A letter from the founder Thomas Wiskow

Alzheimer's & Dementia community selection process

Selecting the appropriate Alzheimer’s and dementia care community for your loved one is more difficult, time consuming, and involved than what people may anticipate. When searching for a community, families will generally select a community that is the most conveniently located to their home. This approach usually does not produce favorable results when you are in need of an Alzheimer’s and dementia care community. General assisted living care needs vary dramatically from those required in a Alzheimer’s and dementia care setting. The two types of care needs and communities are not mutually exclusive.

Unfortunately, families in need of quality Alzheimer’s and dementia care may make false assumptions, or they are often naïve to what questions they should ask in reference to making the best possible placement decision for their loved one. In 1992, I was guilty of making false assumptions in my search for the best and most appropriate community for my father. I wasn’t knowledgeable to what questions to ask the various marketing people at the communities I was visiting. Therefore, within eight months of resident care for my father, my assumptions were proven wrong, and again I was investigating alternative placement options for my father simply because I was informed that the care requirements for my him exceeded the communities care capabilities.

I wish I would have known more about this devastating disease, or what questions to ask during my search for the best possible placement option for my father. If I would have known these things, I would not have made false assumptions, and I definitely would not have selected the community initially selected for my father. Therefore, in an effort to be of greater assistance to you in your placement investigations, I am providing you what I believe are the most important questions to ask when you are investigating Alzheimer’s and dementia placement options for your loved one. I personally recommend and believe you should investigate and tour at least 4 to 5 different communities before you finalize your placement decision, and never hesitate to ask questions if you are unsure.

Resident Discharge Criteria: In my opinion, this is the most important question to ask any potential Alzheimer’s dementia care community under placement consideration. Most people believe an Alzheimer’s dementia care community will provide the required care and related services for their loved one throughout the entire progressive 4 stage disease process, and this placement decision will be the last move required for their loved one. Unfortunately, this assumption is not true. The vast majority of Alzheimer’s and dementia care communities within the Twin Cities prefer, and are staffed, to provide dementia care only to those individuals that are high functioning, independent and their needs are relatively minor in nature (stage 1 and early stage 2 of this progressive 4 stage disease process). Then, as the disease progresses and the care requirements increase (resident becomes a 2-person transfer and/or requires a mechanical lift – stage 3 & 4), the community will request the family find alternative placement. The community will not volunteer this information, thus the family must ask what your “discharge criteria” is and at what care level will you request that we find alternative placement for our loved one? Every time you relocate your loved one from one community to another, the resident has a greater likelihood for declining in overall status, and there is no guarantee they will ever regain what has been lost.

The Wealshire provides Alzheimer’s and dementia care to all 4 stages of the disease, in addition to providing “behavioral” dementia care and assisting the various hospice agencies in providing end of life care when required.

Qualifications of Care-Providers & Care Provider Staffing Ratios: In my opinion, this is the second most important question to ask any potential Alzheimer’s and dementia care community you are considering. Are your care-providers all licensed and professionally trained (RNs’s LPN’s, TMA’s, and CNA’s), or do you accept untrained and/or non-certified care providers? Do you request or expect other departmental team members (housekeeping, dietary, and activities) to assist in providing resident care? Are all of your care-providers able to communicate effectively? Effective communication between residents and care-providers is essential for extraordinary Alzheimer’s and dementia care.

Nursing homes are generally considered to be under-staffed, and the patient to care-provider ratio in nursing homes is normally between 20-22 patients per care provider, with the best nursing homes having a patient to care-provider staffing ratio of 15-1. The Wealshire prides itself on having one of the best resident to care-provider staffing ratios in the industry as follows:

The Wealshire only employs professionally certified and licensed team members to serve as care-providers. Many care communities will state their staffing ratios do compare to the Wealshire, but they may include housekeeping, dietary, activities, and even maintenance team members in their ratios. The Wealshire does not include any departments other than clinical in the ratios. Additionally, we have a RN staffed 7 days a week and is not included in the ratio’s above.

You should never hesitate to ask any potential memory care community you are considering to explain the qualifications of their care-providers in addition to their staffing ratio’s.

Housing of Residents by Their Care Needs: The Wealshire advocates for housing residents by the 4 levels of Alzheimer’s and dementia. While at The Wealstead of Rogers, we pioneered this concept of housing residents by their level of dementia. This concept proved to be extremely effective and beneficial for all of the residents. Most Alzheimer’s and dementia care communities are not large enough to take full advantage of this concept, which greatly enhances the value of “life enhancement activities programming”. Residents perform better, and are more inclined to actively participate in activities if they are associating with other residents with the same cognitive and functional level.

If you have ever visited a nursing home, it is common to have all stages of Alzheimer’s and dementia patients seated in chairs or wheelchairs in the main lobby entrance of the building. This concept can be depressing and emotionally disturbing, especially if you loved one is relatively independent and high functioning. Residents do not thrive as well if they are forced to reside and associate with other residents less cognitively and functionally able as themselves.

