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Developing Transformative Environments that Therapeutically Enhance Memory
Leading Age Washington Annual Conference | June 11, 2014
[ Leading Age Washington] June 11, 2014Developing Transformative Environments that Therapeutically Enhance Memory
� Learn about elements that support engagement and enhance quality of life.
� Review evidence-based design that support a successful design strategy.
� Identify steps a community can take to serve memory care needs and how to
reposition an existing community.
Need to be developed hand in hand
One affects the other
Projected Senior Population
• 10 million in 2012
• 25 million in 2024
• 40 million in 2040
• Highest growth rate (5%) between 2020 and 2024
� Everyday, 10,000 people turn 65
� The U.S. population age 65 expected to double in size by 2040
� By 2030, almost 1 of 5 Americans (72 million people) will be age 65+
� 85+ age group is the fastest growing segment of the U.S. population
� The Census Bureau predicts:
� an incremental increase of 51.6 million of 65+ population
� 85+ population will see 389% growth
� 85+ male population will see 525% growth
� Approximately every 70 seconds someone in America develops Alzheimer’s Disease
� By mid-century someone in America will develop the disease every 33 seconds
Prevalence of Alzheimer’s
Projected Number of Seniors Age 65+ with Alzheimer’s Disease
Source: 2011 Alzheimer’s Disease Facts and Figures, Alzheimer’s & Dementia, Volume 7, Issue 2
Leslie Moldow FAIA // Perkins Eastman
Nora Gibson, MSW // Full Life Care
Perkins Eastman Architects
[ Leading Age Washington ] June 11, 2014Developing Transformative Environments that Therapeutically Enhance Memory
� Industry Experts since 1985
� 20 Principals committed to senior living
� 30 AIA Design for Aging awards
� More than 100 industry citations for excellence
� 550+ clients over the past 25 years
� 600+ completed projects
� 500+ master plans for senior living communities
� 35,000+ skilled nursing facilities
� 30,000+ assisted living apartments
� 60,000+ independent living apartments
� Since 1976, multi-service nonprofit
� Serves persons with Alzheimer’s via:� Adult Day Health� Home Care� Solstice Behavioral Health� Care Consultation � Memory Care Homes
Developing Transformative Environments that Therapeutically Enhance Memory
Full Life Care
[ Leading Age Washington ] June 11, 2014
100% of those living in our supported living homes are technically nursing home eligible
20% came to supported living out of assisted living
40% moved out of locked units at SNFs
80% have moderate to severe dementia
Know each person
Relationship is the fundamental building block of a transformed culture
Respond to spirit, as well as mind and body
Risk-taking is a normal part of life
Person before task
All elders are entitled to self-determination wherever they live
Every elder deserves to live in a mansion
“Our goal for this historical 14-bedroom home was to get away from the sanitized nature of a nursing environment and really create a home. The floors are the original hardwood, oak floors that actually creak a little bit, something you can’t build into a new facility. It draws on the residents’ recollection of a house from their younger lives. The house evokes that and provides a good foundation for a place to live.
Gaffney House: 14 bedrooms, including rooms for couples
Buchanan Place: 12 bedrooms, located next door to an adult day health center
Tasks that in most SNFs are done by nurses are delegated to Dementia Care Specialists who have specific training
Help with personal care, bathing, dressing, cleaning, cooking and laundry
Social Worker, Nurse and/or Health Administrator
Hire, train and supervise staff
Interface with MD, pharmacy and hospice workers
Ensure compliance with boarding home regs
Cook, clean and do laundry as needed
Help with personal care, bathing and dressing
Screen new admissions
Train dementia care specialists for nurse delegation
1. It is more important to know a person through developing a relationship than as a series of tasks to be accomplished.
2. Everybody—regardless of position or role—helps people in the bathroom.
3. No scrubs.
GREATEST CHALLENGES FOR THE BRAVE NEW HOME
� Reimbursement– Money follows the
person
� Workforce– Immigrants and
career ladders
� Resisting and slaying the institutional dragon
� Cost of real estate and development
CASE STUDY
[ Leading Age California ] May 6, 2014Developing Transformative Environments that Therapeutically Enhance Memory
Elder Care Alliance
� Vision: Engaging Hearts, Transforming Lives, Erasing Boundaries
� Established in 1997 by Mercy Retirement and Care Center
(founded in 1908) and Salem Lutheran Home (founded in1924)
� Corporate Members: Sisters of Mercy and Sierra Pacific Synod ELCA
� Currently 6 communities, 800 residents, 725+ employees
� 2 Rental CCRCs | 4 – Assisted Living/Memory Care
� Macro-strategies� Research, Creation, Innovation� Robust Professional Development� Focused Growth and Diversification of Service Mix
• Established 1908 by Sisters of Mercy
• The Assisted Living Tower was built in the 1960s
• Care Center built about 25 years ago
• Strong legacy of person-centered care, Eden Alternative, and premier palliative care program
Issues
• Inadequate Parking
• Pedestrian access on Foothill Blvd.
