Provided by the
Alzheimer's Disease and Related Disorders Association
of Eastern Massachusetts, Inc.
SPECIAL CARE UNITS
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
WHAT TO LOOK FOR IN A NURSING HOME WITH A DEDICATED ALZHEIMER
SPECIAL CARE UNIT.
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
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
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
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
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.