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Reshaping the design and delivery of dementia care

July 12, 2013
by Julie Thompson
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Sometimes it’s as if time and space are suspended when Hollie Fowler steps into Prestige Care’s memory unit, which is something that Fowler welcomes on a day when her role as an executive seems too stressful.

Fowler—who serves as the senior director of product brand and development at the west coast long-term living community—doesn’t look at the dementia and Alzheimer’s residents as suffering from a disease. Rather she sees them as valuable human beings simply choosing to live in their past, and on more than one occasion she has chosen to join them on their adventures.

“There was a time when I walked into one of our communities and there was a little bench at one side and a couple of gals there who had been sitting there for quite a while,” Fowler says. “I walked over and said, ‘What are you girls doing?’ and they said, ‘We are waiting for a bus.’ And I said, ‘Oh, well can I wait with you?’”

Communities like those run by Prestige know that successful memory care is centered around the person rather than those caring for them. Previous care techniques—such as demanding residents to participate in a one-size-fits-all group activity, restraining unruly residents or attempting to orient individuals to the current date and time—have gone by the wayside as research as proven them ineffective and harmful.


Long-term care communities are discovering new ways to meet the needs of memory care residents that reduce unwanted incidents, such as falls and aggressive behavior, and breathe new life into the hearts and minds of the individuals living there. The transformation can be costly—with extra staff training and changes to a community’s physical layout—and requires the commitment of a community’s executive staff as much as its pocket book.

“We need everyone to be moving toward that person-centered care,” says Cindy Keith, RN, a certified dementia practitioner who consults with communities. “It is expensive and there is a lot of resistance from staff because they don’t like change, but the payoff eventually outweighs it.”

Dementia is a disease that causes a decline in cognitive performance. There are several forms of dementia, but Alzheimer’s disease is the most common. Alzheimer’s disease accounts for 70 percent of the elderly with dementia and affects one in eight older adults in America. According to the Alzheimer’s Association, it is the sixth-leading cause of death in the United States.

The need for adequate memory care will only increase over the next two decades. The costs of caring for people with dementia in the United States in 2010 were between $159 billion to $215 billion, and those costs could rise dramatically with the increase in the number of older people in coming decades, according to estimates published this year by researchers at RAND Corp. and the University of Michigan, Ann Arbor. The researchers found these costs of care comparable to, if not greater than, those for heart disease and cancer.

Facilities that refuse to invest in memory care programming could face significant challenges as individuals become more educated and particular about the type of facility they choose for their loved one.


Prestige, which owns 72 long-term care facilities mostly in the western part of the states, saw the changing tide of memory care about five years ago and decided to take a hard look at its what it had to offer. “We wanted to make sure that we were looking at the most recent advancements, techniques and programming,” Fowler says.

Prestige engaged renowned memory care expert David Troxel, MPH, to evaluate its program. It also conducted numerous focus groups with families considering long-term care for a loved one. Prestige’s research found that safety and security were a top priority for families.

“They worry about their loved one and worry because they can’t care for them,” Fowler says. “This was a truth that wasn’t new to us, but we wanted to go above and beyond just offering a secure environment. We wanted to offer a program where you feel like you can enrich lives even while they are still struggling with the disease and that is not something that is commonly used.”

The result was Expressions, a program that puts the resident in the center of the care. Prestige adopted Troxel’s “Best Friends” methodology where staff spends a lot of time up front getting to know each resident—their likes and dislikes, but more importantly their history. “Because those with Alzheimer’s and dementia tend to live a little bit in the past, it is important for us to understand where they came from and what their life was like—what they did for jobs and what kind of hobbies they liked,” Fowler says.

Expressions has five programming areas: healthy, tasty, artistic, educational and spiritual expressions. Each area is carefully crafted to meet the changing needs of those with memory care. For example, healthy expressions require staff to encourage residents to exercise in some form or another twice daily. Research has found regular exercise delays the onset of Alzheimer’s disease and its progression.

Staff receives extra training to not only meet clinical needs, but also goals set out by the Expressions programming. Adequate understanding of the disease as well as the personal history of each individual has transformed the environment in Prestige’s memory units, Fowler says.