How to Evaluate Dementia Care Facilities That Truly Care
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When I visited one of the potential care facilities for mom I noticed a woman sitting on a sofa across the room just starring out the window. A young caregiver walked up to her, knelt down to eye level, gently touched her hand, and spoke to her by name with genuine warmth. That one encounter spoke volumes.
Evaluating care facilities for your loved one with dementia can be overwhelming. You have so many questions usually mixed with a good dose of self-doubt.
Glossy brochures show beautiful dining rooms and sunny courtyards, but they don't reveal what daily life is really like—especially for those who can no longer advocate for themselves.
This is part 2 of a 3-part. In case you missed it, here is part 1.
The 7 C’s of Quality Dementia Care
In this second article of our three-part series, I'll share what I've learned about looking beyond surface impressions to evaluate what really matters. My goal isn't to give you a checklist of "perfect" attributes—no facility is perfect—but rather to help you develop an eye for quality care that matches your loved one's specific needs.
To make this evaluation process more manageable, I've organized my approach into what I call "The 7 C's of Quality Dementia Care." These seven critical factors will help guide your assessment and ensure you're focusing on what truly matters for your loved one's wellbeing.
Competence - Assessing Staff Training and Expertise
The quality of care your loved one receives depends directly on the knowledge and training of the staff providing it. Before evaluating physical spaces or amenities, focus first on the people who will be providing daily care.
Specialized Dementia Training
Ask specifically about:
What percentage of staff has received specialized dementia care training?
Is the training ongoing or just a one-time orientation?
Does the training cover communication techniques specific to dementia?
How are staff members trained to respond to challenging behaviors?
According to Centers for Medicare & Medicaid Services data, higher staff-to-resident ratios—particularly of nurses and certified nursing assistants with dementia-specific training—correlate strongly with fewer health problems, fewer hospitalizations, and better quality of life for residents.
Staff Stability and Turnover
High staff turnover is a major red flag. According to a report from the National Center for Assisted Living, the national average turnover rate in assisted living is around 36%, but ranges vary significantly by facility.
Ask:
What is the facility's staff turnover rate?
How long have key staff members (executive director, nursing director, activities director) been with the facility?
Do the same care providers consistently work with the same residents?
How does the facility ensure continuity of care when staff changes occur?
I found that facilities with lower turnover rates typically had stronger leadership, better staff morale, and more consistent care—all essential for residents with dementia who rely on familiarity and routine.
Communication - Staff Interactions and Information Flow
Communication is the foundation of quality dementia care—both how staff communicate with residents and how the facility communicates with families.
Staff-Resident Communication
Pay close attention to how staff members interact with residents:
Do they address residents by name and speak to them directly, or do they talk about them as if they aren't there?
Do they approach residents from the front, make eye contact, and speak clearly?
Do they rush residents or wait patiently for responses?
How do they handle moments of confusion or resistance?
Small interactions often reveal more about care quality than formal presentations. When I was touring facilities for mom, I watched one aide gently redirect a resident who was trying to leave by taking her arm and walking with her, asking about her family rather than simply saying "no" or physically blocking her path. That told me volumes about their approach to care.
Family Communication Protocols
Clear systems for family communication are essential. Ask about:
How does the facility notify families about changes in condition or care needs?
Who is your main point of contact for questions or concerns?
How often do care plan meetings occur, and how are families involved?
What systems are in place for regular updates, even when nothing is wrong?
How responsive is the staff to family inquiries?
According to Leading Age, facilities with transparent communication policies and regular family contact have higher satisfaction rates and fewer complaints. Don't hesitate to ask for specific examples of how they've handled communication challenges in the past.
Comfort - The Physical and Sensory Environment
While aesthetics shouldn't be your primary concern, the physical environment significantly impacts quality of life for people with dementia.
Dementia-Friendly Design
Look for environments specifically designed with cognitive impairment in mind:
Clear wayfinding cues and visual landmarks
Contrast between walls and floors to define spaces
Secure outdoor areas that allow safe wandering
Homelike settings rather than institutional corridors
Research from the Dementia Enabling Environment Project shows that thoughtfully designed sensory environments can reduce agitation and improve quality of life for people with dementia.
Sensory Considerations
Dementia heightens sensitivity to environmental stimuli. Notice:
Noise levels: Is there constant TV or overhead paging, or is the environment relatively calm?
Lighting: Is lighting even and glare-free? Are there dark corners or shadowy areas that could cause confusion?
Smells: Beyond obvious cleanliness issues, are there pleasant, homelike aromas?
Tactile elements: Are there things to touch and interact with in common areas?
