2013 OPTIMA Award: The gift of the present

Editors' Note: An abridged version of this article appeared in the September 2013 print and digital editions.

The perimeter of the sunny room is lined with three small tables. A staff member from the senior living community and one or two residents sit at each table.

“Are you ready for brain exercise?” one staffer asks her two tablemates, handing each of them worksheets to complete. Following instructions, the residents write their names at the top of their worksheets and begin. A female resident reads out loud the large print on the page while a male resident completes simple math problems. The staff member peppers their efforts with encouragement: “Good job!” “Perfect!”

At another table, a quiet woman slowly picks up large, round chips numbered from one to 10 and places them on a small mat with squares numbered to match the chips. “Nice job!” “You’re flying through this one!” says the staff member with whom the woman is paired. The elderly woman puts the number 10 chip on the number two spot on the mat, but when all squares on the mat are occupied by chips, the staff member clicks a timer and excitedly tells the resident, “You completed this exercise in 1:50 yesterday, and today you did it in 1:05. You beat your record!” Next she asks the resident to count from one to 10. Instead, the woman pushes the chips off the mat and starts the previous exercise again. The staff member tells her, “You’re doing great!

Back at the first table, the woman has completed her reading assignment—stopping occasionally when something in the short narrative prompted a memory and a question to the staff member—and the man has completed his math worksheet. The staff member asks them to write their finish times, obtained from a large clock on the table, on their worksheets. Then they trade reading and writing exercises. When the staff member grades their efforts, she writes a large 100 in red on the pages and congratulates them.

This is SAIDO (pronounced sī–dō) Learning, a nonpharmaceutical program developed in Japan to improve symptoms in those with Alzheimer’s disease or dementia. The goal is not only to improve the quality of life for older adults but also to reduce both their required levels of care and the overall cost of that care.

In SAIDO, caregivers are referred to as supporters, participating residents are called learners and certain principles guide the half-hour, five-day-a-week sessions:

• Exercises are tailored to the ability of each learner.
• Learners receive continual encouragement.
• Learners always receive a perfect score on their performance.

| Related content: SAIDO Learning in action: A typical session [VIDEO] |

The technique has been practiced in Japan for more than 11 years, but it only recently came to the United States, where it currently can be found only at the three communities of the Eliza Jennings Senior Care Network in Northeast Ohio. The program's potential to reduce care needs and care costs could take on increased importance in the United States as the incidence of Alzheimer's disease and other forms of dementia increases with the aging population.

Currently, 5 million people aged at least 65 years have Alzheimer's disease, the affliction that represents 60 percent to 80 percent of dementia cases, according to the Alzheimer's Association. That number is expected to increase to 7.1 million by 2025 and to 13.8 million by 2050 unless a medical breakthrough prevents, slows or stops the disease, the organization predicts.

Three-fourths of those in whom dementia is diagnosed eventually are admitted to nursing homes. Eliza Jennings finds that almost 70 percent of those in its communities and programs have some type of dementia.

Direct costs associated with caring for those with Alzheimer's disease, including Medicare and Medicaid expenses, are expected to total $203 billion in 2013 and could top $1.2 trillion (in current dollars) by 2050, according to the Alzheimer's Association. The average per-person Medicare costs for those with Alzheimer's disease and other dementias are three times higher than average costs for those without these conditions, the organization notes, and the average per-person Medicaid spending for seniors with Alzheimer's disease and other dementias is 19 times higher than the average per-person Medicaid spending for all other seniors.

A NEW TOOL IN DEMENTIA CARE

In 2010, Deborah Hiller, president and CEO of the Eliza Jennings Senior Care Network, joined four other senior care organization representatives at a presentation about a new learning program for residents with dementia. Hiller had never heard of the SAIDO Learning program, developed in 2001 by Dr. Ryuta Kawashima, a neuroscientist, in conjunction with the Kumon Institute of Education in Osaka, Japan.

| Related article: SAIDO Learning: A Timeline |

The program concept sounded too easy to be authentic, Hiller remembers. Residents with dementia would spend 30 minutes a day doing simple reading, writing and arithmetic—tasks that are known to stimulate the prefrontal cortex portion of the brain. After these highly targeted brain-exercising sessions, residents would be able to perform other tasks more easily during the rest of the day. In other words, the program method could reduce or even reverse the effects of cognition loss, presenters told the group.

After seeing a video of the program’s effects on residents with dementia in Japan, Hiller was hooked. The residents in the video were more interactive, expressing choices and remembering things better, and they were far less agitated and frustrated after their program sessions.

| Related article: How SAIDO Learning works |

The Japanese program presenters were seeking participants for a U.S.-based trial for the program. After the presentation, Eliza Jennings was the only organization in the group that volunteered; others shied away, envisioning many new staffing needs, Hiller says. Hiller and several others from Eliza Jennings then traveled to Japan to meet with the Kumon team, partly trying to decide whether the program was for real. “The results are so remarkable that it makes you skeptical—unless you see it,” she says.

SAIDO MEETS OHIO

The program’s sole U.S. trial began in May 2011, involving residents from Eliza Jennings’ main skilled nursing site in Lakewood, Ohio, and a control group of residents at the Renaissance Retirement Campus, its large continuing care retirement community in nearby Olmsted Township, Ohio. “We started seeing results literally within the first week,” Hiller recalls. “I could see that the program was not only totally consistent with person-centered care, it could drive it.”

