Orange County, CA, June 1, 1998 — A 'new age' in residential care for elderly dementia patients?
In his previous facility, an elderly gentleman recovering from hip surgery had been fully restrained and placed on high dosages of psychotropic medications to control behavioral problems.
In his new residential care facility he was not restrained and astounded his caregivers by standing within two days of his admission. A week later he was walking and within a month his psychotropic medications were cut in half. Needless to say, he was much happier and his family was delighted.
This story comes from a new form of residential care facility that combines the best of the assisted living model with the best of the medical model.
(Oddly, the combination was not legal, in California until early last year when Residential Care Facilities for the Elderly (RCFEs) were allowed to apply for waivers to provide hospice services to patients diagnosed with a terminal illness. Previously, RCFEs were required to discharge any resident needing the kind of medical and nursing attention that a hospice typically furnishes.)
The ability for an Alzheimer's patient to live out the remainder of his or her life in an assisted care facility is not only less expensive, but is often preferable for the patient.
Prototypes of this 'new age' in assisted living include the new Boston Alzheimer's Center and Woodside Place near Pittsburgh.
"Life Purpose"
Pioneering dementia care in California is the new Silverado Senior Living facility in Escondido, outside San Diego, California. The four acre, 80-bed community opened in 1997 and is dedicated to a unique concept that allows residents to control and take responsibility for daily activities. By doing this, they are given a sense of "life purpose" that keeps them interested, involved and leading happier, more fulfilled lives.
Residents have the responsibility, with the help of the staff, to feed the family of on-site pets, water plants in the vegetable garden and perform other daily activities. This curbs boredom and provides a sense of value, because residents have tasks they are expected to accomplish each day. Activities such as listening to music, folding clothes or working in the hobby shop are paced to match the patient's needs and desires.
Furthermore, the nurses' station has been replaced with a country kitchen, not unlike a family's home, where the staff can review paperwork or help a resident bake cookies. Every effort is given to give the residents a sense of purpose and a sense of home life.
"Many assisted living centers are not designed to deal with the significant behavioral and physical problems that often accompany Alzheimer's and other forms of dementia," says Loren Shook, president and CEO of Silverado. "Nursing homes may over-medicate or restrain residents in order to control their behavior. We do not restrain residents and are working diligently with our residents' physicians and families to minimize excessive use of medications."
Clinical Research Program
Among the many experts affiliated with Silverado is Dr. J. Edward Jackson, the director of University of California at San Diego's Alzheimer's Disease Diagnostic and Treatment Center. As Silverado's medical director, he works with UCSD's clinical outcomes research program to determine which of the facility's innovative care and treatment techniques are most effective.
The Escondido facility is a model for a series of Alzheimer's and dementia communities, which Silverado Senior Living will develop regionally and then nationwide. Each will range from approximately 19,000 to 34,000 square feet and accommodate from 40 to 80 residents.
"Silverado expects progress from its residents and never gives up on anyone," says Stephen Winner, M.S., administrator of the new residential care facility. "Families bring loved ones to this community who have not responded well to therapy or who have had severe behavioral problems at other facilities. Our results are spectacular, but the action is simple - when people are in a positive, life affirming environment where they find a sense of purpose and are expected to succeed, great things happen."
