When is it time for memory care? The signs, and what to do next

When is it time for memory care? Usually when your parent can't be left alone safely anymore, or when keeping her at home is breaking your own health, and the signs have lasted more than a few weeks. You don't have to wait for a disaster. If two or three of the signs below fit, start touring now, while you still get to choose.

The Alzheimer's Association puts the question in three parts. Is she becoming unsafe at home? Is her health, or yours, at risk? Are her care needs beyond what you can physically do? It also notes that by the middle stages, people with dementia usually need someone watching over them 24 hours a day. One person can't do that for long. A family member working in shifts can't either, not for years.

How do you know when someone needs memory care? Start with her safety

These are the signs that home has stopped being safe for her. One bad day doesn't count. A pattern over weeks does.

• She wanders or tries to leave, especially at night, and locks and door alarms aren't stopping her. The Alzheimer's Association says six in 10 people with dementia will wander at least once, and many do it again. Our guide to wandering at night covers what to do in the meantime.
• She has fallen more than once, or you've had to call 911 or the fire department to get her off the floor.
• She can't be alone for an hour. The stove, the front door, the scam caller and her pill bottles are all real dangers now.
• She's up for much of the night, and someone has to be awake with her.
• Toileting and incontinence care take more than one person can manage.
• She's losing weight, or only eats when someone sits beside her and prompts each bite.
• Her aggression scares you, or home aides keep quitting.

The Family Caregiver Alliance lists the same kinds of triggers: exit seeking, sleeplessness, combativeness, incontinence, and needing hands-on help to move from bed to chair.

Then look at your own health, because it counts the same

Families tend to skip this list, as if the caregiver's body doesn't count. The Family Caregiver Alliance names caregiver health problems, from back injuries to depression, as one of the main reasons people move a parent into residential care. It says that when your physical or mental health is at risk, it may be time to consider a move.

• You haven't slept through the night in weeks.
• You've canceled your own doctor's appointments more than once.
• You've yelled at her, grabbed her arm too hard, or frightened yourself. That tells you about the setup, not about your character.
• Your job is slipping, or round-the-clock help at home now costs about what memory care would. Our guide on how to pay for memory care walks through the money.
• Your partner and kids are getting almost nothing from you.

The Alzheimer's Association lists signs of caregiver stress, including exhaustion that makes daily tasks nearly impossible, sleeplessness, and health problems that start to take a toll. If you have them regularly, it says to talk to your doctor. Tell your doctor that you're a caregiver, and how many hours a week you're doing it.

When is it time for memory care? Use the few-weeks test

Here's a simple rule. If two or three signs from either list have been true for more than a few weeks, start looking now. Looking isn't deciding.

The Alzheimer's Association suggests visiting several places and getting on waiting lists before a crisis. Without that, a fall or a hospital stay can leave a discharge planner telling you to pick a place in a few days.

This week:

1. Write down the signs you've seen, with dates. "Got out the back door twice in March" is more useful to a doctor, a sibling or a director than "she's getting worse."
2. Call her doctor to rule out a medical cause for any recent change. More on that below.
3. Book three tours. Go back to the one you liked best around lunch or in the late afternoon, without much notice.
4. Ask each place whether it offers short respite stays. A week there while you rest is the closest thing to a trial run.
5. Tell your siblings the tour dates. You're informing them, not asking permission.

Take Denise, whose dad got out the back door twice in one week. The second time, a neighbor found him a block away in his slippers. Denise had a door alarm. She slept through it, because she'd been up most of the three nights before. She booked two tours that weekend.

First, rule out a sudden change

Before you decide she's moved to a new stage, make sure nothing treatable is going on. MedlinePlus describes delirium as sudden, severe confusion. Urinary tract infections, pneumonia and some medicines can cause it. Pain and constipation can also make confusion much worse, so mention those too. Many of these causes get better once they're treated.

The memory care decision should rest on the slow trend over months, not on a bad week caused by an infection.

Assisted living, memory care or a nursing home: which one fits

The names get used loosely. The Family Caregiver Alliance describes them roughly like this.

• Assisted living offers meals, housekeeping, help with medications and 24-hour supervision. It suits someone in the earlier stages who doesn't wander and can follow a routine with reminders.
• Memory care is built for dementia. Staff are required to have special dementia training, and the doors are secured. It usually fits a parent in the middle stages who is still on her feet but needs watching and redirecting all day.
• A nursing home, or skilled nursing facility, provides nursing care around the clock, including more complex medical care. It fits someone who needs daily medical care as well as supervision.

Many memory care units sit inside an assisted living building, so moving from one to the other can mean a change of floor, not a change of address.

What to say, and to whom

You'll have this conversation with several people before you have it with her. These lines keep it short.

• To a sibling: "I'm touring three places on Saturday. You can come, or I'll call you after with what I saw. I'm going either way."
• To assisted living staff: "Is she still a good fit here? What would you need to see before you'd recommend memory care?"
• To a memory care director: "Which behaviors or care needs would make you ask her to leave?"
• To a friend who says "I could never do that to my mom": "I didn't think I could either, until I hadn't slept in a month."

When it's time to tell your parent, our guide on how to tell her she's moving to memory care has scripts for that conversation and for the first 30 days.

Questions caregivers ask

When is it time for memory care from assisted living?

Usually when assisted living staff start calling you about her. She's leaving the building, wandering into other residents' rooms, refusing care, or needing someone with her for much of the day. Some communities will ask you to hire a private aide to fill the gap. Ask the director directly what they're seeing and what memory care in the same building would cost. Moving down the hall is often easier on her than moving across town.

Dementia: when is it time for a care home?

In the US, "care home" can mean memory care or a nursing home. The signs are the same as above. The difference is medical. If she needs daily nursing care, such as for wounds, feeding problems or being unable to move herself, ask her doctor whether a nursing home fits better than memory care.

Can a parent with dementia live alone?

Early on, some people can, with daily check-ins, help with medications and someone handling the bills. Once she leaves the stove on, lets strangers in, gets lost on familiar roads or can't tell you whether she's eaten, she can't be alone safely. That doesn't mean memory care right away. It means someone has to be there, and memory care is one way to make that happen.

You're not deciding this because you stopped caring. You're deciding it because you saw clearly what she needs. On the nights it doesn't feel that way, the guilt is a feeling, not a verdict.