An Active Approach
Memory Care Poses Specific Challenges for Assisted-living Residences
Its more than free groundskeeping.
Laurie Kenney, director of residential care at Ruths House, recalled a man who had loved working in his garden when he lived independently. So an area was cleared for him outside the assisted-living home to tend a garden. For someone with Alzheimers disease, she said, that kind of connection to ones past can help keep the mind as sharp as possible.
With Alzheimers or dementia, its important to keep the mind active, added Lois White, executive director of the East Longmeadow facility, one of several assisted-living complexes in Western Mass. to offer a specialized program for residents with memory diseases.
The program at Ruths House is called the Garden appropriately enough for the man with the green thumb and its a separate level of care than normal assisted living. Its not nursing care, because assisted-living facilities are barred by state regulations from providing that, but reflects the additional struggles people with dementia or Alzheimers face with daily tasks.
The residents in the Garden neighborhood need more support, directions, reminders, more one-on-one help, said White. They definitely require more care than our other residents do.
Ruths House isnt alone; the model of a memory-care program within a general assisted-living setting is one thats gaining momentum throughout the region and nationwide.
Were assisted living, and everyone receives a certain level of care, but theres another level of care, a higher level, said Mary Phaneuf, director of marketing for the Arbors, a chain of four assisted-living homes, all with a distinct memory-care unit called Reflections.
Someone might assume that higher level of care is nursing care, but it absolutely is not, she continued. The difference is, its a structured, no-fail environment. What that means is that folks with memory impairment have difficulty initiating activities, always feeling, what do I do next? Whats happening? We try to prevent those feelings of anxiety by structuring the day for them.
And its not a one-size-fits-all approach, Phaneuf added. We have a program director whose job it is to get to know each individual personally and design a program around their needs and their hobbies, what they would enjoy doing. They basically get them in a program from morning to early evening thats structured with their needs in mind, and try to eliminate feelings of loneliness, confusion, and fear.
In this issue, BusinessWest examines the benefits and challenges of memory care in assisted living, and why it has many residents and families a lot less anxious.
Peace of Mind
Staying involved in different forms of activity in order to keep the mind sharp has been a hot topic in Alzheimers circles for the past few years, and Kenney said she has seen the benefits first-hand.
When residents move in, we do a mini-mental test that measures their cognitive abilities and impairments, she said. After six months, they generally improve on it. Thats because they dont have the structure at home; they dont do enough. Here, theyre stimulated and have that structure they need to keep their minds going.
White agreed. If you take someone with Alzheimers or dementia and keep their mind active and keep them engaged socially, they will in many cases have a slower decline; it does kind of stave off the progression for awhile, she said. If youre an older person and youre closeted in your home or apartment, just watching TV and not engaging in life, your mental status will deteriorate faster.
That goes for all seniors, she noted, but it does pose a greater challenge to those with memory diseases, and its why assisted-living facilities tend to create a separate, intensive activity program for their memory-care residents. You have to keep their minds engaged, keep them learning.
Still, programs like the Garden and Reflections, while keeping their own activity regimen, do encourage residents to mix with the general population for many occasions, such as birthday parties, entertainment events, and even some day trips.
Wendy Murakami, wellness coordinator for the Garden at Ruths House, said the use it or lose it maxim applies strongly to the dementia population. I think the goal for them is to maintain their function, she said not necessarily to make gains, but at least to keep their quality of life.
These goals are much easier to reach within such a structured environment, White said, noting that the most well-intentioned families cant possibly keep their loved ones occupied in meaningful activities throughout the day.
Family caregivers are kind of the unsung and often unpaid heroes in this because they give up careers, they spend their own finances and resources, they often dont have a lot of support and help, she said. So assisted living is intended to be a partnership between the resident, the family, the doctor, and the facility. It takes a lot off the family caregiver and allows them to be a son, daughter, or grandchild, because they know were taking care of safety and meals, and checking in on Mom to make sure shes OK.
Thats true of any resident in assisted-living care, but moreso for Alzheimers and dementia patients, who need more attention at a level thats usually extremely difficult to provide if they live in their own home.
Its hard to find someone to be with your parent 24 hours a day, White added. Its even hard to find a private-duty nurse to make that commitment. Thats where we come in.
Asking the Right Questions
Hyman Darling, an attorney with Bacon Wilson, P.C. in Springfield who specializes in elder care issues, told BusinessWest that no two assisted-living facilities are the same.
You want to find a place that meets the needs of the client, he said and those needs are highly individualized from resident to resident.
Some places assist with feeding, he continued. Some have higher levels of client care. Some let you pay additional caregivers to come in, while some only allow you to use their own. Some facilities dont like people taken our overnight or on vacations and make a rule against it, while some allow a client to leave the premises if theyre signed out properly.
According to the Fisher Center for Alzheimers Research Foundation, an advocacy group, families interviewing assisted-living facilities should look for specific elements in a memory-care program, including:
That last point is an important one, Phaneuf said, because people with dementia often become confused as to their surroundings, and that confusion can be exacerbated at night when fewer people are around. Therefore, the memory community is secured to prevent wandering.
Some people use the word lockdown, but I dont like that, Phaneuf said. Theyre not locked in; they can come and go as they please, with an escort. I like to use the term secure. Theyre living in an environment where they wont wander out the door in February at 2 in the morning.
Meeting a Need
Assisted living has been around only 25 years or so, said White, and has transformed the way older people are cared for particularly those who struggle somewhat to live independently, but dont yet need nursing-home care. Models like Ruths House and the Arbors and other facilities in the region, such as Landmark at Monastery Heights in West Springfield and Reeds Landing in Springfield that add memory care to the mix are becoming attractive options.
Part of the reason is the ability to provide a continuum of care, White said. While some residents are immediately placed in the Garden, others move there from the general assisted-living population at Ruths House, meaning families dont have to find another home for their parent or grandparent when their dementia progresses.
Nursing homes serve their purpose, and they do a good job for people who need skilled nursing, Phaneuf said. And, of course, many residents eventually do need specialized nursing care, and have to leave assisted living.
But many people in the early stages of dementia dont need skilled-nursing care not yet, anyway, she continued. They just need someone to help them, and provide them with a comforting environment, give them opportunities to develop friendships and enjoy life. And thats what we do.
Joseph Bednar can be reached at[email protected]