Climbing the memory care mountain

Dane County’s senior population is set to explode — so is the need for memory care.

From the pages of In Business magazine.

The first baby boomers to retire reached that milestone in 2011, but their retirement well-being has been a topic of discussion for years. Most of that discussion has centered on the financial health of entitlement programs such as Social Security and Medicare, but their mental health is increasingly on the minds of architects, builders, and community planners who are gearing up for what has been described as a tsunami of dementia heading our way.

In Dane County, the projected Alzheimer’s population is projected to grow to 21,600 people by the year 2050, compared to the 6,000 reported in the year 2000, according to a report issued by the Task Force on the Aging of Dane County.

Statewide, the number of people with dementia is expected to grow from the current 115,000 to 242,000, including 61,000 Medicaid recipients.

No community is fully prepared yet, but this projected growth has prompted state government to redesign its dementia-capable system of care and will drive future development and expansion of area senior-living communities. While there will be stand-alone memory care facilities, most industry observers expect additional memory care units to be added on existing senior living campuses. Memory care units already represent part of their “continuum of care” that ranges from independent living to assisted living (often coupled with memory care space) to skilled nursing homes.

Tim Conroy, executive director of Capitol Lakes Retirement Community in Madison, says the senior-living industry must figure out how it’s going to care for all these people, many of who will not be able to afford memory care. “Where are all of these people going to live when they age?” Conroy asks. “I don’t think there are enough affordable options, especially for people in low-income populations. So many others haven’t saved enough for retirement. What are they going to do?”

The build out

Jeff Anderzhon, a senior planner and design architect for Eppstein Uhen Architects, has designed senior-living facilities for the past 40 years. Reports about the number of dementia patients tripling over the next 30 years is a big factor in the work he’s doing to reposition senior-living campuses that have a continuum of care. Many of these communities have been in existence for more than 30 years, and their founding predates the need to provide memory support for either assisted-living or nursing residents.

“They’re trying to catch up,” Anderzhon says. “Everybody’s trying to catch up. For that matter, there are a lot of for-profit providers that are in the market building stand-alone, memory-supported assisted living.”

For obvious reasons, memory care residences are designed differently. Due to the possibility of patients wandering off, there are continual reminders of where dementia patients are to help them get back to their rooms after a meal or activity. In addition to more direct wayfinding, older memories are evoked with more subtle reminders in the form of family memorabilia.

In creating such spaces, size isn’t as important as function. “There are things that we can do to the design of the environment that assist those residents — and the care staff for that matter — to enhance the resident’s quality of life and independence,” Anderzhon explains.

For 50 years, CG Schmidt, a Wisconsin-based general construction firm, has had a business unit dedicated to senior-living campus communities. Eric Schmidt, general manager of the western region at CG Schmidt, says the firm sees a renewed interest in memory-care facilities. The firm also sees more research being performed on the types of construction these facilities should employ.

In addition to things that evoke memories, each door might be painted with a different color and the entrance façade might have a different type of construction such as an inviting cabin look. “The idea is to prevent them from wandering away but to also evoke memories and feelings so people can find their way back to their rooms,” Schmidt notes. “As we go into this we’re going to see a lot more of that type of research in order to create a more comfortable and inviting environment for those who are afflicted with dementia versus just trying to build as many rooms as possible to house them.”

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Schmidt also believes memory-care space is likely to be integrated into more campuses rather than in stand-alone facilities. Memory care is a broad enough term to include those with minor care needs and those with advanced Alzheimer’s disease, which is a form of dementia. “They still need to be in a protected, safe environment, but there are others with significant dementia such as an Alzheimer’s patient, and those two populations have drastically different needs as far as care and safety,” Schmidt says. “The campuses we work with allow residents to have care based on their individual needs.”

Based on emerging research, the design features that will be prominent in future memory-care units will include pleasing colors, ample lighting, and basic flooring.

Aaron Kostichka, vice president-principal with McGann Construction in Madison, says his firm is getting more involved in memory care. This includes Noel Manor, a new campus-type community in Verona that will have memory-care units. Such spaces will also feature pleasing finishes and the avoidance of diagonal flooring patterns that are believed to confuse the dementia population.

“Senior living and assisted living always used to feel very sterile,” Kostichka says. “Now everything feels very market rate.”