Life Enhancement Activities Team Members: It is widely acknowledged that if a person with dementia has certain mental and physical abilities, but these abilities are not routinely utilized or challenged, the resident is more likely to lose some of these abilities, which we refer to as “atrophy”. Therefore, the best possible Alzheimer’s and dementia care should include daily life enhancement activity programming to assure the resident’s mental and physical abilities are being constantly utilized or challenged.

Since the disease does not differentiate between Tuesday and Saturday, our belief and desire is to provide such activity programming each day of the week, including weekends. The Wealshire employs a separate trained staff of life enhancement activity specialists that provide activity programming from 9:30am to 8:00pm 7 days a week, including weekends and holidays. Families should definitely inquire about availability and frequency of life enhancement activity programming at any community being considered for placement.

RN Availability on a Daily Basis: RN’s are the vital link between the resident’s physician and the resident’s care plan, thus RN’s generally do not provide resident care at an Alzheimer’s and dementia care community. The majority of communities have an RN on duty during the typical 5-day work week and some communities only provide an RN on a “on-call” basis. The RN is responsible for managing the resident’s daily medications and any other medically related requirements they may have on a daily basis. The RN closely monitors the resident’s healthcare requirements and they effectively communicate with the resident’s physician and with the community’s care-providers to assure the resident is receiving the best possible medical treatment.

At the Wealshire, an RN is on duty each day of the week to include weekends and holidays. In addition to having a nurse practitioner at the community 2-3 times per week, a physician will visit the Wealshire at least weekly, more often if required.

Each resident household at the Wealshire is managed and supervised by a nurse (LPN) all 3 daily shifts, which is a significant medical care advantage for the resident and the foundation for dynamic resident care.

Family members should definitely inquire to the daily work schedule of an RN, the utilization of nurse’s as shift managers, and the availability of a physician/nurse practitioner.

Pricing for Quality Dementia Care: A very important question to ask any community that you are considering is “what does your monthly price include” and perhaps more importantly “what does your monthly pricing not include”? Many care communities in the Twin Cities offer a very attractive monthly base rate to obtain initial family interest, but they either avoid or down play the additional monthly costs if additional resident cares are required during the month. These additional monthly fees can be extremely expensive and this pricing approach is referred to a “non-inclusive” fee schedule.

Non-Inclusive Monthly Fees: The majority of care communities in the Twin Cities offer an attractive monthly base rate, but then they will charge the family additional fees whenever additional resident cares or additional care-provider time is required during the month.

Example: A resident was resisting taking a bath, which required a second care-provider to assist to complete the bathing requirement. The family will be charged from 30-60 minutes of additional care-provider time for this service, which could occur 2-3 times during the month.

Example: A resident wasn’t feeling well, or had the flu, and this resident had to be spoon fed for a few days, which required extra care provider time. The family will now pay for this additional time.

These communities will utilize a 15 minute time schedule whenever such additional care of care provider time is required. The fees can range from $15-$100 per each 15 minute increment of additional time, which we believe is a license for the community to take financial advantage of the resident or the family member. Nursing assistants generally provide these additional care provider tasks, and they may be paid between $12-$15 an hour. It is not uncommon for communities to invoice families an additional $1500-$4000 each month as a result of these additional incidental charges.

The Wealshire utilizes an “All Inclusive” monthly resident care pricing schedule, thus the families know exactly what their monthly fee will be, and the family is not charged any additional expense whenever the resident requires additional care or additional care-provider time. Our experience has given us the confidence to know the approximate amount of careprovider time that is required on average for each stage of the disease process. Therefore, our monthly fees will only increase if the residents care increases. We truly believe the “All Inclusive” resident care structure is in the best interests of the resident and the resident’s family. My personal objective is to again make the Wealshire the best financial value for Alzheimer’s and dementia care in the Twin Cities.

The resident’s monthly rent and care related expense is fixed, but the resident may encounter additional fees on a monthly basis to include but not limited to, the following:

  1. Resident’s medications
  2. Physician ordered nutritional supplements
  3. Incontinent products
  4. Medical supplies & medical equipment

Families considering a community for potential placement of a love one should definitely inquire to the community’s monthly fee schedule. The family should ask what is included and what is not included. If the community is not an “All Inclusive”, the family should know and possibly negotiate the fee for any additional services provided on a 15-minute basis when additional care or additional care-provider time is required. Be aware, communities charging for extra cares and additional care-provider time may have a license to take financial advantage of the resident and/or family. Your best pricing option is to select a community that has an “All- Inclusive” resident monthly fee schedule.

Conclusion: I am confident if you ask the potential placement community the above questions, and you are pleased and satisfied with their answers, you will probably make a prudent placement decision on behalf of your loved one.

As I stated earlier, I was naïve to the questions to ask when I was investigating potential placement options for my father in the early 1990’s, which resulted in making a huge placement mistake.

Hopefully this information will prove to be of benefit to you and your family members as you attempt to find the best possible community for your loved one.


Thomas Wiskow

Wealshire, LLC

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