• Vehicle drop off on basement level
• Building to building transition issues, different levels
• Inadequate Memory Care layout
• No connection of Memory Care to garden
• No showers in Assisted Living or Memory Care
Criteria• State-of-the-art Memory Care
community with outdoor courtyard and rooftop garden
• Demolish existing Senior Center
• Develop new common spaces [chapel, multi-purpose room, wellness center, beauty salon, art studio courtyard]
• Relocate the entrance, drop-off and reception
• Update current amenities, reduce level changes, improve connections throughout the campus
• Renovate AL tower to provide larger, modern apartments with in-room showers
• Construct 5 new apts. and common area to replace the current Priest House accommodations
“Addressing specific areas of design criteria in community living settings allows people with dementia to be more themselves, leading to better relationships with staff and family, i.e. Person Centered Care”John Zeisel
� Engagement� Empowerment� Community
� Dignity� Deinstitutionalization� Safety through surveillance
Program
• All activity spaces relate to inner courtyard at corners
• Dining near services
• Keep wings for households on ground floor equal:15 and 15
• Keep wings on upper floor asymmetrical for variety of programs:12 and 8.
• All private rooms.
5 Concept Designs
• Major spaces on diagonal (1) and (2)
• Non rectilinear courtyard with circulation between service and dining (3)
• Clear Rectangle courtyard “mall” scheme, activity dining spaces not at the corners (4)
• Common spaces close to each other (5)ACTIVITY
UNITS
BACK OF HOUSE / OTHER
CIRCULATION
1 2
3 4
5
• Provide Activity Spaces in both corners
• Have Dining Room South-facing directly along courtyard with corridor at rear
• OK to not have service directly connected to dining
• Create visual draw at each corner
• Maintain CCRC connection between ALF and SNF
ACTIVITY
UNITS
BACK OF HOUSE / OTHER
CIRCULATION
1 2
3 4
5
• New Entry between ALF and MC
• Provide Activity Spaces in both corners
• Have dining room South-facing directly along courtyard with corridor at rear
• OK to not have service directly connected to dining
• Create visual draw at each corner
• Maintain CCRC connection between ALF and SNF
2nd Floor
1st Floor
� Address the person next to you as your partner
� One person ask the other their favorite vacation
�The other person waits 20 seconds before responding
Flexibility
• Sub-Households
12 Units
8 Units
10 Units
Flexibility
• Swing Dining Area
Various clusters of tables
Adaptability
• Activity Area can morph to accommodate a variety of uses.
Courtyard connection
Daylight
Lots of Storage
Supervision at corner
Supervision at corner
Destinations
Continual Discovery
Engaged wandering
Wayfinding
Neighborhoods
15 Units Each
Small Groups | Varied Levels
12 Units 8 Units
Connection to Outdoorsand Natural Light
Connection to Outdoorsand Natural Light
Dining Experience
Promote Personalization
• Unique Entryways
• Shelves for personalization
• Dutch Doors for Preview into room
• Space for Resident’s own furniture
Unit Design: Private Room
View toilet from bed
View out window
Major Objectives
• Designed specifically for advanced dementia patients
• Self-contained world
• Maintain resemblance to normal life
• Residents can move freely within the boundaries of the village
Major Objectives
• Organized around 23 apartments for 6-8 people
• Each apartment reflects a different genre
Era Experience
• Cars & Motorcycles
• Technology
• Social Gathering
• Gardening
Historical References
• Seniors can strongly relate to the 1950s and 60s
• Seattle as a growing metropolis percolating new ideas and technologies
� Programmed Reminiscence Therapy
� Life 24/7 inside 4 walls isn’t “normal”
[ The indoor/outdoor building provides normalcy to mitigate this condition ]
� Era Specific Details [ both subtle and detailed references ]
� Biophilia [ great “wow” hooks, therapeutic, visual and tactile experience ]
� Freedom of movement | Good circulation plan
� Plenty of natural light throughout the space
• 70-Unit Memory Care
• Shared Commons• Post Office
• Bistro
• “Restaurant”
• “Mercantile”
• Bowling
• Family Party Room/VFW Hall
• Beauty Salon
• Doctor’s Office
RestaurantGarden
Garden
Living Room
Living Room
Entry
Bistro
MercP. O.
Garden CenterFamily
RoomLibrary
Back of House
Garden
Garden
Garden Terrace
Wellness
Restaurant
Living Room
Living Room
VFWBowling
General Guidelines
• 1950s Inspired
• Connection to Nature and light
• Biophilia
Developing Transformative Environments that Therapeutically Enhance Memory
For copies of this presentation contact Leslie Moldow, Perkins Eastman L.Moldow@perkinseastman.com
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