During one facility visit, I noticed they had a "sensory room" with different textures, gentle lighting, and soft music where agitated residents could find calming stimulation—this demonstrated real understanding of dementia care needs.
Care Philosophy - Approaches and Interventions
How a facility approaches dementia care—both in theory and in practice—will dramatically affect your loved one's daily experience.
Person-Centered vs. Task-Centered Approaches
Listen carefully to how staff members describe their care approach:
Do they talk about getting tasks done efficiently, or about meeting individual needs?
Do they have specific examples of how they've adapted care for residents with different preferences or behaviors?
How do they handle residents who refuse care or become agitated?
According to the Alzheimer's Association, person-centered care—which focuses on individual preferences, life history, and remaining abilities rather than deficits—leads to better outcomes for people with dementia.
Behavior Management Approaches
How a facility handles challenging behaviors reveals much about its dementia care expertise. Ask:
How do staff respond to agitation, wandering, or aggression?
When and how are medications used to manage behaviors?
What non-pharmacological approaches do they use first?
According to the National Partnership to Improve Dementia Care in Nursing Homes, antipsychotic medications are often overused in dementia care. Quality facilities will emphasize non-drug approaches and use medications as a last resort.
Medical Care Coordination
Quality facilities coordinate physical health alongside cognitive care. Ask about:
How often do residents see a physician or nurse practitioner?
Is there a dedicated provider who specializes in geriatrics or dementia care?
How are medication changes monitored and evaluated?
What is the protocol for managing chronic conditions like diabetes or heart disease?
Depression and pain are often undertreated in dementia patients because they can't clearly express symptoms. Ask about how the facility assesses and manages these conditions in residents who may not be able to self-report their experiences.
Community - Social Engagement and Quality of Life
Social connection remains vital for people with dementia, even as cognitive abilities decline. The best facilities create meaningful engagement opportunities tailored to residents' abilities.
Activity Programming
Activities should be purposeful and appropriate for different cognitive levels, not just time-fillers. Ask:
How are activities adapted for different cognitive abilities?
Are there small group and one-on-one activities for residents who become overwhelmed in large groups?
How often do residents go outdoors or have access to nature?
Are there opportunities for residents to contribute and feel useful (like folding napkins, gardening, or helping with simple cooking projects)?
When looking at the activity calendar, notice whether activities are scheduled throughout the day, including evenings and weekends, or only during business hours when families are likely to visit.
Observe Resident Engagement
The single most important thing to notice is how the current residents are spending their time:
Are residents engaged in activities or conversations, or are they lined up in hallways or parked in front of a television?
Do you see residents interacting with each other and with staff?
Do residents appear clean, well-groomed, and appropriately dressed?
Research from the Journal of the American Geriatrics Society shows that meaningful social engagement is one of the strongest predictors of quality of life for people with dementia. A facility that prioritizes resident interaction over passive entertainment is demonstrating its values through action, not just words.
Dining Experience
Mealtime is about more than nutrition; it's a key social experience. Observe a meal if possible, noting:
Is the dining area calm and inviting, or chaotic and rushed?
Do staff sit with residents who need help eating, or do they stand over them?
Is the food appetizing and appropriate for various dietary needs?
Are residents given choices and respect for preferences?
According to a study in the Journal of Nutrition in Gerontology and Geriatrics, family-style dining with staff participation improves both nutrition and social engagement for residents with dementia.
Continuity - Consistent Care Across Transitions
Dementia often progresses, requiring transitions between levels of care. Facilities with multiple care levels under one roof can provide crucial continuity.
Care Level Transitions
Ask about how transitions between care levels are handled:
What triggers a move from assisted living to memory care, or from memory care to skilled nursing?
How are families involved in transition decisions?
Is there a specific transition protocol to minimize trauma and confusion?
Can the same caregivers follow residents when possible?
During one facility visit, I learned they had a "stepping stone" program where staff from the next level of care would begin working with residents before they moved, creating familiar faces before the transition. This thoughtful approach demonstrated real understanding of dementia care.
Staffing Consistency
Beyond overall turnover rates, ask about:
Staff-to-resident ratios during day, evening, and overnight shifts
Whether the same caregivers are consistently assigned to the same residents
How staff share information about resident preferences and needs
Whether there's a consistent schedule that residents can count on
According to Centers for Medicare & Medicaid Services data, consistent assignment—where the same caregivers work with the same residents most of the time—leads to better outcomes for residents with dementia.
