and the California Assisted Living Placement Guide covers the rest of the decision.