Learn more about memory care options

• Oregon Long-Term Care Ombudsman: Visit www.oregon.gov/ltco or call the help line: 800-522-2602.

• Alzheimer’s Association of Oregon: Visit www.alz.org/oregon or call the help line: 800-272-3900.

• Deschutes County Aging and People with Disabilities: 541-388-6240 (Bend), 541-548-2206 (Redmond), 541-536-8919 (La Pine)

• Crook County Aging and People with Disabilities: 541-447-4511 (Prineville)

• Jefferson County Aging and People with Disabilities: 541-475-6773 (Madras)

Memory care facilities in Central Oregon

• Aspen Ridge Memory Care, 42 beds, 1025 NE Purcell Blvd., Bend.

• Brookdale Bend, 59 beds, 1099 Watt Way, Bend.

• Brookdale Redmond, 32 beds, 1942 SW Canyon Drive, Redmond.

• Cascade View Nursing Center, 119 SE Wilson Ave., Bend.

• Mt. Bachelor Memory Care, 56 beds, 20225 Powers Road, Bend.

• Prairie House Memory Care Community, 18 beds, 51485 Morson St., La Pine.

• Touchmark at Mt. Bachelor Village, 32 beds, 19800 SW Touchmark Way, Bend.

• East Cascade Memory Care Community, 27 beds, 175 NE 16th St., Madras.

Opening this fall

• Mill View Memory Care, 36 beds, 1290 Silverlake Blvd., Bend.

• Country Side Living, 35 beds, 1350 NW Canal Blvd., Redmond.

• Thelma’s Place (day center), 1350 NW Canal Blvd., Redmond.

*Includes facilities with DHS memory care endorsement. Other facilities may accept individuals with dementia as well.

Source: Oregon Department of Human Services

More than or nearly 60,000 Oregon seniors live with Alzheimer’s disease, an irreversible brain disorder that eventually takes away one’s memory and ability to carry out simple tasks.

That number is expected to shoot up to 84,000 over the next 10 years, according to the Alzheimer’s Association.

When those afflicted by the disease inevitably become unable to care for themselves, they’ll need help — either from in-home caregivers or residential care. Demand for the latter, facilities that cater specifically to the needs of those with memory loss, is taking off nationally and in Central Oregon, where three new such facilities will open this fall.

Country Side Living, a 35-bed memory care facility, will open this October in the same Redmond building as Thelma’s Place, an adult daycare center for people with dementia designed to provide breaks for caregivers. Thelma’s Place will be Central Oregon’s only adult day center specifically for individuals with memory loss, said Erik Berkey, the owner of Country Side and Thelma’s Place, both of which have existing locations in Canby.

It’s tricky to design the buildings that will house dementia patients; they must be built specifically with memory loss in mind, Berkey said. That means things like loops instead of dead ends, a secure outdoor area and special lighting that counteracts the confusion often brought on by nightfall.

“It takes a lot of thinking when you’re building these,” he said.

Seasons Management, a Lake Oswego-based senior living company that currently operates four facilities and has six more in the works, will open Mill View Memory Care in Bend this fall.

Services provided by these facilities are crucial for people with memory loss. Local memory care administrators said their staff members provide around-the-clock supervision. They give residents tasks that add meaning to their lives. They are trained to redirect and prevent the aggressive behaviors typically associated with dementia, a general term for cognitive decline that interferes with daily life, of which Alzheimer’s disease is the most common form.

But others are skeptical that facilities with a specialty label actually provide more than typical residential care and assisted living facilities.

“Memory care is usually a basis for jacking up the price,” said Dr. Robert Kane, an aging and long-term care professor at the University of Minnesota.

No staffing ratio rule

More than half of the residents in assisted living and residential facilities, including memory care, paid out-of-pocket for their stays, according to a Department of Human Services survey performed last year. Stays in memory care units typically cost at least $4,000 per month, but vary widely according to the services offered and the severity of the resident’s dementia. Another 39 percent relied on Medicaid, and the rest on long-term care insurance, Veterans Affairs benefits and other means, according to the survey.

Each state has its own rules around what it means to be a memory care facility, which makes for a great deal of variation across state lines with respect to the quality of memory care facilities.

Here in Oregon, the Department of Human Services bestows memory care endorsements on facilities that have already been licensed as either residential care facilities, assisted living facilities and skilled nursing facilities, or nursing homes.

To receive that endorsement, facilities must prove they train their caregivers specifically to care for individuals who have dementia, said Jan Karlen, a policy analyst with the DHS’ Office of Aging and People with Disabilities. There are no standards around what that training must involve, and facilities can do it online or in classrooms.

When most people hear memory care, they assume the facility has more staff members than a typical long-term care facility in order to keep residents safe and make sure they don’t wander away, Kane said. But most of them, including those in Oregon, do not have to abide by staffing ratios, nor are they required to have more staff than a typical long-term care facility.

In Oregon, the only longterm care facilities that must abide by staffing ratios are skilled nursing facilities. Of the 165 memory care facilities statewide, only 14 are licensed as skilled nursing facilities. Most of them — 149 — are licensed as residential care facilities. Two are licensed as assisted living facilities.

“I think consumers need to be very aware that in assisted living and residential care facilities, even with a memory care endorsement, there is no minimum staffing ratio,” said David Berger, Oregon’s long-term care ombudsman.

Choosing the right facility

Families considering a facility for a loved one with dementia should investigate a care home before making a decision to move in.

Most people tour the place at least once, usually accompanied by an administrator or salesperson, but experts caution against just going once. Visit several times, especially mid-morning to early afternoon, said Sarah Holland, program director for the Alzheimer’s Association’s Oregon chapter. That’s when there tends to be a lot of activity and challenges associated with making the transition to daytime and nighttime routines.

