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Memory care and child day care -- two sides of the same coin
Thu, 08/23/2012 - 08:48 - Laurie Orlov
Are we at the crossroads of care? We are at an interesting and somewhat ominous crossroads in the care of those with dementia. AARP (and the media that quote them endlessly) repeat that adults want to remain in their own home as they age. Nice goal, but, not such a good fit for everybody. So combine the growing longevity of middle class adults with the beginnings of a multi-year revival in home sales and perhaps home prices, seniors may have an easier time selling and moving that will shift the average age of residents below today's age 89. To families searching for options, expensive assisted living memory units may look like good care options for those with serious functional memory loss. But are they really good care?
Memory care generates profit assisted living today. Assisted Living communities can charge top dollar for their memory units, which have the highest revenue-to-resident ratio – although they may also have the highest ratio of staff to resident. Like the rest of so many AL communities, often the decorating is top tier and augmented with cheerful colors and eye-catching artwork. Stuffed animals are prevalent, easy puzzles and a regular set of activities are offered at a few specific times of the day, typically led by an activities coordinator. These may include exercises, current events, games, snack, music, movies. Is that good care?
What exactly is 'good' care? Years ago, when working mothers were relatively rare (and I was a working mother), we could read multiple books and magazine articles about what was excellent day care and – and what wasn’t. The goal was to help guilty working mothers assess (beyond word of mouth) whether ‘ABCD-Quality-Childcare’ was the place for their baby or toddler. Since then, there has been an explosion of guides to helping working moms and dads find great child care. This is not so with the decision-making process of finding memory care for aging family members. As a sign that some guidance might be in order for memory care units in assisted living, the Alzheimer’s Association offered a 2009 booklet to help train their managers. And it is good advice, but, what it reveals is the immature state of the art. Mostly about physical assessment, fall risk, and environment, less about social aspects, it is a first step guide, but does it define good care?
Use the Memory Walk money to fund a study of what is great. Instead of all the money and hype going to find a cure for Alzheimer's, let’s see a landmark study that identifies what great memory care looks like. Hint, that does not mean offering a checklist for finding care – that's useful, but insufficient. How will you know if you’ve found great care? Forget Amazon – the search for ‘finding adult memory care’ how-to books found nothing. Caring.com offers a breakdown of the types of long-term care and adds its own checklist, but also sidesteps the question of what exactly is great memory care. It’s easy to correlate goodness with cost, with circular hallways, with a 'specially trained staff' or a full list of activities. But when all is said and done, next time you visit a memory care unit, look around. Are the residents slumped in their too-soft couches and rocker-dangerous chairs? Are they listlessly awaiting the next activity while staff members chat with each other and do their paperwork, often behind privacy-protecting glass barriers? Is that good care? Shouldn't we expect more and what exactly should we expect? Thoughts welcome.
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Comments
"Good" memory care
Laurie, your comments - and questions - are on target. First, as a co-owner of a home care company, with a personal passion for our clients (and me) to age in place, we have told folks (as recently as this morning) that a parent would be better taken care of in a skilled nursing facility (SNF) with memory care than at home. In our experience, that is unusual, but ...
As to what constitutes good care, there are certain things that are universal, regardless of the stage of dementia: respect, dignity, safety, hygiene, courtesy, empathy all come to mind very quickly. Certainly engagement is a priority, although the nature of engagement changes with the stage of dementia. For one of our clients, it was a sunny day on the grass in the park, with a picnic basket. For another it was weekly music concerts at the university and lots of singing at home. Puzzles, reading, walks, encouraging stories, ... all have their places, correlated to the current stage. The point you make, however, is ever-true: having folks sitting around with their heads down waiting is NOT good care.
What should we look for? In our view, it is a focus on Habilitation Therapy as the model for memory care, whether that is at home or in a facility.
Good memory Care
I have a brother whose wife has had early onset AZ for the past ten years. He has kept her at home. He has caregivers come in and bathe her daily, take her on walks, etc. She can not feed herself, no longer talks, etc. Folks in these Memory Care units are getting bathed maybe once a week, sit all day long, etc. It is basically warehousing. How would you like this done to you?
