Questions to ask

when selecting a memory care facility

Selecting the appropriate Alzheimer’s/Dementia care facility for your loved family member is more difficult, time consuming and more involved than what people may anticipate.

-Tom Wiskow

When searching for an assisted living community (facility), families will generally select an assisted living care facility that is conveniently located to their primary residence. However, this approach usually does not produce favorable results when you are in need of a dementia/ Alzheimer’s care facility. Assisted living care is a “walk in the park” compared to dementia/Alzheimer’s care, and every community within the Twin Cities has better than average assisted living care facilities, but this statement is not true for dementia/Alzheimer’s care facilities.

Unfortunately, families in need of quality 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 family member. In 1992, I was guilty of making false assumptions in my search for the best and most appropriate Alzheimer’s care facility for my father, and I was not knowledgeable to what questions to ask the various marketing people at the facilities I was investigating. Therefore, within six 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 father exceeded the facility’s 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 care facility that I 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 dementia placement options for a loved family member. I personally recommend and believe you should investigate and tour at least 4 to 5 different dementia/Alzheimer’s care facilities before you finalize your dementia 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 dementia/Alzheimer’s care facility under placement consideration. Most people believe a dementia/Alzheimer’s care facility will provide the required care and related services for their loved family member throughout the entire progressive 4-stage disease process, and this placement decision will be the last move required for their beloved family member. Unfortunately, this assumption is simply not true. The vast majority of dementia/Alzheimer’s care facilities within the Twin Cities prefer, and are staffed, to provide Alzheimer’s care only to individuals that are relatively high functioning, independent and their care requirements 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 – stages 3 & 4), the facility will request the family to find alternative facility placement.

The facility will not volunteer this negative information, thus the family must ask what is your “discharge criteria” and at what stage in the 4-stage progressive disease process will you request us to find alternative placement for our beloved family member? Every time you must relocate your loved family member from one care facility to another, the resident has a greater likelihood of declining temporarily in overall status, but there is no guarantee they will ever regain what has been lost.

The Wealshire provides dementia/Alzheimer’s care to all 4-stages of this progressive disease, in addition to providing “behavioral” dementia care and assisting the various hospice care agencies in providing “hospice” care when such specialized care is required.

Qualifications of Care-Providers & Care Provider Staffing

In my opinion, this is the second most important question to ask any potential dementia/Alzheimer’s care facility under placement considerations. Are your care-providers all licensed and professionally trained (RN’s, LPN’s, TMA’s and CNA’s), or do you accept lay-people as care-providers, and do you request or expect the other department personnel (housekeeping, laundry, dietary & activity personnel) to assist in providing resident care? Do all of your care-providers speak fluent “English”? Effective communications between the residents and care-providers is essential for good dementia/Alzheimer’s care.

Nursing homes are generally considered to be under-staffed, and the patient to care-provider ratio in nursing homes is normally between 20 and 22 patients per care-provider, with the best of 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 country for the dementia/Alzheimer’s residents, and we will always staff in accordance with the acuity of care on each household.

For example, the Wealshire strives to provide resident to care provider ratios as follows:

Level 1 household: 10 residents per care provider
Level 2 household: 8 residents per care provider
Level 3 household: 6 residents per care provider
Level 4 household: 6 residents per care provider
Behavioral Care: 5 residents per care provider

NOTE: Family’s should definitely inquire to the “resident to care provider staffing ratio” at any care facility under their consideration

The Wealshire only employs professionally trained and licensed personnel (RN’s, LPN’s, TMA’s & CNA’s) to serve as care-providers, and we prefer for each care-provider to speak fluent English. Many care facilities will state their staffing ratios do compare to the Wealshire, but they may include housekeeping, dietary, activities and even janitorial personnel in their resident to care-providing staffing ratios. The Wealshire does not even include their RN’s or the Director of Care into their ratios.

You should never hesitate to ask any potential Alzheimer’s care facility under consideration to explain the qualifications of their care-providers, in addition to providing their resident to care-provider staffing ratios.

Housing of Residents by Their Level of Dementia/Alzheimer’s

The management team of the Wealshire are advocates for housing residents by the 4 levels (stages) of dementia/Alzheimer’s care and the associated staffing requirements. While at the Wellstead of Rogers, we pioneered this concept of housing residents by their level (stage) of dementia, and this concept proved to be extremely effective and beneficial for all of the residents. Most dementia/Alzheimer’s care facilities are not large enough to take full advantage of this concept, which greatly enhances the value of “life enrichment – 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 functioning levels.

If you ever visited a nursing home, it is common to have all stages of dementia/Alzheimer’s patients seated in chairs or in wheel-chairs in the main lobby entrance of the nursing home. This concept can be depressing and emotionally disturbing, especially if your beloved family member is relatively independent and high-functioning. Residents do not do as well if they are forced to reside and associate with other residents with significantly less cognitive and functioning abilities.

The Wealshire of Bloomington currently has 7 households all uniquely designed to house residents based on their care needs.

