Skilled or Assisted Level: Special Care Units (SCU) may be licensed as either Assisted Living or Skilled Nursing facilities (SNF). The primary distinction is that at the SNF level they can accept clients with significant medical problems as well as the dementia (see Red Flags). The other significant difference is in the area of restraints. Generally Assisted Living facilities are quite limited in their ability under the law to use any restraints with residents. At the SNF level, under the guidelines set out the laws of the state, restraints (chemical or physical) may be used in certain instances (e.g., the resident represents a threat to others because of combativeness or to themselves because of high fall risk). Outside of these two significant differences the overview that follows can apply to either level of care (SNF or Assisted). SCU's may be either part of a larger facility or a stand alone facility. In either case there are a number of characteristics to look for. Secure Environment. One of the common behaviors of persons with dementia is wandering. SCU's should be secure at several levels. First of all at the perimeter of the grounds and at the exits of the building, where appropriate. Fencing, gates, alarms, passcode systems, pager alerts, locks (where legal and appropriate), and various other systems exist to keep residents within a safe perimeter. Look for the combination of systems used by the facility. (Note: In some facilities with excellent perimeter security and staff supervision, certain doors to the building are left unlocked and unalarmed so that the residents have the freedom to wander, often reducing their anxiety in the process.) Physical Environment: Apart from security concerns an SCU would typically have plenty of area, both inside and outside, for the residents to wander in. The environment should be safe (uncluttered, handrails, smooth, flat walking surfaces, etc.) and tranquil with plenty of chairs and benches for residents to use when they get tired. Activities: Another hallmark of SCU's is an extensive activity program that is clearly geared to the dementia level of ability. (Note: While the activity program is essential, it is also important that the facility is structured in such a way as to accommodate the many residents who will never or hardly ever participate in an activity. Look also at the care and supervision that is a part of the unstructured pattern of many residents.) Staff Training: Hand-in-hand with the activities is the staff that is trained to realated to the resident with dementia in a way that is understanding and helping. Well trained caregivers understand how to help and guide confused residents in ways that are reassuring and encouraging. Always take time to observe and talk with staff about their work with residents. Look for evidence of effective communication, patience and tolerance of the behaviors of residents with dementia and an attitude of kindness and flexibility that allows them to provide compassionate care. There are more things that can be and are done by quality SCU's and all SCU's should also be evaluated in terms of the basic assisted level care they provide (see Activities of Daily Living and Evaluating Assisted Living Facilities), but these are the primary qualities to look for in an Special Care Unit.
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