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How to Evaluate an Alzheimer Special Care Unit

Provided by the
Alzheimer's Disease and Related Disorders Association
of Eastern Massachusetts, Inc.


An Alzheimer Special Care Unit is defined as a dedicated nursing unit that provides enhanced care and a specialized program of activities for patients with a diagnosis of Alzheimer's disease or a related disorder. A good Alzheimer Special Care Unit creates a therapeutic environment that uses several different techniques that serve to keep the resident independent for a longer period of time in a safe, caring environment. Because the purpose of these units is to care for a unique population of patients, a memory diagnostic evaluation is required by most Alzheimer Special Care Units.


The Alzheimer's Association of Eastern Massachusetts suggests that families address the following issues when going through the process of searching for a special care unit:

1) Determine if your loved one with Alzheimer's will benefit from a Special Care Unit or if they would do well in a nursing home with an integrated population. Special Care Units provide active therapy and behavioral management for individuals who wander and may be difficult to manage in a non-specialized facility. Units can also benefit individuals who require more structure and specialized 'failure free' activities. Visit both types of nursing homes before you make your choice. Consult with your doctor or behavioral specialists to help with this decision, if you are unsure.

2) Who will evaluate your loved one for possible placement and what information will you need to provide?

3) Ask to see a copy of the 'mission statement' or the 'philosophy of the unit.' Does it reflect a philosophy that is therapeutic in its approach to the care of persons with dementing illnesses?

4) Is there a secure door system in place which allows patients to ambulate freely within the unit but also guards against wandering off the Special Care Unit and outside of the facility?

5) There should be rooms that are dedicated to activities and dining on the Special Care Unit and used only by dementia residents.

6) Ask to see a copy of the activities calendar for the current month. The Alzheimer's Association recommends that there be a full-time activities professional who works exclusively on the Special Care Unit and provides a minimum of 60 hours per week of dementia appropriate activities. Interview the Activities Director.

7) There should be a staffing ratio of 1 staff person to 5 residents on all but the overnight shifts. This ratio can include all contact staff on the unit such as activities, social work, physical therapy, occupational therapy, and others. The number of overnight staff is determined by the residents' needs but it should not fall below a 1 to 9 ratio.

8) Ask for a list of primary care physicians and consultants that provide services to residents at the facility. If your family member required emergency or acute care, what hospital does nursing home use for residents?

9) Ask the facility what their policy is regarding the use of physical or chemical restraints. During your tour be observant for signs of residents in geri-chairs, with vest or waist restraints, or resident that may appear to 'look chemically restrained.' How are behaviors managed on the unit?

10) The Alzheimer's Association recommends that a geriatric psychiatrist experienced in Alzheimer care be affiliated with the Special Care Unit and evaluate the use of all psychoactive medications on a periodic basis. This psychiatrist should regularly examine residents on the Special Care Unit.

11) What are the policies related to transfer and/or the discharge from the Alzheimer care unit? What happens when a resident is considered inappropriate for the unit? What happens when a private pay resident becomes Medicaid eligible?

12) How do family members relate to staff and participate in daily care? What are the facility's policies on visiting? After you have toured the unit with a staff member from the facility, plan a second visit to the home either during a meal-time, during the evening shift or on a week-end. This will allow you to see how the unit deals with issues of increasing confusion and behavior management during non-peak hours of staffing.

13) Does the facility have a written waiting list, and will the family receive notice when there is a bed opening?

14) To what extent does the nursing home use agency nurses or nursing assistants? Excess use of agency staff is a negative factor. Does the unit assign the same staff to residents each day, called primary care nursing, a preferred model?

15) Does the design of the unit compensate for cognitive losses such as: color coded rooms to assist with room finding, dull floors to reduce reflection that impede walking, bright non-glare lighting to reduce sundowning, safe indoor and outdoor walking areas to name just a few?

16) Is there a hospice program affiliated with the unit?

17) Is there a support group run by the Special Care Unit for family members of those with dementia?

18) Is there a support group run by the Special Care Unit for their staff?

19) What type of special communication techniques are used by the staff with the dementia residents? How are residents assisted with activities of daily living?

20) Ask to sit and simply observe an hour or more. Do the nursing staff genuinely like the residents and interact with them in a loving way?

21) Ask the administrator for the names of other family members that you can speak with. Call the Alzheimer's Association to see if the home is in good standing. Check with the State Department of Public Health to see if the home has received any deficiencies. Talk with your neighbors to determine what the public's image of the home is.

22) What kind of special training has the staff received on Alzheimer's care? Who provided the training? Is the home certified by the Alzheimer's Association? Ask to see the training curriculum that the home uses.

23) Ask about what opportunities of religious practice exist for the Alzheimer patient.

24) Interview the nutritionist and ask about finger foods or pureed diets.

There are many factors involved in selecting a nursing home. Attempt to get an overall 'feel' for the facility, particularly the Special Care Unit. The Alzheimer's Association of Eastern Massachusetts encourages calls to discuss the many issues involved in the decision to select a long term care facility placement. Call the Association's Helpline at (617) 494-5150 of from the 508 area at 1 (800) 548-2111 for more assistance.


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