Memory care safety checklist: 10 standards every community should meet

Choosing a memory care community for a loved one is a huge undertaking, both logistically and emotionally. You want to be sure they’ll be safe, cared for and treated with dignity, but how can you really tell whether a community will meet those needs once you leave the tour? 

“Families sometimes assume that because a community has a secured memory care unit, their loved one will be safe,” says Jennifer Szakaly, founder and chief executive officer of Caregiving Corner, an aging life care management firm in Charlotte, North Carolina. “But locked doors are not enough.”

Szakaly recommends looking beyond the building to staffing — how well employees know residents and how they respond to emergencies and changes in behavior. 

Whether you’re touring a memory care community or checking in on a loved one who’s already moved in, this checklist can help you ensure the community’s safety practices are meeting expected standards and spot any potential red flags.

1. Licensing is current and inspection records are accessible

The community should be licensed to provide the type of care your loved one needs, and that’s not always a given, says Ryan Majchrzak, owner of an Assisted Living Locators franchise in Maryland and a senior certified advisor with dementia care certification.

“There are some communities who state they offer memory care, or have the ability to care for those in need of memory care, but aren’t licensed to do so,” he says.

Licensing requirements vary by state, so check with the agency that regulates senior living communities where you’re looking. Szakaly also recommends reviewing inspection reports, complaints and enforcement actions and then asking the administrator for more information. 

Going a step further, “don’t just ask whether it’s licensed,” she adds. “Ask what problems inspectors have found and what the community has done to correct them.”

If a community advertises additional accreditation, verify what organization issued it and what the accreditation covers. Accreditation is a separate process from state licensing — it generally involves an external organization assessing a community against its own specific standards and does not replace the state license required to provide memory care.

Find memory care

2. Wandering prevention balances security and freedom

A secured entrance is just one part of a safe environment. “For wandering, there should be monitored exits, staff who recognize each resident’s patterns and a clear plan if someone goes missing,” says Arnold Septimo, a licensed practical nurse and health services manager at Dallas Retirement Village in Dallas, Oregon. 

Septimo adds that safe places to walk and meaningful activities also matter. Security is crucial, but residents should also have freedom to move around, spend time outdoors and engage socially. 

Majchrzak notes that this is also a time for families to be open and honest with memory care staff. He encourages families to share exactly how their loved one’s dementia has been showing up, including any history of wandering, so staff can plan for it.

“Families sometimes assume that because a community has a secured memory care unit, their loved one will be safe. But locked doors are not enough.”

— Jennifer Szakaly, founder and chief executive officer of Caregiving Corner in North Carolina.

3. Staffing levels are appropriate for a memory care unit

A staffing number alone doesn’t tell you whether residents are getting the help they need. Septimo recommends finding out how many caregivers are on the memory care unit specifically each shift, not just the facility as a whole.

And don’t forget about the off-hours. “Ask what happens when a resident needs help at 2 a.m., not just at 2 p.m.,” says Szakaly. It’s also a good idea to find out what happens when an employee calls out.

Majchrzak notes that state memory care licensing typically requires a stricter staff-to-resident ratio than assisted living, though the rules vary. The administrator should be able to explain the requirements that apply to that particular community and how they ensure residents receive appropriate supervision and assistance.

4. Staff receive ongoing dementia-specific training

You’ll likely get confirmation that dementia-specific training occurs, but experts recommend taking it a step further and getting into the specifics. 

“Ask what they learn, how often they get refreshers and how they practice handling real situations, like someone refusing care or becoming upset,” says Septimo.

Majchrzak agrees, noting that this kind of focused training is how caregivers learn to communicate with and redirect residents, making it an essential part of day-to-day care.

5. Staff interact respectfully with residents

The most telling signs of quality care often don’t show up in a brochure. Szakaly suggests observing whether staff speak directly to residents, use their names and give them time to respond. 

“Good dementia care recognizes that people still need choices, relationships, dignity and a sense of purpose,” she says.

As you observe staff and residents, look for these signs of respectful, attentive care:

• Caregivers respond patiently when residents repeat questions or need extra time.
• Staff communicate compassionately with residents who are agitated, rather than seeming frustrated or impatient.
• Residents are encouraged to do what they can for themselves, even if it takes longer.
• Staff find ways to communicate with residents who have limited ability to speak.
• Residents are well groomed and receive prompt help if they’ve had an accident.

