Covid-19 presented multiple challenges for memory care providers.
In many ways, however, the pandemic served to hasten providers’ ability to innovate within the space, as demonstrated in ongoing efforts at Benchmark and Discovery Senior Living.
More adaptable and individualized programs, evidence-based physical plant changes, and strenuous staff recruitment and training efforts are among the approaches and innovations that Benchmark and Discovery have pursued, leaders with the two providers said during a recent Senior Housing News webinar.
While Covid-19 persists and workforce challenges have reached a crisis point, one of the biggest lessons learned during Covid-19 was the resilience of residents in memory care environments, Benchmark Senior Living Corporate Director of Memory Care Michelle Tristani said.
For example, residents have proven adaptable to practices such as masking of staff members, which many operators were concerned would cause increased agitation.
“The amount of resilience they have shown is unbelievable,” she said.
Rethinking how a memory care resident goes through the day has gained momentum in recent years, and it took on greater importance during Covid-19 in part due to the challenge of keeping them safe.
Discovery launched a new initiative, SHINE, in late 2019. The program took the operator’s existing memory care program and layered in more optionality into its component parts, from dining to activities to technology, using the latest in evidence-based practices and information gleaned via data analysis from its business intelligence unit. Bonita Springs, Florida-based Discovery operates a portfolio of 70 communities across 15 states.
The SHINE program, which is accredited by the Alzheimer’s Association, takes a therapeutic approach to resident programming, allowing Discovery to customize and tailor activities in each memory care neighborhood and the individuals that live within these environments, Director of Memory Care Dawn Platt said.
This includes meshing various sciences and practices such as neuroplasticity and Montessori, and tailoring activities and programming based on the cognitive ability of each individual.
Additionally, Discovery applies the customization to training team members, providing staff with all the necessary tools to evaluate the cognitive levels of residents residing in a memory care neighborhood.
“When you have dementia, processing skills, abstract thinking, judgment, critical thinking – all of those things are impacted. We’re able to engage people in functional activities that are impactful at any stage of dementia,” Platt said.
Benchmark’s “Connect First” program – a competency-based training program for frontline associates – is the foundation for its memory care platform, Tristani said. Waltham, Massachusetts-based Benchmark operates a portfolio of 63 communities throughout seven states.
Connect First trains staff in safe interactions with residents at all levels of cognitive decline, providing them with the requisite skills to identify when a resident is agitated, and how to de-escalate a situation.
One of Tristiani’s favorite techniques is hand-under-hand. In this technique, a frontline staff member begins with a regular handshake, moving to a friendship handshake and placing the resident’s hand on top, applying light pressure in their palm to attempt to de-escalate.
The technique can also be used to assist with all activities of daily living (ADL) and to assist with mobility. Notably, the technique can be used to provide dining assistance to persons with dementia by providing sensory motor feedback.
“It really helps because it’s a true partnership,” Tristani said.
Covid-19 has led architects and designers to return to the drawing board, and many are using the pandemic as opportunities to shake up static designs with modern touches, and adapting trends in the greater senior living space for use within the segment.
Benchmark is utilizing the fact that contrasting colors can engage residents without confusing or agitating them, Tristani said.
Accent walls in open layout concepts are painted in colors that reduce glare. Murals are carefully chosen so that residents can interact with them without becoming frustrated.
Additionally, careful consideration is given to reducing ambient noise, which can be challenging for residents and associates alike. This is all a part of honoring the residents’ request to interact with the built environment and manipulate items within it, which also involves staff ensuring that the environment is reset at the end of each day.
“The environment itself, being friendly, fun and forgiving, is the best way to guide us,” she said.
SHINE is a relatively new initiative at Discovery, and the operator is renovating some buildings to give them a neighborhood-like feel, mirroring a growing trend within the memory care space. Improvements include installing smart lighting systems in areas such as activities and dining rooms where cueing and prompting is important, and increasing the amount of natural lighting in a building, which is a critical part of cognitive treatment, Platt said.
Discovery also implements color schemes that compensate for residents’ visual deficits, such as blues, greens and other warm tones, especially in spaces that provide a lot of activity and socialization opportunities.
Discovery is also incorporating directional artwork into its interiors, as a means of prompting residents to engage with the space as they move from room to room, and for location purposes. Textured artwork on walls and in activities spaces promotes sensory integration. Other spaces are used for aroma or lighting therapy.
Indoor spaces serve as physical pathways to outdoor spaces, allowing residents to get fresh air and sunlight, and interact with nature through horticultural therapy.
“The design is really about living, and allowing our residents to experience their neighborhood and facilitating connecting them to it,” she said.
Post-pandemic challenges and opportunities
The slow road to a post-pandemic environment is laying bare several challenges for the memory care space. Notably, staffing memory care neighborhoods – an ongoing challenge prior to Covid-19 – remains an issue and may get harder.
Tristani is confident that Benchmark can recruit new people who have a baseline appreciation of the work involved with caring for people with dementia and other forms of cognitive decline, and the operator took steps to ensure regular connections between staff and residents in a memory care neighborhood.
Specifically, Benchmark implemented 10 to 15 minute “connection visits.” Staff dedicate a portion of their shift to these check-ins, to help gauge what a specific resident’s needs are, and potentially identify changes in cognitive function or other health issues. The visits also ensure that staff are in daily contact with their charges, and helps bridge staffing challenges in a neighborhood.
“The underlying need there – even if it’s to have a five minute exchange – a connection that’s needed, we have to make that happen,” Tristani said.
Reestablishing trust-based relationships with the families of people in cognitive decline is another challenge in a post-Covid environment. Hiring sales directors and staff that understand the myriad needs of people with dementia, and the concerns of their families that they will be in safe environments receiving exemplary care, is essential, and it is something that Discovery is focusing on, Platt said.
Because Discovery’s nursing department is very strong, she tends to hire memory care directors with flexible, non-clinical backgrounds: teachers; recreational therapists; fitness coaches. These candidates need to be able to adapt to their fluctuating environments, understand the programming process of memory care neighborhoods, and complement Discovery’s clinical foundation.
“We’re a collaborative team,” she said.