Someone in the world develops dementia every 3 seconds. In the U.S. alone, more than 6 million Americans are living with Alzheimer’s disease; and by 2050 this number will grow to nearly 13 million. So, it’s not surprising that about 14% of assisted living communities have a dementia or memory care unit, wing, or designated floor; and nearly 9% exclusively serve adults with dementia.
Not only is memory care prevalent, but there is a growing array of programs, technologies, philosophies, and designs bringing innovations to the field. Increasingly, memory care looks like comfortable, aesthetically pleasing homes with all the amenities and activities residents need to find joy, express themselves, stay physically active, and have a sense of purpose.
Eliminating Isolation
The COVID-19 pandemic brought a hard focus on how detrimental isolation and loneliness are, especially on mental health and cognitive function. Memory care stepped up to the plate with videoconferencing, virtual programming, FaceTime, and more to fill the bill as best as they could.
For the most part, any fears or concerns about these efforts being out of reach for residents were quickly dispelled. Angie Frantz, product manager for celebration and expressions at Prestige Senior Living in Vancouver, Wash., said, “During the pandemic, we used FaceTime and Zoom to enable residents to engage with family members and friends. I told them that it was like the communicator on Star Trek with Captain Kirk. That gave it an exciting spin and made it more fun for them.”
Some organizations were fortunate enough to have some tools and processes already in place to promote interaction and prevent isolation. For example, Paula Harder, vice president of resident programs at Commonwealth Senior Living in Charlottesville, Va., said they had headsets that enabled residents to communicate with family and friends during window visits. “We already had the infrastructure in place. We hope that it never happens again, but we will continue to focus on this infrastructure and what we can do different or better next time,” she said.
It is important to note that it doesn’t take a pandemic to promote isolation. Matt Reiners, co-founder and vice president of Eversound, observed that 80% of people over age 85 have some hearing loss and few are using hearing aids. “If someone has moderate hearing loss, they are 3-5 times more likely to develop dementia. And a study just came out showing that hearing aid use makes people 19% less likely to develop dementia.”
His company’s headsets are noise reducing and enable people to listen to individual music or other audio or share audio with others wearing headsets. “We found that these headsets improve engagement by 70%,” he said.
Getting to Know You
There is widespread agreement that it is essential to know residents – their histories, their preferences, their fears, and their joys – to provide effective memory care. Frantz said, “We focus a lot on residents’ life stories. We find platforms around the world to engage residents. Our residents haven’t lost their dignity, and everyone needs to understand that just because they’re in memory care doesn’t mean that they can’t learn, share, and have a purpose.,” she said.
Frantz noted that her directors of nursing in memory care communities utilize life stories to personalize service plans. Staff have devices where they can access these and use them to provide care.
These life stories can make a significant difference for memory care. Frantz shared an example. “We had a resident in memory care with early onset dementia. She would get agitated by shift changes in the afternoon. We knew from her life story that she loved Janis Joplin, so we downloaded some videos and would put them on a screen for her in a quiet place. Every day, she would watch and sing and act like she’d never seen them before. It was life changing for her and for staff who were freed to focus on tasks associated with the shift change and on resident care.”
Tech Talks
It’s a common misconception that older adults don’t like, understand, or use technology, but in reality, many are embracing and using tech even in memory care. Frantz said, “Our residents can still learn through technology—swiping or touch screens or icons they can use to help with communication and accessing information.” She also stressed, “We are moving into a new generation who have more of a relationship with technology.” In fact, she noted that currently, the average resident brings eight devices with them when they enter a memory care community. These include phones, iPads, TVs, and Alexa type devices.
Harder said that her team uses virtual reality with residents. “This helps give them the feeling of being somewhere else. We can take them to the house they grew up in, to the Eiffel Tower, or anywhere they want to go,” she noted, adding, “Afterwards, they have better motor skills, gait, and alertness.”
Commonwealth also uses a family engagement platform that lets family send photos and videos that can be stored in a database and shared with residents. Harder said, “This was particularly great during the pandemic as it gave people an opportunity to interact and engage with their loved ones.”