“I’ve witnessed caregivers who are excellent at properly redirecting,” says Majchrzak. “I’ve also witnessed caregivers who are not or seem put off and speak inappropriately to residents in these situations.” He recommends paying attention to how staff handle these moments during your visit.

6. Behavioral changes are handled with care

Agitation, aggression and sundowning can be challenging for residents and caregivers alike. Septimo says staff should first try to understand what a resident needs rather than immediately treating the behavior as a problem to control.

“Are they hurting, tired, hungry, overwhelmed or needing the bathroom?” he asks. A calm voice, some space and a familiar routine may help, he adds. A sudden change in behavior also warrants a medical assessment.

Szakaly and Septimo say these are warning signs to watch for:

• Staff who argue with, threaten or rush a resident through care.
• Frequent unexplained sedation.
• Staff who dismiss distress as simply part of dementia.

“Medication should have a clinical purpose, never be used just to make someone easier to manage,” says Septimo.

7. Medication management follows a clear protocol

Medication safety involves more than keeping medications locked away. Septimo recommends verifying that staff are trained to manage medications, keep clear records and follow up if a dose is missed or a resident experiences side effects.

The community should also have a process for involving families when a resident’s medication needs change. Majchrzak notes that shifts in cognition or behavior can lead to a conversation about adjusting medications. Family members, especially whoever holds power of attorney, should be part of those discussions.

8. There are clear emergency plans in place for memory care residents

Fires, severe storms and power outages are stressful for anyone, but they’re especially hard on people who may not understand what’s happening. 

One way to minimize that distress is to ensure staff members know their roles during an emergency, including who is in charge of calming and directing the residents. 

“Staff need to practice helping people who may be frightened or unable to follow directions,” says Septimo.

Emergency procedures should include regular drills, plans for evacuating or sheltering residents who can’t follow instructions and a clear process for contacting families during an emergency.

9. The physical environment supports safe navigation and mobility

During your tour, look at the space from the perspective of someone who may have difficulty navigating an unfamiliar environment. Septimo recommends looking for good lighting without harsh glare or deep shadows, clear walking paths and noise levels that allow residents to feel comfortable.

Signs and familiar pictures can also help residents find their rooms and bathrooms, he says. Outdoor areas should be secure and accessible, with regular opportunities for residents to use them.

It’s also important to have realistic expectations about falls. Majchrzak says many families assume a move will eliminate that risk.

“While senior communities can minimize the risk of falls, they are not providing one-on-one care and cannot completely prevent falls from occurring,” he says. 

A good community will suggest ways to reduce the risk, like encouraging a resident to use a walker or recommending a bedside commode so they don’t have to walk to the bathroom at night.

10. Communication with families is timely and transparent

Before move-in, it helps to know how the community will keep you informed and what you can expect when something changes. Szakaly says a clear communication plan should identify:

• A primary contact.
• Which situations trigger a call.
• How quickly families should expect to hear about an incident.

Majchrzak notes that some communities offer online portals or regular family reports. He says these systems can be a sign that a community prioritizes communication and transparency. He also suggests speaking with current residents’ families about their experiences, since management and care staff may change over time.

After their loved one moves in, Szakaly says families should hear about changes in eating, sleeping, mobility, behavior or health before those concerns become major problems.

“If you have to keep discovering things yourself, that’s a concern,” she says.

What to do if you have safety concerns

If something doesn’t feel right, having clear documentation helps. Szakaly recommends recording concerns with dates, times, what happened, who was involved and what staff told you. Keep relevant emails and photographs, too, when appropriate.

Start by raising the issue with the nurse or care manager, then contact the community’s administrator if the concern isn’t addressed. If the response doesn’t resolve the problem, Szakaly recommends contacting the state’s long-term care ombudsman (an advocate who helps residents and families resolve concerns about long-term care) or licensing agency. Suspected abuse, neglect or immediate danger shouldn’t wait for an internal investigation.

Majchrzak also encourages families to put concerns in writing and keep the community’s responses. If a serious incident occurs and the response is inadequate, he says, families may need to escalate the concern to an ombudsman or regulator.

You don’t have to assess everything in one visit. Szakaly recommends visiting more than once, at different times of day, rather than relying solely on the scheduled tour. Have a meal, observe a shift change and pay attention to how residents spend their time. 

Septimo also suggests asking staff, “Can you give me an example of something you changed after a fall or another safety concern?” The answer can tell you a lot about whether a community’s policies show up in everyday care.

“Your job doesn’t end when your loved one moves in,” says Szakaly. “It just changes.”