From ground-up development to retrofits, developers and operators fill void in the marketplace.
By Bendix Anderson
With the help of her family, a former radiologist from Iowa moved into her new home this December. It’s a freestanding memory care community in the Chicago suburb of Naperville, Ill., that helps seniors suffering from dementia.
The Silverado Naperville Memory Care Community, which can house up to 90 seniors, was nearly fully occupied by the end of 2014, less than a year after the facility opened.
That’s an amazing feat for any seniors housing community, let alone a memory care community, which can normally take two to three years to fill up.
Developers like Silverado Senior Living are quickly building new memory care communities for the growing number of seniors who suffer from various forms of dementia. Some of the nation’s largest seniors housing developers now also include memory care in larger assisted living communities and continuing care retirement communities.
How widespread is dementia?
The demand for memory care services is growing as the overall number of seniors grows. The older the senior gets, the higher the risk becomes that person will develop some form of dementia.
One in eight people age 65 and older has Alzheimer’s disease. But nearly half of seniors age 85 and older have it, according to the Alzheimer’s Association, a global nonprofit organization that provides information and support to people with Alzheimer’s.
Communities where the average resident is more than 80 years old may already have many residents in need of memory care services.
“Demand for memory care will continue to strengthen for the foreseeable future,” says Christine Haden, regional director of memory care for McLean, Va.-based Sunrise Senior Living, an operator of seniors housing properties in 31 states.
Construction of standalone memory care facilities has steadily increased for nearly a decade. In 31 primary markets, developers started construction on 1,545 units in the 12 months that ended September 30, 2014. That’s up from 403 units during the same period in 2007, according to the National Investment Center for Seniors Housing & Care (NIC).
This trend is expected to continue over the next few years. Thus far, demand is easily keeping up with the new supply. The national occupancy rate for freestanding memory care properties rose to just under 87 percent in 2014, up from a low point of just under 85 percent in 2013, according to NIC.
Many assisted living and continuing care retirement communities (CCRCs) already include memory care as a component. Typically the residents in memory care units within these facilities are likely to have first lived in other parts of the communities before developing symptoms of dementia.
Silverado meets with local government officials first
In Naperville, Silverado met the growing demand by developing and leasing up a memory care facility quickly.
“We were really blessed — this one could not have gone any better,” says Paul Mullin, vice president of development for Irvine, Calif.-based Silverado.
It took just one year for Silverado to find a site, win approval from local municipal officials and start construction. “It started with a really simple conversation with the stakeholders at the city,” says Mullin. “Our first stop is always with the city.”
Naperville officials had already turned down several proposals because developers wanted to build seniors housing on sites where city officials did not want it. Silverado took a different approach. Instead of finding a site for sale first and then seeking approval from the city, Silverado started by asking city officials where they would like to see a memory care facility.
“They guided us to five or six potential sites,” says Mullin. Silverado chose a wooded, five-acre piece of land that was for sale in a residential neighborhood, next door to a high school and the Naperville Fire Department.
Naperville’s mayor and the city council unanimously approved Silverado’s plan to build a 45,000-square-foot, single-story building on the site. “Life is pretty easy when you are on the same page with the city,” says Mullin.
Silverado’s conversations with Naperville officials started in late 2011. Construction on the memory care facility began in 2012, and Silverado received the certificate of occupancy in late 2013. The community opened in January 2014.
Memory care communities often feature more common space than conventional assisted living communities so that seniors can gather and participate in activities.
Each Silverado community includes a large, secure central courtyard. “It’s our Central Park,” says Linda Wylder, administrator at Silverado’s Naperville community.
Common areas account for more than 60 percent of the space at the Naperville facility. That’s different than most seniors housing buildings, where the residences take up more than 60 percent of the space.
The seniors who reside at the facility have a nearly constant stream of activities in these common areas to help them stay engaged and active.
“We spend as much time with our residents as we would with our own family members,” says Wylder. Silverado’s management team proudly recounts the stories of residents who came to their communities unable to walk or speak and who regained those abilities.
During the day, there is at least one caregiver for every seven residents, slightly above the staffing ratios reported by other memory care providers. All of Silverado’s caregivers have undergone dementia training.
A registered nurse oversees all health services; there’s at least one licensed practical nurse on duty at all times. Social workers who have earned master’s degrees in their field assist families.
Care is a large part of the value Silverado provides its residents. “You can have the Taj Mahal of buildings, but without the clinical team this business can be very difficult,” says Mullin.
By the end of 2014, less than a year after opening, 80 residents were living at the community. That represents an 89 percent occupancy rate for the community, which has room for 90 residents in its 40 double-occupancy units and 10 private units.
“Our budget for the end of 2014 was 50 residents,” says Mullin.
Rents average $5,200 to $6,400 a month for a semi-private residence, according to Silverado’s listing on alzheimers.net.
Developer fills huge demand
Silverado tapped into strong demand for memory care services in Naperville that was not being met. Its market studies found memory care housing for fewer than 100 people within a 10-miles radius of the development site, even though Naperville is a large city in its own right, with about 1 million residents.
Naperville is one of 10 new all-memory care developments that Silverado has completed during the last two years. “Our goal is to open three to five new communities every year,” says Mullin.