Residents with dementia who went through the trial began to show vast improvements. One resident consistently had difficulty finding her room. She would wander down the wrong hallway and get lost daily. Some days, she would wander out of her room not wearing all of her clothing. After SAIDO Learning, she consistently began finding her own room. She began remembering to wear her clothing, and one day, realizing she had forgotten her shoes, returned to her room to put them on. Participants began to interact with others, express choices and exhibit better concentration. In short, they “came back to their lives,” Hiller says.

SAVORING SUCCESS

The biggest challenge in setting up the trial, Hiller recalls, was translating all the learning program materials from Japanese into English—and communicating ideas with their Japanese colleagues each week. The highly individualized learning materials are crucial to the success of the program and need to be delivered within a structured learning environment, Hiller notes.

As an example of the changes needed, chief lead supporter Peggy McDonald says, "On the worksheets, they used terms like chock-a-block for crowded mall. If our residents—or we—were reading that, we would say, 'What's a chock-a-block?' So there was an adaptation of language."

The newly trained supporters at Eliza Jennings get as much out of the program as do the residents with dementia, says Chelley Antonczak, now the network director of training for SAIDO Learning at Eliza Jennings. “Watching residents with dementia come back to life and begin communicating more and wanting to take care of themselves is a source of motivation for supporters and a sense of triumph for learners,” she says. Antonczak, who was part of the original team that traveled to Japan, became the first master trainer in the U.S. SAIDO trial.

| Related article: One-on-one with… Chelley Antonczak |

McDonald reflects: “It’s life-changing. It changes how you feel about seniors. It changes how you feel about their quality of life.”

She adds that being a supporter not only has changed her outlook on aging; it also has changed her personally as well. “I find that I’m looking at people more. You’re seeing light in their eyes. You’re more patient. You listen more,” she says.

| Related content: SAIDO Learning: Seeing is believing [Podcast] |

Antonczak agrees. “Watching families reconnect with loved ones is such a gratifying experience,” she says, adding that because of the strides the elders make, they recognize and can communicate with their family members again. “Some families are even able to take their loved one out to dinner because of behavioral improvement.”

GROWING SAIDO BEYOND ELIZA JENNINGS’ WALLS

All of this progress inspired Hiller, who saw the potential of the program well beyond the Japanese team’s initial presentation. “At first, they really wanted to do the research trial for the Japanese market,” she says. “They never had any intention of bringing it to the United States. Now they trust us, and their parent company trusts us.”

In less than two years, Eliza Jennings has made the program available to all 650 residents in its facilities. The network reached a milestone Aug. 12 when it received final approval from the Kumon Institute to serve as the training/licensing center for the first SAIDO program licensee site within the United States. Under terms of the agreement, other senior care organizations across the country now will be able to apply for training and sub-licensing to bring the SAIDO Learning program’s therapy protocols to their own locations. Eliza Jennings already is seeing great interest from the assisted living sector, Hiller says, and another Ohio senior care organization already has signed on to be the next program trainee site.

Meanwhile, a Cleveland Foundation grant provided the funds to add some personnel and to renovate part of Eliza Jennings’ Lakewood location to serve as the new SAIDO Learning Institute. Construction is under way.

PERSONNEL NEEDS

Organizations don't need to undertake major hiring efforts to implement SAIDO; volunteer supporters can be found among existing staff and members of the greater community. To maximize the program's effectiveness, however, an organization must make a cultural commitment—adjusting staff schedules and responsibilities to enable volunteering during work hours, and involving all staff members, not just those volunteering as supporters, in the organization's efforts related to the program.

“Our goal is to have every caregiver in our network trained. It has to be part of everybody’s daily philosophy and embedded in the culture,” Hiller says. “[Supporters] don’t have to be caregivers. They can be from the finance office or housekeeping or volunteers.”

The formal SAIDO sessions are just the beginning of efforts that can help residents with dementia, McDonald says. The community holds monthly meetings that include a broad spectrum of employees who are not supporters—members of dietary, nursing, housekeeping, maintenance and other departments—who in the course of their work see residents for more than just the 30 minutes of a daily SAIDO Learning session and can share observations.

Out of those meetings, McDonald adds, monthly goals related to activities of daily living (ADL) are set for each resident. Some resident goals might include putting dirty clothes in a hamper each night or joining in more group activities.

“The ADL goals enhance what is started with the learning therapy,” she says. “It should carry out to their everyday life.”

RESTORING PAST PLEASURES

Eliza Jennings residents continue to see remarkable and daily benefits from the program, the trained supporters report. For instance, “Mary” enjoyed playing cards before her memory loss set in. While engaged in the SAIDO program, she re-learned numbers, colors, card-suits and the counting skills necessary for card-playing. She resumed the hobby with a passion, playing game after game with her daughter. Now Mary always is ready to play one more hand. It's just one example of how the technique gives those with dementia the gift of the present.

Click on the OPTIMA Award seal (upper left) to access a gallery of photos.

Related coverage:

How SAIDO Learning works
The SAIDO clinical trial
SAIDO Learning: A timeline
One-on-one with… Chelley Antonczak
SAIDO Learning in action: A typical session [VIDEO]
Blog: The elusive high five
SAIDO Learning: Seeing is believing [PODCAST]
SAIDO Learning: 'It's remarkable' [PODCAST]

The Long-Term Living editors are Editor-in-Chief Pamela Tabar, Senior Editor Lois A. Bowers and Managing Editor Sandra Hoban.

Read more about the Eliza Jennings SAIDO Learning program on the Eliza Jennings website at https://elizajennings.org/saido/.