Alzheimer's and Dementia Facility Checklist

Directions: This checklist is intended for use when seeking a facility that provides specialized care for residents with Alzheimer's or dementia. This form should be used in conjunction with either the assisted living or skilled nursing facility checklist. Complete this for each facility you visit to keep track of and compare different facilities.

Name of Facility:

Date of Visit:

Address:

Phone Number:

Director Name:

Basic Information Yes No Comments
Is the level of care needed offered and a bed is available?
Is the facility small and more like a person's home? Or large and institutional?
Is the facility on a quiet or busy street? Urban or residential?
Is the Alzheimer's and dementia unit separated from the rest of the facility?
What special services are provided in this unit?
Personal and Health Care Yes No Comments
Are residents encouraged to remain continent? Is there a schedule or reminders in place?
Does the staff help with toileting if needed?
Does facility have the ability to determine the cause of confusion a resident may develop (medications versus diagnosis of dementia or Alzheimer's)?
Are there safeguards in place to ensure that medications are taken on time and in the correct dosage?
Does the facility use physical or chemical restraints? If so, under what circumstances and policy?
Residents Yes No Comments
Are residents clean, appropriately dressed for the season or time of day and well groomed?
What percentage of residents wears diapers?
What is daily life like at the facility?
Are most residents at the same level of mental function as your family member?
Facility Environment Yes No Comments
Is the noise-level low? Are walls properly insulated for noise reduction?
Is the facility all on one level?
Are there circular areas for wanderers rather than long hallways with dead-ends?
Is facility well lit for the time of day? Are lights dimmed at night time?
Are there visual cues to help residents navigate the facility? These include signs using symbols, use of bold color, and large clocks and calendars.
Staff Yes No Comments
Does the staff wear name tags?
Is the staff qualified to properly deal with a resident's behavior that may change and become abusive, tearful, or asked repetitive questions?
Is there a difference in training provided to staff that work in the Alzheimer's and dementia facility?
Is the ratio of staff to residents adequate?
Is there an Alzheimer's specialist on staff or available as a consultant?
Does the same team of nurses work with same residents most days of the week?
Residents' Room Yes No Comments
If a resident shares a room, does the roommate have mannerisms or habits that will be difficult to deal with?
What is policy if roommates are not getting along with each other? How does facility deal with problems when they arise?
Menus and Food Yes No Comments
Are small snacks available? How do you ensure residents get enough nutrition?
Are decaffeinated drinks available throughout the day?
Activities Yes No Comments
Are there specific activities offered for residents with memory impairment?
Are smaller, separate rooms used for activities?
Are there protected/enclosed areas for residents with dementia?
Safety and Security Yes No Comments
What safety measures are in place to protect residents from wandering the facility or grounds?
General rating on a scale of 1 (poor) to 5 (excellent):

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