The rapidly changing senior living industry has made sizable strides over the years in the communities that it creates and the care that it provides. Among the areas where some of its most important gains have come is in the way that it cares for its residents with dementia.
Cole Smith, corporate director of care and cognitive wellness for Brightview Senior Living, said the shift centers on giving more attention to these residents and how to improve their quality of life, going beyond a simple focus on how to care for them from a medical standpoint.
“Years ago, we were focusing solely on safety and asked the question are we keeping these individuals safe? And that was about as an industry where we stopped,” Smith said. “Now it’s about purpose, connection, really finding what truly matters to that person, and what barriers can we remove or what support we can add to give them back their personhood – who they are – and having connection to the larger community.”
Tasha Janssen, vice president of operations for Curana Health, which partners with Brightview, agreed that there has been a transformation in how dementia is treated in the senior living space. For years, she said, senior living residents and others who had dementia would be treated first with pharmacological interventions.
“Now we’re seeing that the culture has shifted for the right reasons toward person-centered care, which revolves around getting early intervention, taking really good care of people and finding tasks that help their mind and help them have the ability to do what they love to do,” Janssen said.
Smith and Janssen shared with Senior Living Executive how they see dementia care evolving and how their organizations’ partnership is playing a role in improving care. With dementia diagnoses expected to double by 2060, according to JAMA, they agree the drive for improvement has never been more pressing.
Benefits of in-residence primary care
Curana Health provides in-residence primary care services at 12 Brightview Senior Living communities in Maryland, Massachusetts, Virginia and Pennsylvania. Janssen said having doctors come into the community to see dementia care residents, in particular, is “a really big deal” because it allows those residents to receive medical care while remaining in the environment where they are comfortable. In contrast, Janssen said, residents with dementia who must leave for a primary care appointment, such as an annual wellness checkup, can grow disoriented, leading to a cognitive decline, behavioral challenges and the potential need for increased medication, undoing gains that may have been made leading up to the appointment.
For in-residence primary care to be successful at a senior living community, particularly as it relates to dementia care, Janssen said one of the most important ingredients is buy-in among the community’s staff.
“We want to make sure that they are educated on what it is that we do, so that they can help identify the residents that would best benefit from our services,” Janssen said. “The staff that work with the residents are the people that the families trust.”
Janssen said the payoff can be as simple as staff members recognizing that a resident has been “off” and sharing that with Curana personnel, increasing the chance of catching a cognitive decline as early as possible. It is part of Curana’s emphasis on preventive medicine.
“Our value-based model is completely centered around making sure that our residents’ declines are caught early and making sure that we’re giving them good quality of care instead of quantity of care,” Janssen said.
Similarly, Janssen said it is important to maintain strong connections with family members so that they can share concerns if they witness changes in a resident. With dementia, she noted, early identification of issues is crucial.
“It’s kind of like working your way down a mountain,” Janssen said. “Once they take that first step of a decline, they start declining at a faster pace, and they never fully reach their way back to the top of the mountain. But if we can catch their declines earlier, we can keep them stable near the top of the mountain, and we can help slow the progression of dementia or cognitive impairment.”
Engagement and personalization
It is widely understood that the Covid pandemic served to put a spotlight on the health risks that are associated with loneliness and isolation. Those risks are elevated for older adults – and even more elevated for those with dementia.
“Covid especially showed us that isolation and depression progresses dementia a lot faster,” Smith said. “People die faster.”
With that in mind, Smith said, providing residents with dementia with an array of engagement opportunities and ensuring that they are integrated into their community can provide striking benefits.
“Purpose is something that everyone needs, especially those living with dementia, and we need to make sure that we give them opportunities to be a part of not just the dementia neighborhood or even the assisted living community or skilled nursing, but the larger community,” Smith said. “How are we giving opportunities for people living with dementia to truly engage and be part of their larger community? We want to keep people not just safe but engaged and thriving.”
That means, for instance, a much sharper focus on engaging residents with dementia with activities that they enjoy – “whatever it is that their heart loves,” Janssen said.
“We’re seeing communities keeping people busy instead of just medicating them or keeping them captive in a small area,” Janssen said.
Smith emphasized that communities should be tailoring activities to the resident and their interests and preferences rather than trying to force the activity on them.
“Knowing the person, knowing what drives them, knowing what they enjoy and what gives them purpose, how do I create an opportunity for them?” Smith said. “It’s knowing who the person is, what they enjoy and what support they may need to more independently engage in that activity.”