Capitol Lakes now has 12 dedicated memory-care units in a secure area on a floor of its assisted-living facility. Conroy says the community could have tripled that number and they’d all be full. With a large nursing home and some residents that can be transferred to assisted living, the time is coming when Capitol Lakes can downsize the nursing home and expand assisted living to accommodate more people needing memory care.

That would mean new construction rather than retrofitting the existing facility. “It would likely be that we have to build new,” Conroy says. “The existing facility would be really difficult to retrofit for what you need in assisted living now. If we had 50 assisted living units that could handle assisted living and memory care in an environment that’s the least restrictive as possible, that would be ideal.”

Due to the varying stages of dementia, don’t expect a cookie-cutter approach for this population. Dementia presents challenges even for well-trained caregivers, so it’s important to respond to the needs of individuals. “They’re individuals and everything is based on individual care,” says John Sauer, president and CEO of LeadingAge Wisconsin, a network of 500 nonprofit organizations that provide care to seniors. “It’s based on the resources that are available to that person and it’s based on whether they have a real strong, informal support system that enables them to live safely 24/7.”

One piece to the puzzle could be the return of adult day cares, according to Sue White, president of Sienna Crest, a Madison-based assisted-living community. New construction or retrofitting to accommodate adult day care facilities would not only keep local builders busy, they would ease the burden on family caregivers.

“That was a phase many years ago but because of the lack of funding there aren’t as many around today,” White recounts. “I can see that as an option for folks who are working and all the sudden their parents are having memory issues, but they can’t afford 24-hour care. Going to the adult day care route might be an option again.”

Geriatric guessing game

The factor that makes it difficult to accurately predict the required number of memory-care units is the desire to keep seniors, even those with dementia, in their home environment for as long as possible. That desire is not only true for memory care, but also palliative care and end-of-life care, according to Lynne Myers, president and CEO of Agrace, a hospice and palliative care center based in Madison.

According to Myers, close to 100% of Agrace’s palliative care patients have care provided in their home; whether their home is an actual residence, an assisted-living facility, or a nursing home, Agrace is providing care where the patient resides. With hospice, it isn’t quite that high — close to 93% — so despite public perception, Agrace’s facilities are not where care begins and ends.

“We’re taking care of just shy of 700 people today and about 50 of those people are in one of our buildings (in Fitchburg or Janesville),” Myers says. “We’re bringing the care to them and by a mile that’s where people want to be. They don’t want to be in a facility if they can avoid it. We have built the facilities we have because there are instances where patient care just cannot be handled in the home.”

At some future point, Agrace management believes the epidemic of dementia will require investment in secure memory-care units that are better equipped to provide end-of-life care for people with Alzheimer’s and other forms of dementia. “The proportion of our patients with memory issues is increasing with every passing year,” Myers notes. “It’s on a trajectory to eclipse cancer as the leading reason people need end-of-life care and palliative care.”

Providing that care will require a sufficient number of medical professionals, particularly nurses and nursing assistants, and preparing them in the requisite numbers will be another challenge. At Agrace, it’s a big part of staff and facility planning because the peak of projected staff shortages is supposed to hit in 2020. “Reading the tea leaves, I don’t know if I see the ability to build buildings that are staffed enough,” Myers says. “That’s going to inhibit our ability to take care of these folks in a high-quality way.”

Due in part to the shortage and the need, the cost of building such a clinical staff will only go up, Myers adds. “Nursing salaries are going to start inching up and that, coupled with any kind of facility need, will be incredibly difficult to fund given there just is no hint that revenue sources are going to change in any meaningful fashion as a result of these things.”

Rick Bova, CEO, and Keith VanLanduyt, vice president of marketing and community relations for Oakwood Lutheran Senior Ministries, which owns two Madison-area continuing care communities, are conducting a market study to evaluate unmet needs and determine future site planning. Oakwood has an idea of future demand based on its waiting list for occupancy and input from community partners such as local hospitals, the Alzheimer’s & Dementia Alliance of Wisconsin, and the South Central Wisconsin chapter of the Alzheimer’s Association.

Feedback received so far indicates the need for a lot of specialty care. As the baby boom generation reaches retirement, there are more people with very specific health issues such as drug and alcohol abuse that will require specialized care. “For people with specialized and greater needs, the cost of providing those services is greater, realizing that the [Medicaid] reimbursement rates are not going to cover a lot of those costs,” says VanLanduyt.

