Essential Risk Management Strategies for Memory Care Facilities

Risk management is paramount in senior care, but it takes on heightened significance in memory care settings. The complex challenges posed by cognitive impairments demand innovative, tailored strategies that go beyond traditional approaches. Caregivers must navigate a delicate balance between ensuring safety and maintaining quality of life. This requires specialized methods to address the unique vulnerabilities of residents with dementia and related conditions.

Jay Mikosch, campus executive director at Wellington Bay

By implementing proactive risk management measures, facilities can ensure the safety and well-being of both residents and staff members while also minimizing the potential for accidents or errors. These strategies not only mitigate immediate risks, but can also protect memory care programs from potential legal liabilities, enhancing the overall quality of care and fostering trust with families.

The Heightened Risks of Memory Care

Certain risks are heightened in memory care settings due to the unique challenges presented by cognitive impairments. These include behaviors that could present as a danger to the individual resident, other residents, or caregivers. “The risk of elopement, dehydration and weight loss can also be concerns for people affected by dementia or Alzheimer’s disease,” says Jay Mikosch, campus executive director at Wellington Bay.

Falls and swallowing hazards are major concerns in memory care, too. “With decision-making skills impacted, residents with dementia lose the ability to protect themselves, making close supervision critical,” explains Micki Buchanan, director of memory care at United Hebrew.

She notes that even seemingly harmless gifts can harbor risks. “For example, a beaded scarf might make a beautiful gift, but a cognitively impaired individual may be tempted to put the beads in their mouth,” she explains. “We inspect items for potential risks, and work closely with families to ensure their loved ones receive items that are both enjoyable and safe.”

Steps to Reduce the Risk of Legal Claims

Pre-Admission and Family Relationships

Reducing the risk of legal claims starts with the resident pre-admission process. “One of the most important things a community can do to reduce the chances of incidents and legal claims is to conduct a thorough pre-admission assessment with the resident and family members, preferably in their home environment,” says Mikosh. It’s essential for memory care programs to know as much as possible about the person’s routines, interests, likes, dislikes, and more, and more than one conversation or visit may be necessary to get that information. “The more a community knows about the resident in advance, the better it can individualize its service plan to meet the needs of the resident,” he explains.

Developing a close working relationship with the resident’s family is also important in mitigating risk. “It should be a partnership with open, two-way communication throughout the resident’s stay in the community,” says Mikosch. “No one knows the resident better than their loved ones.”

Micki Buchanan, director of memory care at United Hebrew

That relationship with the family also plays a key role in understanding the family’s expectations and educating them about what the community can do, as well as what it can’t. These conversations should take place before the resident moves in. Mikosch also highlights the importance of providing ongoing education about the disease process and encouraging the family to participate in community-sponsored caregiver support groups.

United Hebrew prioritizes prevention to reduce the risk of legal claims. “Adequate staffing, especially for residents prone to wandering, is crucial,” Buchanan explains. “We provide rigorous training for staff and educate our visitors and vendors to ensure that all safety protocols are followed, including a robust sign-in system to minimize the chance of incidents.”

Additionally, United Hebrew prioritizes open communication, information, and education, including learning about residents from their families and providing regular updates on their loved ones’ medical, social, functional, and cognitive condition. “This collaborative approach fosters trust and ensures a smooth transition through various stages of care,” says Buchanan.

Training and Protocols

Staff members are integral to helping memory care communities mitigate risk, so it’s important to focus on hiring the right staff and providing appropriate training. “A community can’t train personality, so the first step is to hire right,” says Mikosch. “At that point, the training begins and never ends.” In addition to adhering to state-specific training requirements, he notes that the best training is resident-specific. “Are staff aware of the resident’s specific service plan? Are they aware of their likes/dislikes, hobbies, education, profession?” he poses. Mikosch encourages memory care communities to share the pre-admission assessment with staff, as knowing the resident as an individual fosters more personalized care.

It’s equally important for communities to establish risk reduction procedures. Buchanan encourages a comprehensive approach which might include annual competency evaluations, rigorous new hire training, ongoing performance monitoring, camera surveillance for extra oversight, and real-time feedback to ensure staff are meeting expectations.

Facility Design

Strategic design can also enhance resident safety, notes Buchanan. “Elements may include a locked unit with alarms on entrances and exits, a U-shaped interior design so that staff can view longer hallways and keep residents in their line of sight, and designated areas that encourage residents to gather and rest,” she says. Cameras can also offer insight into staff-resident interactions, helping identify areas for improvement.

Resident Assessments
“An alert and compassionate care team is the best line of defense that a resident with dementia has to receive the best possible care, as they cannot always express their needs verbally,” explains Buchanan. Regular assessments are critical for memory care residents, as changes in behavior may indicate an underlying medical condition.

Additionally, Buchanan emphasizes the importance of a vigilant care team. “They communicate verbally and through written notes, as part of an interdisciplinary approach to inform families, and help them make decisions regarding medical care, activities, and diet,” she says. “For example, if we identify a transition, like poor swallowing or chewing, we can immediately change their diet to pureed or chopped foods, improving their quality of life.”

Comprehensive Risk Management

Memory care communities face numerous risks, so a comprehensive, multi-pronged approach to risk management is essential. By taking a proactive approach to risk management, memory care communities can help ensure residents receive quality care and prevent potential problems.

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.