But the sheer number of innovative memory care concepts can also make it difficult for providers and caregivers to determine what works and what doesn’t.
That challenge is heightened for McLean, Virginia-based Sunrise Senior Living, which is exposed to myriad ideas at its 327 locations across the U.S. and the United Kingdom.
To learn how one of the nation’s largest senior living operators separates the wheat from the chaff, and manages a large-scale memory care offering, Senior Housing News caught up with Rita Altman, the company’s senior vice president of memory care and program services.
The following interview was edited for length and clarity:
Tell me about your memory care philosophy at Sunrise. What is it centered on and why do you employ that philosophy?
It has many dimensions to it. We say that our goal is to create pleasant days for residents with memory loss. That really includes so many different types of approaches and environmental elements.
We do it in lots of different ways. One of the key ways is through approaching residents entering their world and joining their journey, not expecting them to come into our world. Prior to moving to Sunrise, that may have been a difficult journey for them to take. Families, they want their loved one to be all that they always were.
There’s a lot of, at first, denial when a person has memory loss. There are lots of approaches that people use, and not only families, but even some caregivers. When someone is asking for someone from the past, they may respond with, well, you know they passed away. That person [then] re-lives the event because they have forgotten it.
Instead, at Sunrise, we use validation, which was developed by Naomi Feil, and I studied under Naomi. The validation method is something we teach the basics of to all of our team members, as well as, we have higher-lever certification trainings in it.
It’s essentially entering that person’s world with empathy, not lying, not using redirection all the time, but going to where they are. Asking open questions. Rephrasing what they said. If the person no longer has the ability to speak or can’t articulate what they need, learning how to look for that unmet need that person has, maybe through their motions or through repetitive things they may say or do.
There’s a lot of training that goes into helping our team members enter the world of the person with memory loss, join their journey, and be with them through that strong, empathetic approach.
Beyond that, we have what we call Live With Purpose programming which is the overall umbrella programming in all areas of Sunrise, whether that’s independent living, skilled nursing, assisted living or memory care, which we call Reminiscence.
And we have another memory care program for individuals in the earlier stages called the Terrace Club Neighborhood, as well as a program in assisted living for residents who may be on the cusp of needing memory care but not yet needing to move into a secure neighborhood. That’s called our Live With Fulfillment program.
But all of those different programs of care follow the Live With Purpose philosophy, which is all about the evidence-based programs we’ve developed.
Whenever a resident moves in, we get to know them. We get to know their life story, their profile. We have life enrichment managers charged with getting to know that resident down to a basic understanding of who they are as a human being or what makes their heart sing.
What are the keys to a good memory care program in your view?
I think it actually always starts with person-centered care. Each resident is a unique individual. We have to know them, know their life story.
We have to know how they’ve coped in the past, because when they have stressful moments due to having memory loss, whether it’s confusion or disorientation or a spatial recognition issue, that we know what helped them in the past. Sometimes, they can’t remember how they coped. And if we understand that, we can pull that out and remind them of those things.
It’s also very much about the philosophy and having the team members aligned with that philosophy. The Sunrise principles of service strongly guide our team members.
You have to hire people who have empathy, and have a really excellent training program whereby they’re well-trained and prepared. It’s not just about coming to a classroom and hearing it, but it’s about how you do it. And there’s a lot of mentoring and support that go into that.
It strongly focuses on having standards and building those standards according to what the evidence-based practices are. It’s having programmatic consistency and building those programs according to what the latest evidence-based standards are.
That’s where we look to the Alzheimer’s Association and their dementia-specific recommendations.
We’ve seen how memory care has been one of the hardest-hit sectors in senior living in recent years, at least in terms of occupancy. What has the competitive landscape looked like for Sunrise?
Everybody knows that we’re all kind of waiting for the baby boomers to begin to enter the senior housing world. It’s probably going to take a couple more years, but we’re expecting that large influx soon.
As a result, there’s been a lot of building. And a lot would say there’s an oversupply in some markets. Wherever that is the case, we continue to do what we do and do it to the best of our ability and continue to thrive.
We know that occupancy is an issue across the industry right now, but it’s expected to improve.
At the SeniorCare360 conference, there was some discussion that older adults and their families are getting to the point where they better can identify quality in memory care programs. Can you elaborate on why you feel that way?
Most providers are striving to provide good resources and good information on the key elements of quality programing.
The Alzheimer’s Association itself has very good literature. AARP. JD Power. We’ve got more and more consumer organizations that have started to give so much more information to the public. But I also believe it comes down to each and every company to share information, to share resources, to open their doors, to provide support groups and to hear from families.
I just see it continuing to grow. We know we have more than 5.5 million individuals living with Alzheimer’s disease or related dementias, and that number is expected to grow as the baby boomer pop continues to age.
One challenge in memory care is scale. With nearly 300 communities at Sunrisewhat’s the key to scaling a memory care program?
One of the biggest keys to scaling is having those standards and ensuring that all of the training involved clearly articulates those standards, the philosophy of care. It’s having quality guidelines for every single detail of what your memory care program should look like.
Ongoing quality assurance is that key element to ensure consistency. And it has a lot to do with having a support team or a resource team.
Sunrise has a really strong support team, memory care experts, who support the communities, who visit the communities, who train the community team members. Along with our quality team, care team, directors of operations, and our executive directors, if everybody is educated to what quality memory care is, the expectation is there. And we set the expectation with a lot of training and support.
It’s having the fundamental philosophy, training, support, resources, ongoing education, continuing education and measuring quality. As long as that’s all happening, you can have consistency and scalability.
To what extent can you work in more hospitality-focused offerings like fine dining or wellness offerings into memory care settings?
Every element of that.
Fine dining, absolutely, is equally displayed, seen and lived out in memory care as it is in any other level of care in the company. And any of the elements of hospitality. The neighborhood is very homelike. Lots of natural light. Color coordination to help residents with wayfinding. Life skill stations they can engage and interact with
It doesn’t look clinical at all. It’s all about residents feeling at home.
Very comfortable settings. Suites that resemble their bedroom at home. It’s cozy, warm, inviting, engaging. All of those are key elements, because it is their home and we want it to look and feel comfortable and give them the best quality of life.
What are some memory care trends you think will help shape this industry in the coming years?
There are some ongoing trends with technology. We’re seeing a lot more innovations with virtual reality. Whether or not that will be for residents or whether that will be more for training of team members to increase their understanding and empathy remains to be seen.
I think you’re going to see a lot more with music. More focus on balance and on strength training, because of the increased falls. And we’re seeing more technology-based products coming out in that realm.
There’s more to do with pet therapy. The sky’s the limit. There’s just so much different work being done right now.