Residential Care of Persons with Alzheimer's Disease (Dementia)
Jonathan M. Evans M.D. Mayo Clinic
Perhaps the biggest difficulty which nursing homes face when housing ambulatory residents with dementia is their tendency to “wander.” In general, humans who are physically able to walk do so many times throughout the day, either for a specific purpose, such as toileting or for exercise, or because they are motivated by curiosity or boredom. Unfortunately, the physical environment of the nursing home simply cannot accommodate this in most instances. This behavior, which is, after all, a normal human desire to move, puts residents with dementia in conflict with the nursing home environment.
Historically, this has resulted in the use of physical or chemical restraints to suppress or restrict it. What is necessary is ample space to move, as well as structured, predictable and meaningful activities to participate in and enjoy. Other difficult behaviors, such as agitation, aggression, and “resistance” of care (which are also quite commonly seen in dementia patients in the nursing home environment) often stem from boredom, loss of control, or misunderstanding. Allowing seemingly mundane daily rituals such as bathing, dressing, grooming, meal preparation and eating to become participatory social events to be enjoyed, as well as enabling one to “do” things to be celebrated rather than discouraged makes care giving easier and more rewarding, and enhances the quality of life for residents.
The Cottages are just such a place. The Cottages are assisted living facilities with space for 28-32 residents. Each cottage is composed of four “apartments” physically connected by a commons area for structured activities, as well as for socializing. Each apartment is composed of four bedrooms, a living room, kitchen and dining area as well as bathroom facilities. The Cottages specialize in the residential care of individuals with Alzheimer’s Disease and related disorders (dementia). In contrast to nursing homes, which offer a medical model of care, The Cottage environment better accommodates impairments found in Alzheimer’s. Psychology and psychiatry consultations as well as laboratory services are available to residents on site. All of the medical care is overseen by a medical director, a geriatrician familiar with issues of Alzheimer’s and related disorders.
The most obvious beneficiaries in this new model of care are the residents and families. The caregivers benefit as well. They benefit from an attractive and healthy environment in which to work, from the close relationship with residents and family members, and they enjoy the opportunity to be problem solvers, immediately rewarded for their expertise. There is a greater sense of control over their work, and a greater sense of pride, in knowing that in the most personal terms, what they do everyday makes a very real difference in the lives of the residents they care for. The health care community benefits by a higher standard of quality dementia care, local nursing homes benefit by having beds available for skilled and subacute care, and the local hospitals benefit by having more beds in the community, decreasing hospital length of stay for patients in need of skilled care.
The aging of our population, the changing landscape of healthcare financing, and the growing need for specialized housing with services creates new opportunities in designing facilities to meet the special needs of residents. The population of Americans living with Alzheimer’s disease, particularly those living in (or at risk for) nursing homes may have the most to immediately gain.