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Montessori and dementia care – studied but not deployed?
Sun, 04/14/2013 - 16:34 - Laurie Orlov
Perhaps you’ve seen them, idle and bored 'memory' care residents. If you study the calendar at a typical dementia care setting (adult day, assisted living, or nursing home) – it is possible to find a time of day in when there are no facilitated activities underway. Before and after meals, perhaps – a time period stretching an hour or more. The TV is on or music is playing. The day or evening shift staff members are doing a variety of chores, nurses are dispensing and recording medication doses – and residents are wandering or seated, in wheel chairs perhaps, or perhaps they are repeatedly approaching and deflected from exits.
What is the difference between good and great care? Perhaps someone you know has visited one of these units and does not know what to make of what they see. Is this a positive setting? Good enough? Does it meet the requirements set forth by the Alzheimer’s Association? Or perhaps a checklist is used by families to select an appropriate setting. This particular element is intriguing: "Are residents actively engaged in activities that are appropriate and/or interesting to those with Alzheimer’s or dementia? Are there opportunities for residents to contribute to the community (as appropriate), such as folding napkins, towels or clothing?"
Memory care is the best contributor to senior housing profit. Consider the senior housing industry -- one that is watching its move-in and average age of residents rise (87 and 89), one year each year. And memory care is the fastest growing and likely the most profitable segment of the senior housing sector. Prospective residents face a price boost of 42% from the assisted living average rate of $42,600 for assisted living up to an average of $57,000/year for assisted living with memory care. This cost can rise up to $1000/month more if the business is (entirely) specialized in memory care. For today, let's not dwell on who can afford this or why the average age is older each year.
So what are examples of memory care settings where residents are engaged? One of the more intriguing approaches to memory care I’ve heard about uses the Montessori method (as used in this link to a particular Toronto senior center) for engaging residents. I'm not sure that it so much combats dementia as it combats boredom, but certainly it is an approach that "relies heavily on the sensory environment." But further surfing around reveals that this method has been both widely studied and also that it is in use here and there -- although it does not appear to be an attribute you can use in customizing a search for care on search sites like Caring.com. My guess is that it is both costly to set up the physical environment and labor-intensive for staff to monitor and help residents engage. But are there possibilities in setting up large touch screens, including interactive video, as one or more of the individual stations in which residents engage? Thoughts?
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Alzheimer's - Focus on Research AND Caregiving
Thanks for raising another important issue for discussion, Laurie. Having cared for my mother who lived with Alzheimer's disease for 17 years at home until the end of her life, I learned the value of the habilitation techniques described by Dr. John Zeisel in his book "I'm Still Here." John founded the Hearthstone residences (www.thehearth.org)for Alzheimer's patients, centers architecturally designed for memory loss and environments that utilize the arts and minimize the use of prescription medication to help people maintain cognition for as long as possible. These techniques are not expensive to implement but they do require that we acknowledge the negative impact that overuse of prescription drugs has on our loved ones. Haldol, widely prescribed, for example, produces a "zoned out" affect that may lead families to mistakenly think that the cognitive change is the progression of the disease instead of the result of meds.
I appreciate the idea that interactive technology may fill some of the "downtime" that the staff (or family caregivers) need to get other work done. Engaging the Alzheimer's patient on tablets with music, games, movies, etc. not unlike what young children enjoy can stimulate cognition and pleasure. Have MIT's AgeLAB or other researchers looked into this?
Mental stimulation!
Great point! I would add that appropriate, engaging stimulation is needed just as much for home care as in memory care facilities. Just as pre-schoolers should not spend their days watching TV, elders need to be actively engaged in activities that absorb them.
One problem is that an activity that is terrific for one person will not be suitable at all for another, making it difficult to schedule group activities in facilities. One thing we've found successful in creating good activities for individuals is to tap into past interests and skills. Someone who loved gardening may not be able to plant a garden, but will love looking at seed catalogs and listing things they'd like to plant or even plotting a garden on paper. Someone who played the piano may enjoy reading simple music on a keyboard (with earphones, we hope, because it may not sound great!). A fisherman might play for hours with a tackle box and a collection of lures. Long after the memory required for bridge is gone, playing solitaire is an option. Wood carving, crocheting, painting, fixing an old alarm clock - that kind of activity may not be successful in the usual sense, but if it employs a person's prior skills and engages their interest, it is certainly more healthy than just watching TV.
If technical people can develop interactive activities on tablets that utilize old skills and interests such as these, there will probably be quite a market.
A model by which to understand Alzheimer's
I second the previous contributor's recommendation of John Zeisel's book http://www.amazon.com/Still-Here-Breakthrough-Understanding-Alzheimers/d...
The benefits of his model for thinking about Alzheimer's are that it helps in (1) understanding the changes brought on by the disease (2) assessing the various techniques for interacting with sufferers, and (3) providing rational and compassionate techniques for dealing with what, at times, seem like unreasonable behaviors.