An Active Approach Memory Care Poses Specific Challenges for Assisted-living Residences

It’s more than free groundskeeping.

Laurie Kenney, director of residential care at Ruth’s 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 Alzheimer’s disease, she said, that kind of connection to one’s past can help keep the mind as sharp as possible.

“With Alzheimer’s or dementia, it’s 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 Ruth’s House is called the Garden — appropriately enough for the man with the green thumb — and it’s a separate level of care than normal assisted living. It’s not nursing care, because assisted-living facilities are barred by state regulations from providing that, but reflects the additional struggles people with dementia or Alzheimer’s 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.”

Ruth’s House isn’t alone; the model of a memory-care program within a general assisted-living setting is one that’s gaining momentum throughout the region and nationwide.

“We’re assisted living, and everyone receives a certain level of care, but there’s 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, it’s 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? What’s happening?’ We try to prevent those feelings of anxiety by structuring the day for them.”

And it’s 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 that’s structured with their needs in mind, and try to eliminate feelings of loneliness, confusion, and fear.”

This month, The Healthcare News 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 Alzheimer’s 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. That’s because they don’t have the structure at home; they don’t do enough. Here, they’re stimulated and have that structure they need to keep their minds going.”

White agreed. “If you take someone with Alzheimer’s 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 you’re an older person and you’re 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 it’s 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 Ruth’s 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 can’t 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 don’t 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 we’re taking care of safety and meals, and checking in on Mom to make sure she’s OK.”

That’s true of any resident in assisted-living care, but moreso for Alzheimer’s and dementia patients, who need more attention at a level that’s usually extremely difficult to provide if they live in their own home.

“It’s hard to find someone to be with your parent 24 hours a day,” White added. “It’s even hard to find a private-duty nurse to make that commitment. That’s 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 The Healthcare News 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 don’t like people taken our overnight or on vacations and make a rule against it, while some allow a client to leave the premises if they’re signed out properly.”

According to the Fisher Center for Alzheimer’s Research Foundation, a research and advocacy group, families interviewing assisted-living facilities should look for specific elements in a memory-care program, including:

• A structured routine for residents in comfortable, familiar, and safe surroundings;
• A compassionate staff that takes time to gather specific lifestyle information about residents in order to individually cater to their needs;
• Activities that reflect the routines that each individual resident has established over a lifetime, and that help people succeed at familiar tasks, whether it is making their bed or baking cookies, giving them a feeling of satisfaction and productivity;
• A slate of outdoor activities, such as secured walking paths and waist-high gardening boxes for people to do their own gardening without bending over;
• A proven ability to deal with difficult situations and behaviors, and stated examples of how the staff deals with them; and
• An emphasis on preventing wandering.

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 don’t like that,” Phaneuf said. “They’re not locked in; they can come and go as they please, with an escort. I like to use the term ‘secure.’ They’re living in an environment where they won’t 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 don’t yet need nursing-home care. Models like Ruth’s House and the Arbors — and other facilities in the region, such as Landmark at Monastery Heights in West Springfield and Reed’s 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 Ruth’s House, meaning families don’t 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 altogether.

“But many people in the early stages of dementia don’t 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 that’s what we do.”