We often receive questions related to occupancy of secure dementia care units in licensed assisted living with dementia care facilities.

In recent weeks, we are also seeing several practices and survey themes worth reviewing.

AL Licensure and Secure Dementia Settings

In Minnesota, we worked hard during the development of AL Licensure to not prohibit individuals who do not have dementia from residing in a secured dementia setting to accommodate couples, access to care, and preference. The outcome is that an individual can reside in a secure unit who does not have a dementia related need, but they are required to have free ability to come and go without staff assistance to do so.

Several concerns in practice are emerging and becoming themes in surveys:

• Limitation of free access to freely come and go:
  • If a fob or code has been provided but the resident lost it – it needs to be immediately replaced.
  • Under no circumstances, including if a resident has let other residents out, can the ability to freely come and go be restricted.
    • Staff need to evaluate reasons why other residents have gotten out, and develop prevention plans. Explore questions such as: Did the person intentionally allow others out? If so, why? Are there system issues that need to be addressed? For example, does the door close fully upon exit? Etc.
  • No agreement can be in place to restrict the free access for any reason.
• Although not a specific requirement, documentation of why the person has chosen to reside in a secure unit is recommended.
• The appropriateness of the applicant for placement in a unit, in consideration of other residents, should be assessed before rental (and throughout their stay). Are they comfortable in the company of those with dementia? Are they a safety risk for those with dementia? 
  • If concerns are identified, the person should not be admitted, or very specific measures to address any risks should be planned for and identified and implemented in the IAPP and service plan.
  • If concerns develop during the course of the resident’s stay, consideration of a transition to an unsecured setting should be explored.
  • The staffing plan must reflect consideration of these elements. Further, ensure adequate staffing to meet resident needs, interventions, oversite is identified in assessments and plans.

Further Dementia Unit Details

Relatedly, a person with a dementia diagnosis is not required to reside in a secure unit. There are many types and levels of dementia, and in fact, many individuals with dementia can live and function in the broader community.

A resident who is actively “exit seeking” is certainly in need of a secured setting, however a secured setting is not required for all individuals. If not living in a secured setting, staff and caregivers need to be vigilant for changes in cognition, comments regarding finding home or work, or increasing difficulty in way finding.

Technology solutions have been very helpful in supporting and keeping individuals with cognitive impairment safe as well. Technology as simple as cell phone tracking or more sophisticated tools such as GPS Smart Sole Tracking devices can be utilized for individuals who may need assistance if out of the setting. Assuring a person has identifying information on their person such as an ID bracelet or necklace can also be helpful.