Residential Care of Persons with Alzheimer's Disease (Dementia)
Jonathan M. Evans M.D. Mayo Clinic
A New Model Of Care
What if you could create a facility from the ground up, designed in every way for residents with dementia? What would it look like? And how would the community respond?
A home-like environment, the ability to participate in and enjoy meaningful activities which are relevant to one’s life experiences, unrestricted space to move and walk in, space to socialize and enjoy the company of others, as well as quiet, personal and private space: these are essential ingredients for any healthy home. Also essential are the elements of safety, particularly for older individuals with some visual impairment and musculoskeletal limitations: well lit public areas, the absence of steps, wide corridors with railings, bathrooms with tubs that can be stepped into without the need for a hoyer lift, and other modifications such as grab bars to promote safe access and freedom of movement.
Nursing homes were built to house medically ill individuals in need of nursing care. As a result, they emulate a hospital model. Unfortunately, this has resulted in the “medicalization” of non-medical activities. For example, a doctor’s order is needed for everything from allowing the resident to go out on a “pass” with family to permitting the resident to be “helpful” by assisting with everyday activities in the facility. Although dementia is a medical illness which becomes progressively worse over time, it only effects the brain, and it effects certain parts of the brain selectively.
As a result, certain areas of brain function remain relatively intact. Because the rest of the body is not affected, skilled medical care is generally unnecessary unless other medical illnesses supervene. And although all individuals with dementia are limited in their ability to certain things, they are still capable of doing many other things and of engaging in meaningful social interaction. In other words, individuals with dementia have a chronic illness, but for the most part, they are not sick. The illness affects their ability to interact with their environment and other people in it, but in and of itself, dementia need not make them feel bad. What is most necessary, however, is safety because cognitive impairment affects judgement and decision making. Supervision is perhaps the most critical element of safety, in addition to environmental modifications. However, supervision does not need to mean isolation, intrusion, or restriction in activities. It may mean guidance, redirection, or assistance when necessary. It also means encouragement and social stimulation, while enjoying personally meaningful activities.