Financing is more readily available today to build memory care properties than it was five or even 10 years ago, according to Mullin. To build the memory care facility in Naperville, Silverado received a construction loan from Chicago-based Private Bank. Toledo, Ohio-based Health Care REIT, a key partner for Silverado, provided equity capital for the development.
In order to obtain a construction loan from a bank today, a developer still needs to show experience and have strong operating staff. “You need a proven track record of at least five to six properties,” says Mullin. “You also have to have an experienced player like we have in Linda Wylder.”
Memory care retrofits on the rise for Erickson
Baltimore, Md.-based Erickson Living, one of the largest U.S. seniors housing operators with 20,118 units under management as of June 1, 2014, is also building new memory care neighborhoods at its CCRCs.
“Seventeen of our communities have memory care,” says Margaret Stewart, Erickson’s senior director of health informatics and clinical programming. “Our remaining communities that don’t have memory care are retrofitting.”
Last year, Erickson added new memory care areas or “neighborhoods” to five of its existing CCRCs. In 2015, another six of Erickson’s communities will add memory care to their mix of residential choices.
These new memory care neighborhoods often provide enough room to house 36 residents in the advanced stages of Alzheimer’s or dementia. However, the layout of hallways is designed to create four smaller neighborhoods, each of which houses nine seniors.
“We can get small and bring residents together for activities like flower arranging,” says Stewart.
These neighborhoods offer a robust events program seven days a week, including physical activities, creative work and one-on-one attention from staff to help residents stay engaged.
The neighborhoods also feature stations — a variety of comfortable chairs and small tables — where residents can pursue their own activities. The seniors also have access to a secure outside area. “Individuals can do what they want, when they want,” says Stewart.
The use of anti-psychotic drugs to treat elderly persons suffering from dementia can be reduced if seniors stay engaged and the staff pays close attention to their needs, according to the latest research.
Erickson also provides memory health services in other parts of its CCRCs. In Erickson’s independent living areas, residents in the early stages of Alzheimer’s or dementia have access to health services to help them live more independently for as long as possible before having to move to memory care.
That’s important for a growing number of residents. “Seventy or eighty percent of the people living in our CCRCs probably have some form of cognitive impairment,” says Stewart.
Even if they show no signs of dementia now, Erickson encourages residents to make choices that reduce chances of developing symptoms, such as controlling chronic illnesses, and getting regular exercise for the body and mind. Learning a new language is a way to stay mentally fit.
Erikson also provides social activities like its Memory Café program, which provides a place where people in the early stages of dementia or Alzheimer’s can talk with other people in their situation.
As long as a resident with cognitive impairment is functionally able to remain in an independent living apartment, Erickson coordinates services including social work, home support and housekeeping to help that person remain successful in their daily life. For example, Erikson’s Intermission program provides structured activities designed to interest residents and help them stay engaged.
Relationship between staff, resident is focus of Sunrise
Sunrise Senior Living, a leading operator, is now integrating memory care into all of its new assisted living properties. Sunrise currently has three new communities under construction that include memory care, including two in California and one in Ohio.
Sunrise has provided its brand of memory care to residents for years with relatively few changes. Its decision to build memory care into all of its new communities shows the growing demand for the services.
“The majority of our buildings have memory care,” says Sunrise’s Haden. “It’s a smaller, more secured area that really supports someone in a more advanced stage of the disease.”
At first glance, the memory care areas at Sunrise assisted living facilities are not physically much different than the other parts of the Sunrise communities, other than the controlled entrance to prevent the residents from wandering.
“It’s not so much the design — it’s what goes on within the rooms,” says Haden.
A long list of small differences help the memory care residents succeed in their daily activities. For example, each memory care area at a Sunrise assisted living community has its own separate dining hall, which is similar, though typically smaller, than the community’s main dining hall.
At the memory care dining hall, the plates are bright yellow Fiestaware, which provides a strong visual contrast with the darker table linens. Residents who are in advanced stages of the disease can use “adaptive ware.” For example, the bowls might have a wider two-inch lip to help seniors avoid spills.
The menu is subtly designed to help residents succeed independently for as long as possible. A choice of drinks, including coffee, encourages residents to stay hydrated, a major issue for people in the more advanced stages of Alzheimer’s or dementia.
Residents also have multiple choices, providing an opportunity for them to engage cognitively. These choices often include a finger food like French toast sticks that can be gracefully eaten by residents who have difficulty handling silverware.
The memory care communities at Sunrise also have large, flexible common areas that can be used for a variety of programing, including group and one-on-one activities.
Services are the real key to the success of memory care, according to Haden. Each day includes a long list of group or one-on-one activities designed to draw out the residents and validate their feelings. “Dementia is a really inward journey. A lot of the residents in the early stages of the disease will isolate themselves,” says Haden.
Each resident is assigned a designated care manager, who coordinates care for the resident.
Sunrise also doesn’t rotate its caregivers among the residents. “The residents are able to develop a relationship with the person taking care of them,” says Haden. The caregivers get to know the habits and the likes and dislikes of the residents they care for every day. The caregivers are also better able to notice subtle changes in the behavior and condition of the seniors.
“We aren’t task-focused, we are person-focused,” says Haden. “There’s nothing that gives a family more comfort than knowing that someone is taking care of their mom or dad.”