Health and Safety Systems
Safety is foundational, but shouldn't come at the expense of dignity and quality of life:
Fall prevention protocols that still allow for mobility
Wandering prevention and elopement protections
Infection control practices (especially important post-COVID)
Emergency response systems and staff training
According to the Alzheimer's Association, about 60% of people with dementia will wander at some point. A good facility has multiple systems in place to prevent elopement while still allowing freedom of movement within safe boundaries.
Cost Transparency - Financial Considerations
Understanding the full financial picture is essential for sustainable long-term planning.
Facility Financial Health
The financial health of a facility affects everything from staffing levels to food quality to maintenance. Look for these indicators of financial stability:
Well-maintained buildings and grounds (look for deferred maintenance like peeling paint or broken fixtures)
Consistent staffing levels
Regular facility improvements and updates
Transparent financial discussions
According to LeadingAge, a nonprofit organization that represents aging services providers, facilities that struggle financially often cut corners on staffing first, followed by food quality and maintenance—all of which directly impact resident care.
Cost Structure Clarity
Ask detailed questions about costs:
What services are included in the base rate versus additional charges?
How are cost increases determined and communicated?
What happens financially when a resident needs to move to a higher level of care?
What is the average annual rate increase over the past five years?
Get everything in writing and have it reviewed by a family attorney or elder law specialist before signing. Make sure you understand exactly what you're paying for and what might trigger additional costs.
Long-term Financial Planning
Consider the financial implications over time:
If there's an entrance fee, what refund options exist?
How long can your loved one's resources sustain the monthly costs? Remember these costs will go up over time as your loved one’s needs increase over time.
Does the facility accept Medicaid if private funds are exhausted?
What financial documents are required for admission?
According to research from RetireGuide, families typically end up covering about 65% of dementia care expenses out-of-pocket, so realistic financial planning is essential.
Making Unannounced Visits Count
Scheduled tours show you what the facility wants you to see. Unannounced visits show you reality. Try to visit at least once during each of these times:
Mealtimes (particularly dinner)
Evenings (after 7 PM)
Weekends
Shift changes
Each time offers a different perspective on staffing, activities, and overall care quality. During one of my evening visits to a prospective facility for mom, I discovered that despite the impressive activity calendar, there was absolutely nothing happening after 4 PM—residents were just sitting in front of a TV that no one was watching.
What to Look For During Unscheduled Visits
During unannounced visits, pay attention to:
Staff presence and engagement with residents
Whether activities are actually happening as scheduled
Cleanliness and orderliness outside of "tour hours"
How call lights or requests for assistance are handled
Take notes during each visit to compare impressions and help you remember specific details when making your final decision.
Don’t Ignore Red Flags
Some issues are more than just concerns—they're dealbreakers that indicate fundamental problems with care quality or facility culture.
Unengaged Residents and Inattentive Staff
If you consistently see residents sitting alone, unattended, or in front of TVs for long periods, this suggests inadequate staffing or lack of commitment to engagement. Research from the Gerontological Society of America shows that social isolation increases both cognitive decline and mortality in older adults.
Evasive Answers to Direct Questions
Quality facilities are transparent about their challenges as well as their strengths. Be wary if staff:
Deflect questions about staff turnover
Can't clearly explain their approach to dementia care
Give vague answers about costs or fee increases
Won't share state inspection reports
The National Consumer Voice for Quality Long-Term Care, says that transparency is one of the strongest predictors of overall care quality.
Pressure Tactics During Sales Process
Good facilities don't need high-pressure sales tactics:
Pushing for quick decisions or deposits
Creating artificial scarcity ("We only have one room left")
Discouraging comparison with other facilities
Limiting access to current residents or certain areas of the facility
Take your time with this decision—any facility that rushes you is putting their needs above yours.
Conclusion: The 7 C's Working Together
Finding the right care facility for someone with dementia is a journey, not a single decision point. As you evaluate different options using the 7 C's framework—Competence, Communication, Comfort, Care Philosophy, Community, Continuity, and Cost Transparency—remember that perfect facilities don't exist, but good matches do. Trust your observations and your instincts. The clipboard full of questions matters, but so does that feeling you get watching how staff interact with residents.
In the final article of this series, we'll discuss how to make the transition from home to facility care as smooth as possible for both your loved one and your family. Until then, be gentle with yourself as you navigate this process. You're doing your best to make informed decisions during what is undoubtedly one of life's most challenging transitions.
The right facility isn't necessarily the newest or the one with the most amenities—it's the one where your loved one will be known, respected, and cared for as an individual.
Keep that goal at the center of your search, and you'll find your way.
Additional Resources
IMPORTANT: This website is informational only and does not provide medical advice, diagnosis, or treatment. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
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