Bloomington's Level of Dementia/Alzheimer’s Care Households:

  • Level 1 dementia/Alzheimer’s care
  • Level 2 dementia/Alzheimer’s care
  • Level 3 dementia/Alzheimer’s care
  • Level 4 (Late stage/hospice) dementia/Alzheimer’s care
  • “Behavioral” Dementia Alzheimer’s care for both males and females
  • "Reassurance" or high anxiety household

Medina's Level of Dementia/Alzheimer’s Care Households:

The Medina facility opened in April of 2018, and eventually, as the resident count increases, it will have households similar to what is currently offered in Bloomington. Currently, Medina offers the following 3 households:

  • Combination of level 1 and level 2 dementia/Alzheimer’s resident care
  • Combination of level 3 and level 4 dementia Alzheimer’s resident care
  • “Behavioral” Dementia Alzheimer’s care for male residents

Life Enhancement Activities Personnel

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, that the dementia resident is more likely to lose some of these abilities, which we refer to as “atrophy”. Therefore, the best possible dementia/Alzheimer’s care should include daily life enrichment activity programming to assure the resident’s mental and physical abilities are being constantly utilized or challenged, which should include Saturdays and Sundays.

In my opinion, the biggest change in dementia/Alzheimer’s care in the last 10-12 years has been the increase in “Life Enrichment Activities” for the dementia/Alzheimer’s residents. When we owned and managed the care facility in Rogers from 1999 to 2008, we never had an activity staff greater than 5 individuals. Today, I do not believe any competitor to the Wealshire in the Twin Cities has an activity staff greater than 5 or 6 people. In Bloomington, our activity staff as of April 1, 2019, is at 33 people, 16 full time employees, and 17 part-time employees.

Our Life Enrichment personnel provide an ongoing extensive calendar of activities that is designed to appeal to each resident’s interests and abilities.  Our activities enhance the residents’ highest practical level of physical, mental and psychosocial well-being.  The best possible dementia/Alzheimer’s care should include daily programming to enrich the residents’ mental, physical and spiritual needs.  Our dedicated staff offer opportunities for our residents to engage in a variety of stimulating activities.  The Wealshire employs a trained staff of 33 life enrichment specialists that provide activity programming from 9:30 am to 8:00 pm, 7 days a week, 365 days a year. Our extensive calendar offers a blend of activities that enrich the mind, body and spirit.

Some of our highlights are:  daily ice-cream social, weekly community service projects, happy hour in the Cheers lounge, movies and popcorn in the cinema, Catholic, Lutheran and non-denominational church services, kitchen creations, pet visits and monthly birthday parties.

Our staff are also trained in helping resident’s overcoming obstacles associated with living with dementia.  In addition to our daily programming we provide an extensive music therapy program, including individual and group sessions, with a full-time licensed musical therapist and on-staff musicians.  We provide an environment that allows the residents to simply shine.

Our 33 life enrichment activity specialists do not administer resident cares, but they do help serve resident meals, in addition to being another set of eyes and ears on behalf of what and how our residents are doing.

NOTE: Family’s should definitely inquire to the number of activity specialists that a potential dementia/Alzheimer’s care facility employs, in addition to the hours of daily activities, and the importance to include resident activities on Saturdays and Sundays. 

Pricing for Quality Alzheimer’s Care

Obviously pricing is a very important subject to explore, but more importantly you should ask, “what does your monthly pricing include” and “what does your monthly pricing not include”. Many dementia/Alzheimer’s care facilities in the Twin Cities may 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 as an “ala-carte” fee schedule

Ala-Carte Monthly Fees: The majority of Alzheimer’s care facilities in the Twin Cities may 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 to 60 minutes of additional care provider time for this encounter, which could occur 3-4 times, or possibly even more, 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 additional care-provider time. The family will now pay for this additional care-provider time.

These facilities will utilize a 15-minute time schedule whenever such additional cares or care provider time is required. The fees can range from $15-$20 per each 15-minute of additional care provider time, equating to an hourly rate of $60 to $80, which we believe is a license for the facility to take financial advantage of the resident or the family member. Nursing assistants generally provide these additional care-provider duties, and in the past few years they may have been paid between $8 to $14 an hour. Today, the Wealshire pays CNA’s from $18 to $22 per hour, but the ala-carte fee facilities may charge the family $60 to $80 per hour for the extra services of a CNA.

It is not uncommon for families to be invoiced from $1,500 to $3,000 additionally per month as a result of these additional fees being allocated for the additional cares or care provider time being provided on behalf of the resident.

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 cares or additional care provider time. As a result of our 20 years of experience, we know the approximate amount of care provider time that is required, on an average, for each of the 4 levels of Alzheimer’s care. Therefore, our monthly fees will only increase if the resident’s level of dementia/Alzheimer’s care increases. We truly believe the “All Inclusive” resident care fee 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 dementia/Alzheimer’s 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, if provided by the Wealshire and not the family
  4. Medical supplies & medical equipment
  5. If desired, Direct TV services available to the resident’s room
  6. If desired, private telephone service to the resident’s room

Families considering a facility for potential placement of a beloved family member should definitely inquirer to the facilities monthly fee schedule.

The family should ask “What is Included” and “What is not Included”. If the facility is not “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, facilities charging for extra cares and additional care-provider time may have a license to take financial advantage of the resident and/or the family. Your best pricing option is to select a dementia/Alzheimer’s care facility that has an “All Inclusive” resident monthly fee schedule.


I am confident, if you ask the potential placement facility the above indicated questions, and you are pleased and satisfied with their answers, you will probably make a prudent placement decision on behalf of your beloved family member.

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 me making a huge resident placement mistake.

The physical amenities of the Wealshire’s facilities, resident households, size of resident rooms, common areas and secured courtyards are truly beautiful and amazing, but the primary reason for placing your beloved family member at the Wealshire should be that the quality of care we provide is simply outstanding, and truly the best resident care in the Twin Cities.

Hopefully this information will prove to be beneficial to you and your family members when you attempt to find the best possible placement option for your loved family member.

Please contact me if you have questions, or if I can be of additional assistance.


Thomas A. Wiskow