Best Memory Care is Habilitative Care
Laurie - As someone with 25 years in health care and the past dozen advising family caregivers, I'm well versed in all of the options for families. Habilitative care, like environments created by John Zeisel and Hearthstone IS the right way to care for someone with memory loss. His book, I'm Still Here is instructional. He recently piloted an adult day care at an Assisted Living Facility in Concord, MA. I also refer families to a home care provider who uses Habilitative techniques.
Parenthetically, I cared for my own mother who lived with Alzheimer's at home for 17 years until the end. Using similar techniques, she took few Meds, and had cognition through her last years. One cannot expect institutional care to replicate what can be done at home, but the Hearthstone facilities come close. John advises assisted living and skilled nursing homes in how to replicate these practices.
Your comments on memory care and day care
Hi Laurie:
Your comments on memory care and day care are right on target. Money is needed to research the question - What is a great space for the AIP client? (Memory as well as other client needs). How helpful it would be if there were monies available to fund a study to define great interior spaces for AIP clients with the end product creation of educational materials that can be used by business and the private sector. Too often spaces are just "decorated" so they look good; in reality they are not functioning as they should for the Aging Client.
I am a retired college department chair/professor who early in my career headed up training programs for Child Development students studying to be Day Care providers AND later Interior Design Students learning to create environments for AIP clients.
I can verify many educational/training materials can be found about physical space needs of a Day Care Center; the search for AIP physical space needs produces limited educational materials. The reason for this is Day Care Training developed back in the 1960's when mothers went to work; a need developed for Day Care Centers. The AIP Client needing physical space definition is newly developing as a business area.
When information for AIP is found it tends to be general ADA information NOT the specific needs of an Aging Client. All Aging Clients are individuals - the generic plan of ADA does not fit all.
I advocate writing Physical Space Prescriptions for each AIP client. The Physical Space Prescription can often be as important as the medical prescription.
The Physical Space prescription addresses the TOTAL client's living space needs by area with very SPECIFIC recommendations. Product information, product application is provided in a prescription - caretakers often realize what is needed but don't know how to find it or incorporate it into the client's apace. Caretakers are not facilities managers nor are facilities managers caretakers. The AIP Interior Space Prescription written using excellent training materials can bridge the gap.
Nancy Bredemeyer, PhD
Registered Interior Designer, FL #ID 10000158
Quality Memory Care - Adult Day Services
Laurie the spectrum of memory care should include adult day services. Yes there are some individuals who require a residential solution. For those who often live with family, adult day services provide quality memory care. While care can always vary by provider, there are some adult day service providers who provide exceptional, person-centered care. You will not find individuals "listlessly awaiting the next activity". Readers of this blog should seek out quality providers if a day services model is right for their family. If you want to learn more about providers who are redefining and shaping the future in this space let me know.
Home Care Options for Elderly with Memory Loss
We all know about Nursing Home care, Assisted Living Facilities and Group Homes for those elderly persons with memory loss. What other option is available? Just look back into the past! A lot of people had a large home with more than one generation living there. If your elderly parent has memory loss consider (if you can afford it) moving to a 2 family home, or if you have a large home, turning part of it into a mother-in-law type residence. The elderly parent can live on the ground level where family members can easily look in and give needed help. The elderly parent is included in family functions, which helps prevent social isolation and if there is an emergency, family is there to help. Another advantage is that it is far less expensive, and the family won't be driving back and forth to a facility, making it much easier on a daughter who acts as part-time caregiver and is also is employed.
This solution isn't for everyone, but I'm throwing it out there as a thought.
making the changes that count and that matter the most!
Just read your 09/20/2012 post and as an active 77 year old senior, I do agree that society ought to examine the possibilities and come up with better definitions for good, better, optimum, ideal and BEST health care for seniors and elders including aging in place options and what to do to support wholesome independent living options for those willing to take a little initiative! ....otherwise BIG HUGE ENORMOUS COSTLY Health Care troubles for all of society!!! . . . . . and not just pay lip service to the problem(s). At the present time, most health care expenditures have been used to help the elderly deal with chronic illness, but what is happening at this time is that young children at the age of 5 are developing the the same chronic health problems of 75 year old seniors and they will require this same very expensive health care for their entire lifetime. Who gets the point? Who comprehends? This is simple cause and effect and not rocket science. I'll bookmark your site and return from time to time. You can follow my thoughts on elderchanges.wordpress.com. Is middle aged spread inevitable or easily preventable?