Memory Care: Back to the Future

by Jeff Shaw

Operators experiment with new programming and design ideas while redoubling their commitment to traditional person-centered care.

By Jane Adler

Despite suffering big pandemic-related occupancy losses, the memory care segment is focused on the future as it rebuilds its census. Operators are adopting new technologies and open building designs to advance established person-centered care protocols. 

The Montessori teaching method, popular for children, is being applied to programs for seniors with memory loss. Virtual reality, circadian lighting and multi-sensory rooms are being used to ease anxiety and boost engagement among residents. Locked units are less common as providers find ways to integrate the forgetful into the broader resident population. Improved staff training to recruit and retain workers is another priority (see sidebar). 

“We’ve worked through a lot of issues,” says Isaac Scott, founder and CEO at Anthem Memory Care based in Lake Oswego, Oregon. “Memory care is making great advances.”

During the pandemic, memory care suffered the biggest decrease in occupancy among seniors housing property types. Memory care occupancies declined 15.1 percent on average in 2020, according to a recent analysis by the American Seniors Housing Association (ASHA) and HealthTrust. The data was compiled by the American Seniors Housing Association and HealthTrust and included in the 2021 edition of “The State of Seniors Housing” report.

Independent living showed the least impact with an occupancy drop of 7.3 percent. The average occupancy decline among all senior living property types was 9.5 percent.

Memory care providers attribute the occupancy drop to the vulnerability of their residents, and also local health mandates and restrictions on move-ins. Families were also hesitant to move a loved one into a memory care community if they were not able to visit the person, sources say.

Memory care is also costly. Monthly rates range from about $8,000 to $10,000, and higher in expensive urban areas like New York and San Francisco. Many providers have been hesitant to raise rents because of the occupancy challenges. But the rising cost of labor and other expenses is likely to push up pricing this year, sources say. 

For the past two years, operators have been focused on the safety of residents and staff and maintaining operations. As the pandemic eases, lead generation is strong, sources say, which will help boost occupancy. At the same time, operators are shifting their attention back to improvements in programming and building design.  

Anthem Memory Care is a good example. The company owns and operates 11 memory care buildings and operates a 12th. Anthem recently assumed management of nine memory care communities owned by Irwin Investors, bringing Anthem’s portfolio to 21 properties in nine states. Anthem also has one new project in the early stages of development in the Chicago area. 

On April 1, Anthem plans to roll out a new resident engagement program called “Pathways to Purpose.” The 140-page program, which was developed over the past 24 months, is based on scientific and research methods for how to engage seniors with memory loss. 

Focused on person-centered care, the program identifies a path each day for each individual. “The goal is to identify what is core to that person,” says Scott.

Person-centered care has long been the fundamental practice of memory care programs, according to Sam Fazio, director of quality care and psycho-social research at the Alzheimer’s Association based in Chicago. The idea is to get to know the person and then build an environment and relationships around that knowledge to improve engagement. 

“More and more operators understand the importance of person-centered care,” says Fazio, explaining that the goal is to provide just enough support to help the person be as independent as possible. The association hosts a dementia care provider roundtable of 28 organizations, including
private-pay building operators.

Back to school

The latest twist in person-
centered care is the use of the Montessori teaching method to engage those with memory loss.

The Montessori method is a system of child-centered education that develops natural interest rather than rely on formal teaching methods. Person-centered care for those with memory loss is a natural fit, sources say. 

The Center for Applied Research in Dementia of Solon, Ohio, is a leader in research and training in Montessori-inspired memory care.  The center also offers a credentialing program for communities. 

The Frank Residences is a new assisted living building on the San Francisco Campus for Jewish Living. The $140 million building features 113 assisted living and 77 memory support suites. It opened in late 2020.

“We are using a version of the Montessori method in our programming,” says Robert Sarison, assistant executive director at the Frank Residences.

The community’s memory care program is designed to provide options for residents, instead of grouping them all together for one activity. Programming focuses heavily on creative arts therapies, including music, art, dance, storytelling, improvisation, poetry and drama. “Our programming is geared toward interaction instead of simply filling time,” says Sarison.

For the last decade, building design has focused on small neighborhoods for those with memory loss. Each neighborhood of about 12 to 15 residents typically includes its own common areas and dining room, often with an open kitchen where residents can participate in meal preparation. 

The Green House project is one example. This model features small separate structures for about 12 residents. The idea of small-scale groupings is to capture the feeling of “home” instead of an institution. Smaller groups make it easier to build relationships, too.

The Frank Residences has a residential feel with five different neighborhoods, camouflaged medication carts and no nursing stations. The medical staff wears regular clothes instead of scrubs. Dining areas look and operate just like a restaurant.  

Open concept

Architects and designers are now envisioning something beyond contained neighborhoods and the small house concept. They are exploring how to connect dementia care units to the wider community. 

“We are looking at the shared communal space,” says Max Winters, senior associate at Perkins Eastman who is based in the architecture firm’s Pittsburgh office. He recently co-hosted a podcast series on dementia care design. “We are moving away from the locked-up approach,” he says.

Winters explains that the assumption for years has been that memory care units needed to be locked to stop wandering residents and control other unsafe behaviors. It didn’t matter what other amenities might be nearby because forgetful residents were never going to have those different environments available as an option. 

