Many senior living providers have been pivoting to wellness in their operational models, and memory care is no exception.
But given the particular needs of memory care residents, fostering a wellness-first approach is not easy. Bringing wellness into memory care involves engaging multiple stakeholders, specific training, transforming physical spaces, and integrating technology.
Most importantly, memory care providers pivoting to wellness are reassessing their approaches toward caring for residents in their charge. That is according to leaders with Senior Star and Sunshine Retirement Living, who spoke during a recent webinar hosted by Senior Housing News.
The tendency of memory care providers used to be approaching residents from the perspective of their cognitive decline, instead of as people who still have much to give, and plenty of life to live, said Shadoworee Betts, senior vice president of clinical services at Senior Star. The Tulsa, Oklahoma-based senior living provider’s operates a portfolio of 12 communities in five states. Memory care is a particular area of expertise; company founders Bill Thomas and Bob Thomas have served at the national leadership level of the Alzheimer’s Association, and Betts sits on the National Alzheimer’s Association Dementia Care Roundtable.
“We like to look at the person holistically – these individuals, prior to the diagnosis, had fulfilled lives and careers,” Bettssaid.
Kena Phillips, regional vice president with Sunshine Retirement Living, agrees. Based in Bend, Oregon, memory care is offered in 23 of the provider’s communities. In Dec. 2020, the company announced an expanded rollout of a wellness-focused memory care program, including Montessori-style programs, new sensory experiences and technology, and other elements.
Phillips believes that wellness is a complementary holistic component to clinical and health care, and helps create environments where memory care residents can thrive, creating situations where they have more life in their days.
“We want to get away from identifying individuals as a disease process, and remember that they are a sum of their parts,” she said.
Giving staff ownership
Hiring the right people — not just having the proper staffing levels — is essential to bringing wellness into memory care.
It involves hiring for the type of culture providers plan to implement – having the necessary soft skills and approachability to get residents to engage with frontline staff, Betts said.
If a job candidate has those skills in place, then odds are solid they have the purpose required for a career in memory care, and then providers can train them in the needed skills. For instance, how to assist residents, identify what agitates them, and learn de-escalation techniques if an episode occurs.
“We spend a lot of time on the process of hiring right, first,” she said.
New hires at Senior Star’s memory care facilities spend a lot of their onboarding and early weeks on the job in sensitivity training, including simulations to provide a clearer sense of what it is like to live with cognitive decline. This leads new staff members toward being more patient and empathetic toward residents.
The training is continuous, and involves engaged leaders who observe and are willing to teach in the moment. Leaders provide associates with the flexibility to make on-the-spot decisions and empower the lives of the residents that they’re serving.
“When you’re able to address what [staff are] asking you to address, you create raving fans from your associates. That allows them to be a little bit more successful in an engagement process,” Betts said.
Sunshine completely immerses its frontline staff in the care process, and solicits their advice on developing care plans, building on a team’s collective experience, Phillips said.
This approach helps staff forge bonds with residents as well as each other, and gives all team members – from CNAs to housekeeping staff – agency in the care of residents.
“We encourage a whole team approach, and we encourage that no one department is above another department,” she said.
Residents embrace technology
After lagging behind other industries for years in embracing technology, Covid-19 shattered the barriers holding the senior living industry from incorporating tech platforms into their operations.
Technology poses unique opportunities, and challenges, for memory care settings. But providers are pleasantly surprised by how residents are embracing tech, in particular.
Sunshine implemented virtual reality capabilities within its memory care settings, and Phillips had doubts if it would take root.
“When we first started talking about this, I thought, ‘Oh, no. This is not going to be pretty,’” she said.
Instead, memory care residents have embraced virtual reality goggles and headphones. The VR tech allows for near-unlimited scenarios, from skydiving and virtual tours of foreign destinations, to watching musicals and touring museums and other cultural institutions.
“It’s an amazing tool that I would have never embraced, if our wellness team had not been pressing me to do that,” she said.
Sunshine also uses video technology to assist in calming agitated residents. The provider uses recordings to capture primary caregivers and loved ones and, if they cannot be contacted when an event occurs, plays the recordings as a second option to calm residents.
Phillips indicated that Sunshine has only scratched the surface in how deeply it can ingrain technology into its memory care operations. In the future, she sees potential for creating video scrapbooks, and even more opportunities for personalized virtual experiences that can lead to positive outcomes.
“I encourage everyone to not get in the trap that I was in, [convinced] this won’t ever work,” she said.
Senior Star is bringing in virtual reality capabilities for its memory care neighborhoods, and intends to train staff and residents’ families on the technology, in addition to residents, Betts said.
She sees Senior Star using VR as a tool to give staff and residents’ families, in particular, a semblance of what residents in cognitive decline live with on a daily basis.
“They’re used to being caregivers. They’re not used to being the person that has the disease; VR equipment will allow us to help with those experiences,” she said.
Senior Star is exploring partnering with a third-party provider on an artificial intelligence-based fall detection platform, which can predict when a resident is most susceptible to falls, and eventually reduce the likelihood of an event occurring.
Betts believes that gathering data will help Senior Star identify the contributing factors behind falls, put measures in place to reduce the chances of a fall in the future, and explain to families why loved ones are falling and the measures being taken to prevent future incidents.
Senior Star plans to launch the partnership in early 2022. The provider is also exploring additional engagement technologies for residents and associates to more positively engage in their environments.
“It provides great reassurance for our family members,” Betts said.
User-friendly design
Senior living has adapted wellness-based design trends for years, and the pandemic has accelerated the adoption.
This is especially true of memory care, where building designs are a foundational component of an operator’s care programming. Sunshine designs its buildings in a figure-eight layout with seating areas and watch stations throughout, in order to keep residents engaged should one decide to walk around, Phillips said.
Design innovations extend to exteriors, as well. Sunshine’s courtyards incorporate bright colored flowers in landscaping as engagement tools and wayfinding devices, and wide walking paths with more seating areas.
To encourage stimulation, Sunshine also has spaces designed to resemble offices with desks where residents can “work” or nurseries where residents tend to “babies.”
Kitchen stations are stocked with melamine plates and service ware for residents to safely wash dishes and feel a sense of purpose.
The operator constantly assesses these stations and their frequency of use, going so far as to review residents’ life histories to customize how these stations are designed, and where they are laid out.
“It’s important for the physical plant to be easily modifiable, if you will. We can’t move walls, but we can move areas,” she said.
Senior Star’s memory care design incorporates many of the same principles as Sunshine, with the courtyards situated in the middle of the neighborhood for engagement and connections. These areas are laid out similarly to a neighborhood outside a community. Seating stations are designed to resemble those at bus stops, parks, or schools. Senior Star brings in cars for residents to wash, as an engagement tool.
“When [families] choose to bring their loved ones to memory care, they’re not prepared at times for what they’re going to see. We try to take that trauma away from them and make sure our environment is inviting,” she said.
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