As more and more people are diagnosed with Alzheimer’s, dementia and other forms of memory loss, some memory care providers are finding that modifying certain lifestyle factors or changing resident settings earlier in the game can generate ‘dramatic’ results—and sometimes stave off disease progression, at least to an extent.
Kirkwood Orange, a be.group assisted living community with a memory care component located in Orange, California, converted several assisted living units into a mild-to-moderate memory care neighborhood, boosting its original memory care neighborhood to a more advanced level. And Silverado, a California-based provider with memory care communities in six states, along with at-home and hospice care services, recently implemented its research-based Nexus program for people with mild cognitive impairment.
Similar to early onset memory care programs, like that rolled out by Sunrise Senior Living last year, approaches like the be.group’s or Silverado’s target those in the initial stages of memory loss. However, they differ in that early onset programs tend to be specific for younger populations, while mid-level memory care encompasses residents of all ages. The latter also denotes lower acuity memory care for those who have been diagnosed with Alzheimer’s or other diseases but haven’t yet experienced dramatic memory loss, and an effort to ward off further decline.
“We have seen improvements that have been dramatic and a surprise to us all,” Kim Butrum, senior vice president of clinical services at Silverado, tells Senior Housing News.
Six Pillars of Memory Improvement
Stemming from research of modifiable lifestyle factors to alter the onset and progression of Alzheimer’s or dementia, Silverado established Nexus, which consists of six activity pillars aimed at meeting memory care patients midway in their diseases. These include physical exercise, stress reduction, cognitive exercise, specialized digital programs, purposeful social activities and support groups, all of which have been shown to make a difference amongst memory care patients.
“It’s very much strength-based, and never going on the assumption that someone can’t do something just because they’re in memory care,” Butrum says.
Memory care patients are often assessed in the mini-mental state exam (MMSE), during which health professionals ask patients a series of questions to examine their everyday mental skills. They’re given a score up to 30 points—anywhere between 20 to 24 suggests mild dementia, 13 to 20 moderate dementia and less than 12 severe dementia. On average, someone who has Alzheimer’s will see his or her MMSE score decline two to four points each year.
Silverado monitors this score when residents move in and again every six months, and through Nexus, the memory care provider has noted improvements of five to eight points. That’s not to say that the Nexus approach will restore or reverse cognitive loss or provide a cure, but it slows progression, Butrum says, and boosts residents’ overall quality of life.
“From our perspective, when you have just enough of that structure and support, then somebody can be completely free,” Butrum says. “It’s the best option for care with someone with mild disease.”
A Mid-Level Conversion
Kirkwood Orange opened in October 2000 with the intent to primarily serve assisted living residents and maintain a small memory care component. But over time, residents in assisted living began showing cognitive decline, and extra services were needed, says Jessica Morales, administrator at the community. Still, they weren’t at a severe enough stage to be relocated to the dedicated memory care space.
So about a year ago, Kirkwood Orange took 14 assisted living units to develop a mild-to-moderate memory care neighborhood, changing the makeup of the community to 23 assisted living and 40 beds total for memory care—20 for mid-level impairment and 20 for more severe needs. The purpose of the distinction is that those that fall under the mid-level umbrella have more care needs than traditional assisted living residents might have, so instead the community is meeting residents where they’re at.
“We’re capturing the middle ground that never used to be captured before,” Morales says.
For example, the community initiated a 24/7 nursing staff in July in an attempt to set the mid-level program apart from standard memory care and typical assisted living. Kirkwood Orange also touts an engagement program specific to this subset of memory care, which adheres to residents’ interests and focuses on different dimensions of memory.
The approach has proven successful not only in seeing residents flourish and lowering readmission rates in hospitals, but also in terms of occupancy and limiting how many assisted living residents might end up elsewhere, according to Morales. Kirkwood Orange is as “full as full can be,” but such success also has its downside.
“A lot of people say it’s really terrific, and yes, it’s great that we’re serving those residents well,” she says. “It’s hard, though, because we can’t serve the next person.”
Written by Kourtney Liepelt
Photo courtesy of Silverado.