Dementia Care: Seeking a Better Solution  

A senior-living expert describes his successful care model that will be the basis of an innovative dementia-care village.

By Larry Carlson

As a thought-leader and operator in the senior-living industry for over 45 years, my approach to assisted living and memory care has put the organization I formerly led on the cusp of offering a ground-breaking dementia-care village. In general, our intention in serving seniors is to enable them to live the lives they love. We approach this from the perspective of positivity: saying yes more than no.

Eight years ago, we transitioned to a new model of care to better serve seniors. Changing our standards and practices meant dropping the old school language and procedures — being more “person–centric” rather than “patient-centric.” The words we use to describe what we do and how we do it have changed to reflect kindness, respect, humanity and community.

Our memory-care program embodies these precepts, too. The Avandell dementia village will be an extension of what we do inside our full continuum of care senior living communities. Here’s a look at our memory-care model.

The familial household

One of the foundations of the memory care model is the idea of a “familial household,” the normal environment we all live in. The idea is to have residents live in an environment that feels more like a house/home and less like an institution. This includes the physical environment, relationships and operations.

The familial household approach is partly about space and process, but it’s the staff who really make it happen. To make this work, we had to cross-train our staff to embrace more of a universal-worker concept. We moved employees away from having a job with a singular function. Certified nursing assistants have assumed additional roles and are now responsible for dishes, laundry and medications for the household.

Each resident has one dedicated staff member responsible for most of their care during a shift. Seeing that one staff person’s face helps a person with dementia form a vital connection with that individual.

The cross-training and new roles in the memory-care program have brought out the best in our staff. It’s given them the insights they need to be more loyal employees and has lessened turnover. Caring for residents who need memory-care requires a great deal of dedication. Our model brings out this potential in people.

A day in our ‘household’

A day in our “household” starts with something we call “natural rising.” We don’t wake up our residents to make it convenient for care staff who are changing shifts. Instead, we adjusted medication times to what we called “upon rising.” Whenever a resident decides that they are going to get up and start their day, that familiar staff member greets them.

The cross-trained employee help provide any assistance that the resident needs. It’s important to tell you that we encourage our residents to be independent, so employees perform “guided care.” We try to not do too much for residents because we want them to experience autonomy and independence. We try to help them maintain a similar daily rhythm and schedule to how it what they had prior to moving into our residences. For example, they eat breakfast whenever they wake up, just like in their own home.

Person-centric engagement

Our term is “person-directed.” The key to success is to “know thy resident,” and anticipate what an individual wants and desires. This increases the frequency and quality of engagement.

It’s very important for our staff to figure out what might be distressing residents because individuals with dementia often cannot articulate this and it might lead to negative behaviors. Our staff then treats the cause of distress, which often mitigates the negative behavior.

Person-centric engagement can yield some remarkable breakthroughs in resident experiences. Because the staff gets to know residents on a personal level, they can gain some useful insights into what makes them tick. This can enable them to bring residents joy, minimize their distress and, in turn, avoid the need to use psychotropic medications to treat the unwanted behavior.  Many times, it’s pretty simple to figure out, but the staff need to “know thy resident.”

Respecting routines

Most importantly, we honor the people who come to live with us. They bring their routines with them. We try to discern what a resident’s “daily pleasure” is and then try to replicate it. Some people wake up at 6 a.m., some at 10 a.m. We don’t force anyone to eat or dress at a certain time. We’ll ask them, “Do you want to wait for lunch, or do you want breakfast now?”

We offer a structured “sitting down time” at noon. People will either eat the lunch we prepare or an alternative — something we already know they like from “experiencing them” and include as part of their routine.  We also provide sandwich ingredients for residents who prefer to make their own sandwiches. The kitchen is always available and open for them — just like at home.

Our schedule, a looser term than in a typical elder care setting, is based on the individual’s needs and preferences, not what is convenient or more efficient for the staff. We offer some element of structure, but residents are free to disregard that structure. We learn how they navigate the day and support them and their choices, keeping in mind safety and their physical and mental health.

Supporting families

Supporting people’s mental health and well-being is always front and center. Many of the staff have some background and training in mental health counseling, which helps them be sensitive to the emotional needs of families. Our staff members use their skills every day to communicate with families and fellow staff members.

Facing the future is a hot button that some adult children avoid (as did their parents) but now they are immersed in decision-making and they often express a variety of emotions. We validate family members and try to release them from their fear, guilt and other feelings.

Whether families ultimately decide to plan for at-home care or consider a move to a memory care community, we help them take small steps to make changes. Sometimes we give specific direction if they are paralyzed with emotion. No matter the situation, it’s important to remain neutral and nonjudgmental.

Supporting staff members

Working every day in an emotionally intense environment is not for everyone. Our dedicated memory-care staff is carefully screened. Many of them come to work as a personal life mission.  They are beyond special, with higher levels of empathy and tolerance for unexpected behavior.

We use best practices when training our staff. This includes teaching them how to gather essential information about the routines, likes and dislikes of individuals with dementia who come to live in our communities. By doing this and keeping our radar up, we feel we can avoid and get ahead of circumstances that may become a recipe for disaster in traditional nursing homes or assisted-living facilities.

We prioritize the mental health of our residents and staff. And we also create a safe, comfortable and transparent space and always encourage and support communication.

I find it sad that some people are afraid to address dementia and aging until they are exhausted and appear on our doorstep, ready to move their parent or loved one into our community. Avoiding what comes with aging is very common; a great percentage of people don’t want to know about it. They don’t want to talk about their own fears and often feel paralyzed.

Additional Reading: Moving Beyond Dementia Denial

The move in

Trust is vital to the relationship between our professionals and families. We encourage them to reach out to our memory care director with any questions. We also invite them to attend support groups, even if they do not choose our community.

Move-in day is very emotional, and our staff does a lot of hand holding throughout that process. We remind staff to be patient with families. It is extremely common for families to take out their initial frustration on the staff. However, after a number of months families and employees can become best friends and true partners in caregiving for their loved one.

Our memory-care program has positively impacted the resident and family experience. We had to rethink how we operate, train people, assign them roles to perform, and so much more. The transition to this model of care represented a massive shift in the way we did dementia care. But the time and resources we invested has been worth it on many levels. Everyone’s experience has improved. This programming has also put us in an excellent position take the next step: to make the dementia village a reality.

Larry Carlson was the president and CEO of United Methodist Communities, a multi-site provider of senior living in New Jersey for 11 years before his retirement.  Larry’s career in senior living spans more than 45 years. He served in leadership roles for six not-for-profit, faith-driven organizations in four states. His book, “Avandell: Reimagining the Dementia Experience,” available on Amazon, is for anyone whose life is impacted by a person with dementia.  Avandell embraces people with dementia, allowing them the dignity and joy to live the life they love.

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