In that vein, Smith said that Brightview has customized playlists for residents in dementia care designed to help them during the day, including upbeat music when energy is required and calming music when something low-key is a better fit for the task at hand. Brightview employs music programs that are proven to enhance mood and attention span, improve quality of life and sleep, and minimize pain.
“We know that music can engage, it can heal, it can soothe,” Smith said.
Meanwhile, the Bright Minds program is a collection of Brightview community offerings that are designed to improve the overall brain health and cognitive function of all residents. For residents with dementia, in particular, the program – which includes diet, exercise, music and socialization, among other aspects – is designed to help slow the progression of their diagnosis.
“Now that we’re seeing the benefits of what happens when you do engage with people living with dementia, I think that just drives this energy and excitement that we have to want to support them and to help them live fully engaged lives,” Smith said.
Embracing community-minded spaces
In addition to programmatic changes, the physical design of dementia care facilities also are changing, Janssen said. The spaces are more “homey” and feature more community spaces where residents can spend time together no matter their cognition level.
“They’re making those larger areas more safe for them, so that we don’t have to have so much medical intervention,” Janssen said. “And it’s giving them a better quality of life, which is what value-based medicine and health care is all about.”
As Smith explained, “It’s about how can we design their neighborhood, their environment, to maximize their strengths and minimize their limitations so they can still do everything that they can with independent possibilities and choice.”
Smith said that Brightview designs its communities in thoughtful ways for its residents with dementia, including providing access to outdoor courtyards so that they “don’t have to ask permission to put their feet in the grass.” Designs are mindful of the visual changes that occur as someone contends with dementia, such as the need to minimize contrasts with flooring to help prevent falls. These details are not just about safety but about creating spaces where residents can maneuver safely and with freedom, he said.
“The ultimate heart of a well-designed dementia-inclusive environment is going to maximize independence, minimize limitations and allow the person to fully enjoy their whole home,” Smith said. “But I also believe that means the home should be the home for our associates, for our residents and their families.”
In fact, Smith said, families should be in the foreground when planning care and spaces for residents with dementia, noting that “when you’re caring for someone living with dementia, you’re not just caring for them – you’re caring for their family as well.”
“I want your grandson to be able to take his shoes off and watch a movie with you in the living room,” Smith said. “This is your home, and you deserve to have new memories created in your home.”
Learning to provide care
As there has been a growing awareness of the importance of human interactions with residents with dementia, it has placed even more of a focus on the caregivers who work with them, Janssen said.
“Getting more people to want to come and work in the senior living setting and be trained appropriately to work with residents is an area we can definitely grow in,” she said.
Janssen said it is about offering communities where people with cognitive impairments can be free and “not just in a room,” recruiting people who will be passionate caregivers and creating community-based programs that aim to get families involved.
“Treating residents that have dementia takes a whole team,” Janssen said. “It’s not something they can do on their own or just we can do on our own. It takes a whole team effort approach, so finding the right partner and finding places that really know how to care for true dementia patients and expand on their quality of life is something we all need to stay focused on.”
Smith said Brightview prioritizes hands-on activities and plain language in its training for caregivers. Training starts with providing them with a foundational understanding of dementia, including the path from diagnosis to end of life. A virtual tour helps them experience what it might be like to live with dementia. Then the focus turns to practical approaches and using what they have learned to care for a resident. In the case of caregivers, there is clear value in bringing their humanity to the work, he said.
“I want our caregivers to show their whole selves because then they’re going to be open to trying new things and learning new things,” Smith said.
The ability, patience and willingness to forge connections with residents is indispensable. Smith said caregivers must know residents well so that if they are distressed or otherwise in need of support the caregivers can ask themselves, “What do I know about them that can help right now? What tool do I have in my toolbox that I can lend to the situation to help the person living with dementia be successful?”
“At the heart of caring for anybody is figuring out what they need and what strength you have that you can lend to that situation to help them be successful,” Smith said.
While Smith believes the senior living industry has made notable progress in how it cares for residents with dementia, he said there is still a great deal of room for improvement as more communities adopt a person-centered model that does not default to medication-based interventions.
“We often look at caring for people living with dementia through the lens of fear, focused on risk,” Smith said. “We’ve got to embrace this idea that we can help people engage any way they want to. We just might need to provide different resources or support to help make that happen so that we’re always looking at people with dementia as fully engaged, lovely people that we can help find purpose and meaning and engagement.”
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