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Do special care units work in dementia care?

by Sue Lanza

Struggling with dementia care choices available outside the home, caregivers may consider placing a loved one with dementia in a special care unit within an assisted living community or in a long-term care setting. Some health care facilities are realizing that the unique needs of clients with middle to late stages of dementia may require placement in a distinct area in the complex. Here's an overview of the special care unit for dementia care and its place in health care facilities.

As caregivers soon discover, the home care needs of a person with the mid-stage dementia can easily overwhelm a family, prompting them to look for care assistance to cope. Although each different type of dementia presents distinctive symptoms, the middle stage of dementia generally brings an increase in safety and the other concerns about the person living independently at home. The person with dementia may exhibit behavioral problems, could be unsafe leaving their home alone and may have serious challenges with daily activities such as eating and bathing. As the disease of dementia continues to progress from the middle to the late stages, the need for almost constant caregiving escalates even further.

When the dementia caregiving tasks advance to a level in which a caregiver may seek assisted living or long-term care placement for their loved one with dementia, there exists a niche option generally referred to as a dementia special care unit.

Benefits of a dementia special care unit

What would prompt a facility to segregate residents who have a certain stage of dementia? I remember a family member asking me this very question when I was an administrator of a facility with a dementia special care unit. My answer? It was considered good practice when residents with similar needs are placed together so the special needs of that group can be focused on and met.

Let me illustrate further. Paul comes into Happy Acres Care Center to recover for two weeks after his knee replacement surgery. The policy of this care center is to match roommates by the bed openings. Paul welcomes new roommate Shawn and things get off to a rocky start. In the first hour, Shawn wanders around their room and tries to help Paul get out of bed. You see, Shawn has Alzheimer's disease, the most common form of dementia. Within minutes, Paul is yelling at Shawn, the nursing staff and anyone within earshot. The problem here is that two patients with completely different needs were placed together. Paul has clinical needs and he should be placed in an area of the facility where the medical model of care is supported along with excellent customer care to speed his journey home. Shawn will not do well in Paul's clinical setting with medical equipment and a high focus on heavy nursing care. He would fare much better in an area of the facility where he could see a familiar, home-like environment and a nurturing social model - exactly what could be should be found on a dementia special care unit.

Besides the obvious benefits to the resident, I have seen that a dementia special care unit allows better staff retention because staff are specially trained, are working with the population of their choice and this empowerment translates into good, supportive care for the resident. These factors lead to happier residents.

7 goals of successful dementia unit

According to the Alzheimer's Association, the key goals of a successful dementia unit should be to do the following:

  1. Maximize safety and support
  2. Facilitate social opportunities
  3. Support of functional abilities
  4. Provide opportunity for control and privacy
  5. Adjust the amount of stimulation
  6. Maintain self identity
  7. Maximize awareness and orientation

To support these goals, the ideal configuration of a dementia special care unit would be to create neighborhoods or households that each would have distinctive character and permit further personalized space. The layout also supports the person-centered way of thinking where the needs of the person drive the care. Although the residents with dementia in assisted living are usually more independent in their daily activities than those in long-term care, the same core principles apply of creating a physical, emotional and social environment plus specialized training for the staff.

Do dementia special care units work?

Despite the feeling in the health care industry that dementia special care units are a good standard of practice, reports state that only about 13% of all long-term facilities have dementia special care units. The reasons may be that no additional funding exists for dementia care as yet, and it takes much extra dedication to get a unit successfully running.

Other professionals who have studied the feasibility of a special care unit have agreed that there were positive differences to living on a special needs unit versus within the general long-term care population. Hopefully more facilities will see the benefits of modifying space to accommodate neighborhoods or unique units as part of their total bed complement.

The dementia special care unit I was involved with is still going strong after almost ten years. Sure, there were normal ups and downs along the way. But it has provided a safe, supportive environment for many residents and filled a community need in our county. Now that it is here, we wonder how we managed without it.