Caring for Residents with Dementia

Quality Measure 9: Specialty Care – Ensuring that facilities provide safe and responsible specialty care.

Quality Measure 9 includes regulations related to dementia care in assisted living facilities (87705, Care of Persons with Dementia).  One of the most frequent dementia-related citations issued to facilities is for failure to complete annual assessments for residents with dementia (Regulation section 87705(c)(5)).  

Specifically, 22 CCR § 87458 (Medical Assessment) states, “Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year.”  For California RCFEs in 2018, 4% of facilities received a citation for this regulation. However, only 1.3% of Choose Well Members were cited for the same violation.

There are several ways it can be mitigated or avoided.  Below is a strategy that facilities can use to manage annual assessments.    

Strategies for Scheduling Annual Assessments 

To stay on top of annual assessments, use calendar invites as a tracking system for residents who have dementia.  Most email platforms have a calendar feature that can set an annual, recurring event for all residents with dementia.  Although residents have different admission dates, having one set date for everyone ensures that residents will not be missed.  Be sure to set alarms to give prior notice, either a week or month in advance, before the actual assessment date.  

Amparo Senior Care, a Choose Well Member, explains how they manage annual assessments for dementia residents.  

“Residents with dementia have changing care needs.  The team at Amparo Senior Care meets every month to complete a care plan for all the residents at the home.  For residents with drastic changes, the Appraisal/Needs and Services Plan (LIC625) is updated at this meeting.  Almost every resident will have had at least one change in condition warranting an updated LIC625 every year. Holding a monthly care plan meeting ensures that each resident's assessments are always current and that our team works together to effectively meet each resident's needs.” 

Securing Items for Residents with Dementia

Citations for specialty care also included 87705(f)(1) and 87705(f)(2).  These regulations consist of: 

“The following shall be stored inaccessible to residents with dementia:

(1) Knives, matches, firearms, tools, and other items that could constitute a danger to the resident(s).

(2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies, and disinfectants.”

Resident safety is a priority for assisted living homes that serve residents with dementia.  Sometimes, facilities may leave out items that potentially harm residents. In other cases, RCFEs may not realize which items are considered hazardous, like bleach and air fresheners.  Properly storing and securing these items prevent these citations. For California RCFEs in 2018, 3% of facilities received a citation for this regulation. For Choose Well Members, 11% of facilities received this citation.

Home Safety Tips for Residents with Dementia

Practice proper safety measures for residents who have dementia.  

• Secure all items that may pose danger to residents with dementia.  

• Consider installing a hidden gas valve or removing knobs on the stove.

• Ensure that safety equipment are in working order, i.e. fire extinguishers and smoke detectors.  

• Maintain clear and well-lit walkways. 

• Regulate food and water temperature. 

• Be prepared for emergencies by keeping updated contact information of nearby police department, hospitals, poison control helplines, etc.

Dementia causes changes in the brain and body that may affect resident safety.  Having safety measures in place allow residents to live more freely in their physical space.  Additionally, using scheduling tools enhances planning for required annual assessments. Prioritizing safety in specialty care settings can best accommodate the needs of residents with dementia.  

https://www.alz.org/help-support/caregiving/safety/home-safety