When do you move a person with memory loss from their home to a greater level of care?  This is a very complicated and subjective decision. 

Let’s start by assuming the person is living at home with a family member and memory loss is still mild to moderate.  Furthermore, assume they have lived in the same house and neighborhood for at least 5-10 years.  All of their friends and routines are well established and over learned.  In short, there are few surprises and little need to learn much that is new.  Life runs mostly on long-term memory.  The best place to be is at home and in familiar locations with lock-step routines.  Minimum care is needed.   As the memory loss and confusion builds the decision will become more and more the role of the primary caregiver and family.

This is the time the family to evaluate possible future needs and resources, should memory decline and other skills deteriorate.  What are the options for outside care?  Either one can bring the care into the home or move to another location where care is available.   Which route one chooses depends on personal preference and financial resources. Home care has the advantage of being in a familiar environment and established routines.  There is nothing new to learn other than familiarity and comfort with new caregivers/companions.

Alternatively one can move to a community with multiple levels of care that may include independent living, assisted living, memory care, and skilled nursing.   These may be on one campus or separate locations.  The campus concept may be either “a la carte” or a continuing care retirement community CCRC).  The former has set prices, either to rent or own, for all different levels of care.  You pay and move as you need services.  It often helps to have long-term care insurance to afford advanced levels of care.  Of course this must be purchased before you need it as insurance companies screen for memory loss to qualify.

A CCRC offers admission and the promise of a more-or-less fixed price, either to own or rent, plus variable entry fees.  In effect, you are paying for long-term care insurance in a lump sum up front.  Of course, as with long-term care insurance, you must choose before there are noticeable changes in memory.

In short, choices depend upon taste, whether you want to be close to family, comfort, level of memory loss, and financial resources.  This is very complex decision making which is often made when you are stressed and with great resistance to the loss of independence.  There are a number of useful resources with persons quite knowledgeable and who will spend the time to help you understand the choices and trade-offs.  For example, you may wish to work with independent case managers, organizations such as the Alzheimer’s Support Network, your financial advisors, and/or an elder care attorney.

Of course it is always better to make these decisions proactively rather than reactive to crises.  This is where good memory assessment by a memory expert helps you better know what stage of memory loss you are dealing with. Thorough feedback from the assessment takes time and repeated assessments are required to monitor and track changes that may require implementation of plans.