Housing & Alzheimer's: Moving On to Create a New Home

About 18 months ago, my grandma who is now 85, put her name on the waiting list for an assisted living apartment.

My uncle’s step-mom lives in the building, so we all met with her for an unofficial guided tour. Since then, I’ve been in the building while canvassing for an election, and it continued to strike me how great this environment would be for my grandma - but how now, eighteen months later, adjusting to the environment would prove more difficult than it would have when she first put her name on the list. And, it goes without saying much has changed on the inside of the building since then to keep tenants as safe as possible during these challenging times.

Housing options for people with Alzheimer's

Of course, staying home as long as is safely possible is ideal right now. That said, timing is always a challenge. Anyone who has a loved one with Alzheimer's has faced this battle between levels of independence, desires of both the person with Alzheimer's and their loved ones, and the delicate balance between changing care needs and levels of care available.

Once a person moves into an apartment or care home with one level of care, how long will that stage of care be appropriate for them?

Different levels of care

Over the past many months we’ve learned about these different care levels. They may have different names or change slightly based on where you live, but I presume them to generally be the same. This wording is based on the senior care system in Canada.

• Independent living at home. Many people with earlier stages of Alzheimer's are, of course, able to live at home, either alone or with their spouse.
• Home-based care. Some people with Alzheimer's, depending on their needs and family situation, may live their whole lives in their own home. Live-in or visiting caregivers, or family members, may assist with care needs, activities of daily living, meal preparation, and so on, in the person’s home.
• Assisted living. These facilities offer a greater number of amenities in an apartment-like setting. Suites may have full kitchens or kitchenettes, sometimes with common area kitchens for tenants. They offer meals in a dining room, social activities, housekeeping and laundry services, transportation to shopping and other activities, and generally have supports in place to help ensure safety and wellbeing. For example, at the complex we toured, if residents don’t put out their garbage each morning, or their “no garbage today!” magnet, a staff member will check to ensure they are okay while ensuring a high level of independence when protocols are followed! There may also be different specialties of assisted or supported living homes. Where I live, assisted living and supportive housing are two separate tiers. Supportive housing is for seniors who need 24-hour supervision and support but may have different care needs, and some may specialize in supporting people with dementia.¹ They may be smaller and better suited to people with dementia in some cases. In other places, supportive housing is a “lower” tier than assisted living, further complicating the issue!
• Home care. As mentioned, home care may be provided to people still living in the greater community, but may also be used in tandem with lower-levels of senior living care, for instance, assisted living facilities.
• Long-term care/Nursing homes. Not all senior care residences include nursing services, though some basic care may be available. Long-term care homes or nursing homes offer specialized healthcare services for seniors. Where I live, they are also referred to as personal care homes. These homes manage medications, meal services, socialization and recreation, and most aspects of life for seniors with higher care needs. These facilities can offer a higher degree of safety to seniors with dementia and are equipped to facilitate some Alzheimer's care, such as through alarmed doors and elevators activated by a wristband, while allowing others without wandering concerns to access doors and elevators more freely. Some long term care may be in converted family homes that are set up to care for multiple seniors in a home-like environment and include similar health care services to nursing homes.²
• Dementia/Memory care. Some memory care facilities may operate independently from nursing homes, but others consist of a locked and/or alarmed unit or wing in a personal care facility. These are facilities specializing in caring for people with Alzheimer's disease, including higher staff ratios and special training.³ They will provide programming most appropriate to people with later stages of Alzheimer's disease, and support consistent with the individual’s level of need.

Certainly, there is no best option for all situations—it all depends on what works for a person and their family.

Figuring out what housing option is best

Most often, doctors, occupational therapists, social workers, and families will help seniors figure out where the safest and most beneficial living environment might be. If you are facing a move and housing change in the midst of these challenging times, it is likely to be even more complicated than in “normal times”, when it still wasn’t easy!

When I visited the assisted living facility nearby during last year’s election, I pointedly asked people how they liked living there. Most answered happily, if not extremely positively. I was pleasantly surprised as I figured most folks would be reluctant to move away from what's familiar. As I saw tenants clustered in hallways and in the area outside the dining room for an after-dinner chat and walked through the back of the recreation room where a movie was playing on a large screen from a projector, it again made me think how this would be such a great environment for someone like my grandma. This is especially true given the fact that she can make conversation with anyone she comes across!

As things get tougher for my grandma to manage at home, even though it’s hard, we are all as a collective looking forward to when she is able to move, and use her energy for the things she enjoys—rather than spending large portions of the day on food prep and other chores that are becoming more difficult as the months go on!

As a millennial who struggles to make friends myself, I can just imagine how many acquaintances she may reunite with from long ago or new friends she will make. And while we’d be anxious about her moving during these difficult times, I think as long as things are done safely, it will all work out for the best, even if it takes a while to see it happen.

What helped you to figure out which housing option or options were better for your loved one? How did they adjust to a new living environment?