Memory care construction has surged in recent years, bringing to the market both new products as well as repositioned communities that are expanding to meet the growing need for memory support services.
However, despite the innovative approaches that have arisen, industry veterans say most modern memory care design principles are largely missing the mark.
In the past year and a half, the inventory of memory care units has increased by 3.1%, far outpacing the supply growth rates of other senior housing segments.
This uptick in construction is the result of two things, said Mark Rockwell, principal and CEO of Oregon-based Anthem Memory Care, during a recent Irving Levin Associates webinar.
“One, there’s a pronounced growth in need. Since dementia is a disease of aging, the incidence rate for dementia increases as the elderly population increases,” he said.
In fact, by the year 2050, the number of Americans 65-plus is expected to almost double, and those with Alzheimer’s disease, the most common form of dementia, may nearly triple, from 5 million to as many as 16 million, according to the Alzheimer’s Association.
And the senior housing industry has taken note.
“There is a real recognition about dementia that wasn’t in place, say, 15 to 20 years ago,” Rockwell said. “So there’s a greater sense that we need specialized care, a respect for people suffering from dementia, and as a result we’re [building] new, creative communities.”
Still, he cautions that the theory “build it and they will come” has contributed to overbuilding, and says developers and operators must be cautious when identifying market opportunities.
“It’s safe to say five to seven years ago you could find unmet needs in every city in the U.S.; I don’t think that’s the case anymore,” he said. “Operators need to be extremenly careful in identifying the market.”
The industry must also rethink the way it builds, designs and creates programming in memory care communities, as experts challenge everything providers thought they knew about this segment of senior housing. Here are 4 tensions experts say will have industry participants playing tug-of-war with their existing notions about memory care:
1. Standalone Community Versus Continuum Support
By the end of 2013, there were 1,060 memory care property types, according to the National Investment Center for Seniors Housing & Care (NIC). Of that total, 965 were freestanding memory care models, while the remaining 95 properties offered memory support services along with other care levels.
So 91% of the memory care market is banking on the freestanding model’s success in providing care.
However, while experts suggest there’s no “one-size-fits-all” approach, some argue that standalone memory care communities don’t do residents any favors.
One provider, in particular, expressed his concern over standalone communities segregating people with dementia and pulling them out of their familiar environments.
“One must be cautious about offering segregated communities that are only supporting people with one particular diagnosis,” said Michael Smith, president and CEO of the Alzheimer’s Research Center of Connecticut, Inc. “Standalone entities need to be deeply embedded in the communities they’re a part of.”
Additionally, freestanding sites can put those with early stages of memory loss in a tough position, said David Hoglund, president and chief operating officer at Perkins Eastman.
Hoglund’s father is experiencing memory loss, but doesn’t yet need the kind of specialized support a freestanding community offers. In this case, he said he recognized the value of the care continuum.
2. Resident Safety Versus Resident Freedom
Secured wings and locked communities are pretty standard features in memory care design. But for residents, these elements create physical barriers to their freedom.
“We’re seeing sometimes a tension between what a family member may be wanting and what someone with dementia may be wanting,” Smith said.
One of those disagreements centers around safety and security. While family members are concerned about how their loved one will be safe in a memory care community, residents may fear losing their freedom to padlocks.
“Creating alarms and locks [may] appeal to family members, but for the people living in there, they don’t want to feel like they’re in a situation where their freedom is contained,” Smith said.
Ensuring residents’ safety should remain a top priority, but providers should rethink the way they go about doing so.
3. Focusing on the Past Versus the Present
Of late, memory care providers have focused their programming around reminiscence activities, in hopes of sparking memories from the past. Emphasizing residents’ life experiences and stories, some say, can increase engagement and therefore decrease the isolation felt by many suffering from memory loss.
However, by focusing on the past, providers may stifle residents’ current interests and goals. The Alzheimer’s Research Center of Connecticut seeks to learn not only about residents’ pasts but also their goals, and recognizes that their aspirations don’t end when they move into the memory care community, Smith said.
“Traditional supportive programming focuses on reconnecting with the past, but [residents are] very much in the present and there is a future,” he said. “A lot of that is driven around how we might connect with people emotionally.”
4. Design Aesthetics Versus Functionality
Windows with a view to a nearby park or french doors that allow light in from an otherwise restricted outdoor space may be aesthetically pleasing, but can cause unnecessary frustration in memory care residents, providers said.
“[Make] sure that anything someone has the ability to see in a community, they have the ability to access,” Smith said. “It creates an incredible amount of frustration if they can’t access those [areas].”
While it’s critical to focus on the outdoor spaces visible from within a community’s walls, it’s also important to make sure interior decor isn’t just an aesthetic touch.
For example, the themed wings that have risen in popularity of late may soon be a thing of the past, as experts encourage providers to look beyond “hokey” design and toward functional interiors.
When asked whether having a themed environment is important in memory care design, Hoglund said, “Creating Disneyland is not real; what we’ve always said is we’re trying to create a normal living experience.”
So rather than focusing on themed designs, providers should create landmarks and distinguish one area from another through furniture choice and layout, he said.
“Having dining rooms that have different looks, finishes, chair shapes and layout really becomes memorable,” Hoglund said. “It’s about making environments that are familiar and comfortable.”
Despite some clear tensions that will have existing memory care developers and providers rethinking their communities, there are plenty of opportunities for others looking to enter the space. But now is the time to do so, said Dave McDowell, senior vice president of development services at Greystone.
“If you’re not building now, by the time you make a decision to build, then the market you think you’re going to serve may have already been served by someone else,” he said. “We promote if you’re going to do it, do it now. Time is of the essence.”
Written by Emily Study