As for memory care, Bova says Oakwood Lutheran Senior Ministries is focused on getting in front of developers to talk about how it can develop a more dementia-friendly facility. “As we look at further developing our two campuses and the new campuses, we’re going to look at those around us to make sure we are meeting the needs of our aging population,” Bova says, “particularly around memory care.”

Whatever the emerging need, senior-living architects such as Anderzhon figure to be busy for a long time, but he wouldn’t mind less business on the memory-care front. “I would like to think that there would be a cure for dementia and so many other diseases the elderly are afflicted with,” he says. “That would be my wish.”

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Seniors for hire

Older employees welcomed in many workplaces

When some employers think of seniors, they think of people who’ve been put out to professional pasture. Todd Holman thinks of them as godsends.

Holman, director of administration for Goodwill Industries of South Central Wisconsin, manages 20 employees over the age of 65, which represents 7% of his workforce. The organization has the benefit of having long-term employees with 30 to 40 years of service, including five who are past retirement age. They don’t all work cushy desk jobs in the office; some do physically demanding work in donation centers and stores.

“Our second oldest employee is 77 years old,” Holman says. “She spends 40 hours a week sorting and pricing donations and making sure they get out to the floor.”

Among the job duties of Goodwill Industries’ Carol Samuel, hired as a production clerk in November of 2009, are collecting and sorting donations.

There are several advantages to hiring seniors, not the least of which is they are already work trained and understand the concept of work. For Holman, the common theme is they are not ready to retire and they typically look for the kind of work that allows them to give back to the community.

“They aren’t ready to retire and they don’t want to do what they’ve been doing,” he explains. “If they were at a high-stress, high-pressure job — a management type job — maybe it was time to do something they’ve always wanted to do.”

Although labor shortages demand that some companies hold onto seniors and their lifetime of knowledge for as long as possible, the perception is that with age comes some slippage. Gil Atanasoff, executive director of Senior Helpers in Madison, notes there also is a positive perception of seniors as dependable, reliable, and hard working.

“It really depends on the industry, too,” Atanasoff states. “A fast-paced, high-tech industry may not be the right place for an older worker, but the service industry, especially customer service, is a good fit. In our case, many of our employees don’t need to work; they want to work.”

At Metcalfe’s Market, more than 12% of the workforce is over 60 years old, including the oldest, who is 84, but that’s not enough for President Tim Metcalfe. The grocer employs 67 people over 60, including 27 who are over 65, but laments a low applicant flow for seniors. “The few that do apply tend to have extensive work backgrounds and are our best employees,” Metcalfe notes. “If additional quality seniors applied, Metcalfe’s would double or triple our employees over 60 just based on their performance and customer-service skills.”

As a result, Metcalfe’s will be adding seniors and disabled adults to its targeted applicant population. That comes as no surprise to Mary Ann Drescher, president of Attic Angel Association, a Madison nonprofit organization serving children and the elderly. “Seniors are really still the pillars of the community and making some valuable things happen,” Drescher says, “whether it’s through their volunteer or paid efforts.”

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3 signs of a dementia-friendly business

The state of Wisconsin has launched a significant effort to improve its dementia care and delivery system, and employers are viewed as a vital part of building dementia-friendly communities. While criteria and programming have been established for such communities, including a promising Music and Memory initiative, there is still much work to be done to develop dementia-friendly businesses.

Not to worry, however, because it involves some basic steps. Joy Schmidt, a dementia specialist with the Dane County Aging and Disability Resource Center, cites three fundamental characteristics of a dementia-friendly business.

  1. At least 50% of employees have been trained in what to look for, including whether somebody has cognitive issues, struggles to communicate, or appears lost or confused. They have been trained to do things like make eye contact, pay attention to the customers’ body language, and even smile to offer reassurance.
  2. The same percentage of employees already have undergone training on ways to communicate what they can do to help patrons with dementia and training on how they can adjust their approach to help them. (Needless to say, the ideal is to have 100% of employees trained to recognize dementia and help patrons who exhibit the aforementioned signs).
  3. It’s open to suggestions about the business or store environment including changes to simplify signage or provide better directional signage toward restrooms, improve lighting, and install more basic carpeting (without the busy patterns that can be confusing to seniors with dementia). “Some of these suggestions are for caregivers as well because a lot of times, especially as the disease progresses, caregivers will be with the person most,” Schmidt says. “If the person acts in an unusual way, it’s about showing them that you’re not judging them and just showing compassion that this person struggling. It’s about basic customer service with increased awareness and increased understanding.”

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