Assisted Living/Dementia Care: What To Do When Couples Have Different Needs

Mike McClernon, senior living advisor and owner, Assisted Living Locators of Long Island

Accommodating couples in assisted living and dementia care communities when one of the two people has meaningfully more complex physical or dementia support needs is a challenge faced every day by senior placement professionals.

People do not age at the same rate, either physically or cognitively. Sometimes the differences are relatively minor, and the couple can continue to live together, with some support. In other instances, though, dementia or physical difficulties are significantly more advanced with one person and living in the same apartment becomes complicated.

While one solution is almost always separate apartments within a supportive senior community, separate apartments cost 80% or so more than one common apartments with separate support services. This cost is prohibitive for most couples. The following discusses specific solutions for couples with different needs desiring to live together in assisted living or dementia care communities.

Timing is everything

In my experience, most couples move into assisted living relatively late – their experience living at home typically has been deteriorating for several years, yet they resist the move to more supporting housing because they perceive the move as a loss of independence.

If the couple is confined to a two rooms, though, as is often the case, with dementia or physical problems are severely limiting one partner and care providers coming and going every day then independence has probably already been lost.

It is often better to move into a community where care is more readily delivered, and the focus can be shifted to family and social activities. So many times, people have told me that “I just moved here too late.”

Focus on time together earlier in the disease process

Unfortunately, many types of dementia, such as that associated with Alzheimer’s and Parkinson’s, have reasonably predictable progression timelines. For many people, the last years of these diseases are spent with rapidly decreasing cognition and increasingly debilitating physical problems.

Many couples want to live as many of their “better” years together, and they want solutions within senior living that allow them to live together as long as is practical. Smart assisted living and dementia care communities are innovating to make this possible.

One partner has dementia; the other does not

This is one of the most common scenarios. One senior has relatively intact cognition, while the other has dementia that is progressing. In a surprising number of cases, the couple can continue to live together in assisted living, with a care plan set up to help the partner with dementia receive assistance with the activities of daily living (dressing, bathing, etc.) in the apartment, administered by the staff.

In some cases, the partner with dementia will go to the community’s memory care section during the day and participate in activities appropriate for a person with dementia. This frees up the partner without dementia to enjoy the standard activities of the community. The couple then comes together for at least the evening meal and goes back together to the apartment to sleep.

One community I work with has an intermediate option – a day program for people with dementia set up right in the community. This is a great option for people with moderate dementia.

Some communities will accommodate couples in dementia care sections even when only one partner has dementia. This is not as common – the apartments in dementia care are typically smaller than in assisted living, and some states have laws preventing a person who does not have dementia from living in dementia care.

Some communities, though, have gotten waivers for this joint accommodation, and have worked through the logistics of giving the non-dementia partner access to activities elsewhere in the community that provide social and physical stimulation appropriate for a senior without dementia. This is another way for a couple to stay together even as their needs for care diverge.

When dementia progresses

The causes of dementia are several, and each progresses at a different rate. Most types of dementia, too, have neuromuscular and other physical changes associated with different stages of the disease process. The later stages of Alzheimer’s, for example, typically limit a person’s ability to walk, talk, and use many of their muscles.

At some point, people with advanced dementia often need to live in a specialized facility – a more advanced dementia care community or long-term care facility. This period is extremely hard on couples, and their strategies and choices are determined by a variety of factors, including cost.

Sometimes couples will move into separate housing at this point – a separate apartment within the community for the healthier partner, or even moving out of senior living altogether, while the other moves into housing that can manage sometimes completely nonverbal and non-ambulatory residents.

Creativity leads to good solutions

Senior living communities are working to accommodate couples with different capabilities, giving them as many years together as possible.

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