Tech also helps attract and keep good staff. “Having updated technology has helped staff engage residents so they can handle other tasks residents enjoy activities and recreation.” Some communities are using robots to deliver things like meals or birthday cakes. While these aren’t substitutes for human interaction, they free staff for more effective staff interaction and engagement.
When it comes to technological innovations in memory care, Frantz said, “We need to look 5-10 years down the road and think about the kinds of technology residents will want and need; and we have to make sure our communities have the infrastructure to accommodate these and continue to be cutting-edge.”
Harder agreed, observing, “Being proactive with the most advanced technology is important. We have to think about future residents. We are seeing a younger demographic that has more advanced tech abilities and not only want but expect innovative devices and the ability to easily use their devices.”
Check your thoughts and beliefs about technology, Harder suggests. Keep an open mind and scour resources for information about your options. Request demos and compare and contrast products.
“Look at your population and think about what they need to enhance their quality of life. Ask them and use their feedback to cross-reference products. And, finally, make sure any company you partner with offers adequate service and support. This is all significant,” she said, because “everyone in senior living is looking for the new hot-ticket item that will attract residents to our communities. Everyone needs to be thinking about it.”
Reiners noted, “What I’ve seen recently is organizations adopting technology packages and using different devices and innovations together. We need to work together as an industry to create solutions that work for communities and residents.”
Memory Care and Design
Just like memory care units need specific processes, technology, and staff training, they also need a design that appeals to residents. Charla Goss, an interior designer at Pi Architects in Austin, Texas, said, “For memory care, we try to create an environment that is as homelike as possible. We don’t want to overuse accessories that people might break or move; and we try to focus on items that are more durable – such as wooden bowls instead of ceramics.”
While abstract and modern art may have a place in independent or assisted living, Goss notes that they try to use art in memory care that is more realistic, bucolic, calming, and relatable. “We also use some audio art, where you push a button, and the picture makes a sound – such as birds chirping or a song playing.”
While locked, secured doors may be an unavoidable part of memory care units, Goss stressed that they downplay these doors and have hallways that lead people to secure indoor and outdoor spaces. She stressed that the secure outdoor spaces and access to lots of natural light are essential to memory care residents.
All these considerations need to be addressed in a conversion of units from assisted living to memory care. Recently, First Colonial Inn, a Kisco Senior Living community in Virginia Beach, Va., started expanding to include a memory care neighborhood.
Jackson Cherry, executive director at Kisco, noted,” For us during the process, we wanted to make sure that everything we are doing in this space is intentional and doesn’t look like an afterthought.” They had to work to make sure that the unit that was converted to memory care reflected the unique aspect of this setting and the specific needs of memory care residents.
Worth the Investment
Implementing cutting-edge programming and technology for memory care residents isn’t without a cost. But there is a real value to these efforts. Frantz said, “ROI is something everyone is looking for – the ability to attract new prospects, etc. We started an online system to track resident engagement. When we create spaces where residents are safe and enjoy life in new ways, we can grow census and hopefully enable residents to age in place longer.”
It is important to be able to track outcomes related to programs that cost money. For example, Harder noted that they use a platform that collects data about participation in activities. “We can see what activities are successful and popular and what ones aren’t being used or don’t resonate with residents. We can use this data as a jumping point to increase participation and engagement,” Harder said.
Other ROI is more specifically related to resident care and outcomes. For instance, Harder said, “The more engaged someone is, the less likely they are to need pharmacologic interventions.” At the same time, she suggested that when residents are happier and more joyful, it also takes the stress down in memory care for staff; and this contributes to retention.
Hether Arce, director of strategic accounts at PharMerica, noted that polypharmacy and adverse events contribute to residents having to leave memory care for a hospital stay or to move to a nursing home. Therefore, she suggested, “It is important to work with pharmacists and prescribers to help them optimize medication use, identify and address possible side effects, as well as understand the unique aspects of memory care.”
She added that she is starting to see teams coming together to focus on the patient so there aren’t disconnects. “We are scratching the surface on this, but it’s a big pain point when you have different practitioners prescribing drugs that result in different interactions,” Arce said.