Kane, of the University of Minnesota, recommends visiting during a meal.

“Meals are usually the most stressful time for the staff,” he said. “They have a lot of things they have to do at the same time. You can just observe how the staff talk to the residents. When they’re under stress, do they maintain their cool or do they get upset?”

Prospective residents and families should also ask administrators about the level of training the staff members receive, Kane said. Not just the number of hours, but the course content and who performed the training.

“Ask some hard questions,” he said.

Quality memory care facilities will create goals and tasks for their residents rather than just contain them, and Kane said people should ask administrators about their philosophies in this area.

At Mount Bachelor Memory Care in Bend, for example, each resident is assessed for their remaining skills and assigned roles based on those, said Mallory DaCosta, the facility’s executive director. It’s not just folding towels, either. They’re social roles, such as baking and handing out bread to other residents, teaching a photography class and making cat beds that are donated to animal shelters.

“It’s all life-skills based,” she said. “So instead of just, ‘Oh sure, the residents help us with chores,’ most of them have name tags with their responsibilities and it’s creating an actual job for them or social role so they feel like they still have a purpose.”

Use public records

There are a number of easily accessible public records on memory care facilities, too.

Every two years, the DHS Office of Licensing and Regulatory Oversight’s community-based survey unit visits memory care facilities and determines whether they comply with Oregon’s administrative rules, Berger said. If they’re not in compliance, the inspectors revisit the facility and, if necessary, can revoke its license. Regardless of how they performed, facilities are required to prominently display the surveys in their lobbies for potential residents and their families.

People can also call their local Aging and People with Disabilities office and schedule a time to view complaints and inspection reports on specific facilities. Deschutes County has offices in Bend, Redmond and La Pine. Facilities are required to report certain events to DHS, such as altercations between residents, a common occurrence in memory care facilities.

The state’s Long-Term Care Ombudsman office operates a free help line to assist people in making sense of the community-based survey unit reports and corrective action taken. The Alzheimer’s Association’s Oregon chapter has a similar help line, too.

Once people have a decision, Berger urges them to read the contract carefully before signing it. Do not rely on oral promises, either, he said. If a certain stipulation — gluten-free meals, for example — is important, be sure it’s included in the contract.

“Be meticulous about the business arrangement,” he said.

Aggression and fights can sometimes happen

Typically, before residents move in, staff members at memory care facilities meet with them to evaluate their stage of dementia. They also want to learn more about the person’s life: What did they do for a living? What was their religious or cultural background? What are their favorite foods?

At Touchmark at Mount Bachelor Village in Bend, this is called the Life Story Project, said Angela Stewart, the facility’s memory care administrator. A staff member writes a story about what the person did professionally and what he or she still enjoys doing. The information is then used to create his or her care plan, which dictates the supervision and assistance he or she requires and what activities he or she should be encouraged to do.

“If you’ve met one person with dementia, you’ve only met one person,” she said. “The care plan and the solutions for individuals with brain disease is different for every single person.”

Aggression is a common theme in memory care facilities, as evidenced by the numerous reports in Central Oregon of resident-on-resident altercations. Touchmark reported no such events within the past four years, according to DHS records.

Mount Bachelor Memory Care ­­­— a separate facility from Touchmark — reported several altercations to DHS in the last few years. However, in most those cases state investigators found the facility free of any wrongdoing.

DaCosta, the facility’s executive director, said aggression happens because people with dementia are frustrated. It’s an indication that they have an unmet need and can no longer express themselves like they want to, she said.

“We’ll see people who are aggressive and very, very unpredictable in their violent behavior,” DaCosta said. “Yelling out, calling, screaming. But I always say, ‘If you had everything taken from you and you weren’t sure where you were, you’d be that way too.’”

Cutting down on meds

Research has shown many long-term care facilities rely heavily on psychotropic medications to calm residents with dementia who become aggressive.

DaCosta said her facility recently launched a focus group to cut down on medication use among residents. Although the staff there can’t deviate from doctors’ orders, they routinely ask doctors if they can try non-pharmacological interventions, such as better communication techniques. Mount Bachelor Memory Care has managed to reduce its overall use of psychotropic medications by 20 percent over a two-month period, and it’s correlated with a decrease in negative incidents, DaCosta said.

Aspen Ridge Memory Care in Bend saw far and away the largest number of substantiated and unsubstantiated complaints of any memory care facility in Central Oregon within the past four years. Many of them were for altercations between residents, which the facility is required to self-report. Kim Luis, the executive director of Aspen Ridge Memory Care, did not return requests seeking comment.

In several cases, staff negligence resulted in residents becoming injured. In April 2014, two residents were found to have been left in soiled undergarments for eight hours at a time and suffered skin breakdown as a result. One suffered a foot injury that was not diagnosed for five weeks after the resident told a staff member about it. In October 2013, a resident was sent to the emergency room twice due to medication errors. In May 2013, a resident suffered a fractured hip after being left alone during toileting.

Berkey, who is opening the two memory care facilities in Redmond, said if a facility is operating well, it should not see many altercations between residents, because the staff can prevent some of the frustration that leads to aggression. He tells his staff not to correct residents if they refer to them by the wrong name, for example, because that can worsen their confusion.

“It’s frustrating for the person if you’re correcting them and telling them that they’re wrong,” he said, “instead of just saying, ‘Yeah, I’m doing good. Do you want to go for a walk?’”

— Reporter: 541-383-0304, tbannow@bendbulletin.com

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