The latest thinking is to find ways to integrate the dementia care unit into other senior living venues on a campus. “How can amenities and services for everyone else incorporate people with cognitive challenges?” asks Winters. 

For example, he points to the United Minds program at United Active Living in Calgary, Canada. Residents with dementia live on the same floors as everyone else, eat in the same dining rooms and attend the same programs. The focus is on knowing the individual and providing the services and care that person needs.

Winters admits that some residents with late-stage memory loss may not be able to safely access other parts of a campus. 

But again, it comes back to person-centered care and knowing who is an elopement risk and who is not. 

At Belmont Village Senior Living, residents with mild and moderate dementia live in assisted living apartments. Those with late-stage disease are in a secured environment. Residents with mild or moderate dementia participate in the Circle of Friends, a structured activity program with a specially trained enrichment leader. 

Participants are free to come and go, but 75 percent attend at least four hours a day, according to Beverly Sanborn, a gerontologist and vice president of program development at Belmont.

New building designs incorporate outdoor space in courtyards and terraces. The outdoors functions as an extension of the indoor living space. 

The Virginian, a rental life plan community in Fairfax, Virginia, has a new sensory lounge that opens to a larger living room. “It’s a whole different approach,” says Andy Carle, a consultant, former executive director at the property and an adjunct faculty member at Georgetown University’s senior living program. 

The Virginian recently underwent a $56.5 million renovation. The new memory care section, called Shenandoah, consists of two wings with 20 beds on each wing. 

Carle notes that older sensory rooms, often used to calm residents, are small and claustrophobic. The Virginian’s sensory room looks like a comfortable lounge, but comes equipped with the latest technology for the memory impaired. 

Technology is a big part of recent innovations in memory care. Sensors can track resident movements and quickly alert the staff when a problem arises. Technology is being used to engage residents and provide helpful interventions that can hopefully reduce the need for medications with harmful side effects. 

The cost of the latest innovations varies. Some charge a set-up fee and monthly subscription fees. Others are a one-time purchase. 

Operators say that the investment in technology can pay for itself. The right systems can shorten the time it takes staff to conduct routine duties. Technology can also provide better resident engagement, sources say.

The sensory lounge at the Virginian includes a circadian light system that can also be programmed for residents’ rooms. The computerized system provides light intensities that mimic outdoor patterns. The light rises in the morning and sets in the evening. Light colors — blue, green, pink or soft yellow — can be adjusted to ease the mood of the resident. 

The room includes aroma therapy, tactile artwork and a big fish tank. The Amazon Alexa virtual assistant can be programmed to play soothing bird sounds.

The Obie game system is available for residents, who sit a table and operate games by waving their hands. The games have different levels of difficulty. Obie also gathers data on results and resident preferences. Carle says data will be collected over the next six months and the findings will be shared with the industry. 

Bend, Oregon-based Sunshine Retirement Living recently completed the installation of sensory spas at each of its 23 memory care communities. A pilot program at the company’s Tucson property showed a drop in the use of antipsychotic medications.

The Palace at Weston, a year-old property near Ft. Lauderdale, Florida, includes a multi-sensory room for its memory care residents. The room features an LED faux fireplace, fiber optic waterfall, weighted blankets, soothing light and gentle sounds to help reduce anxiety and confusion. The room can be used by one resident and a caregiver and is also large enough to accommodate a small group, according to Zack Shaham, executive director at the Palace at Weston. 

The memory care section also has its own plaza, something like a hotel lobby, adjacent to an ice cream parlor and activity rooms. The plaza features a nature wall with various scenes of nature on framed screens, giving the appearance of looking through a window. Public areas, including a courtyard, are family friendly to encourage visits, says Shaham. 

More technology 

Fall detection technology is advancing, a potential game changer for memory care operators. The product called SafelyYou is getting a lot of buzz. Anthem has a pilot under way with the system. As soon as the technology detects someone on the floor, the SafelyYou system alerts its own team about a potential fall. The building staff then receives a video of the situation so that they can assess what has happened. If there was not a fall, it could avoid a costly trip to the emergency room. 

Other technologies are making a splash, improving resident engagement and reducing staff time spent on repetitive duties.

The tech company LifeBio recently launched a life story app called LifeBio Memory. It uses machine learning to provide reminiscence therapy. The individualized data and background on the resident helps the staff to facilitate person-centered care and engagement activities.

Another reminiscence technology is Telememory. It collects information about residents through a digital biography process and curates personalized content including music, art, video and images. 

CarePredict’s wearable, called Tempo, observes a resident’s daily activity and behavior patterns for changes that precede health declines.  This allows the staff to intervene before an actual issue arises. Tempo also integrates keyless door access, a concierge service button and two-way voice communication. 

Operators are experimenting with virtual reality. New research shows that virtual reality may improve recall among those with mild cognitive impairments. It also improves engagement.

The Frank Residences has an “Experience Station,” a multi-media immersive experience in a semi-enclosed booth that accommodates two at a time. Residents don’t need goggles. The station combines high-definition visuals with aroma therapy and music. There are about 15 experiences to choose from, including a trip to Italy. 

Family members can join in too. Participants enjoy the sights and sound of Italy, along with a post-trip slice of pizza. “It’s like taking a journey using all the senses,” says Sarison, “Residents respond very well.”

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