The distinction between mild cognitive impairment and dementia can get a bit blurry. In California, Residential Care for the Elderly (RCFE) facilities can accept people with varying degrees of memory loss. Once a person is diagnosed with dementia, there are additional licensing requirements a facility in California must meet.
The definitions that follow are from the Community Care Licensing regulations:
“Mild cognitive impairment” (MCI) refers to people whose cognitive abilities are in a “conditional state” between normal aging and dementia. Normal age-related memory changes can include:
- forgetting a person’s name
- location of an object
Individuals with MCI have difficulty with short-term memory loss. MCI is a state in which at least one cognitive function, usually short-term memory, is impaired to an extent that is greater than would be anticipated in the normal aging process. MCI is characterized by short term memory problems, but no other symptoms of dementia (e.g., problems with language, judgment, changes in personality or behavior) that affect a person’s daily functioning. Individuals with MCI may experience some difficulty with intellectually demanding activities, but lack the degree of cognitive and functional impairment required to meet diagnostic criteria for dementia.
“Dementia” means the loss of intellectual function sufficient to interfere with an individual’s ability to perform activities of daily living or to carry out social or occupational activities, such as:
- thinking
- remembering
- reasoning
- exercising judgment
- making decisions
- other cognitive functions
Dementia is not a disease itself, but rather a group of symptoms that may accompany certain conditions or diseases, including Alzheimer’s Disease. Symptoms may include changes in personality, mood, and/or behavior. Dementia is irreversible when caused by disease or injury, but may be reversible when caused by depression, drugs, alcohol, or hormone/vitamin imbalances.
Someone meeting with Mr. Sweetbriar might wonder why his family is so concerned about his memory. He is alert and focused and answers your questions with reasonable clarity. However, his family describes his difficulty remembering his grandchildren’s names, dialing wrong numbers, and losing his sunglasses twice in the last month. The key to providing care for Mr. Sweetbriar is in the diagnosis from his physician. His doctor has diagnosed mild cognitive impairment.
There are a considerable number of additional requirements for a RCFE to be approved to provide care and supervision to people with dementia. A person with dementia will be considered “non-ambulatory” (even if he/she walked into the doctor’s office unassisted) because he or she would need assistance in leaving the facility in an emergency. The local fire authority must approve the beds for non-ambulatory residents. There are some common sense requirements for safety – to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials. All staff are required to receive training when they begin work on specific issues for people with dementia, as well as eight continuing education hours on dementia each year.
It is wise to ask if a facility is approved to care for people with dementia (it was referred to in the past as having a “dementia waiver.”) These homes are approved by Community Care Licensing for dementia services, if they can show adherence to the licensing requirements.
Rhonda Krantz Mayer
Community Training Connection, Inc.
Chatsworth, California