What You Can Learn from an Award-Winning Alzheimer's Residential Facility
What should you look for in a residential facility when you are making the decision to place a loved one who has Alzheimer’s? The selection process is so important, not only due to the quality of care for your loved one, but also for your own peace of mind. And it is so easy to be swayed by a glossy brochure or nice landscaping which can lead to incorrectly basing a caregiving decision on appearances instead of the quality of care.
Recently while on a trip to New Mexico, I had the opportunity to visit with several staff members and family members from The Cottages of Albuquerque, which received a 2003 Quality Award “for commitment to quality improvement” from the American Health Care Association. I was interested in learning what made The Cottages special with the idea that these lessons might be helpful to this site’s readers when they are faced with making a placement decision for a loved one.
Please note that the cost for the type of care provided at The Cottages (which focuses on individualized care for patients with moderate to advanced levels of dementia, or mid-stage to late-stage Alzheimer’s) is not cheap. However, I think The Cottages’ approach to care as well as some of its programs can be replicated at other facilities, no matter what the price range. Additionally, The Cottages has moved from being an independently-owned facility in the early 2000s to being owned by a corporation. The two family members that I interviewed noted they saw a dip in quality of services right after the purchase, but both said the level of care has returned almost to the quality evident prior to the sale. I believe this is an important point for family members to note since I’ve heard about companies that have purchased residential facilities in which the level of services decreased and did not rebound.
So what lessons did I learn? Here’s what to look for:
- Home-like environment – The staff and the two family members noted that a special effort is made to ensure that The Cottages doesn’t feel (or smell) institutional. The facility’s physical layout features many windows and big corridors which are designed in a circular pattern so that residents can easily wander around. The rooms are described as being comfortable. The facility is well-maintained and the interior is updated periodically. Staff members are welcoming to all visitors.
- A welcoming process for the resident – New residents take part in a special welcoming ritual when they join The Cottages. A very experienced and highly skilled staff member, nicknamed the “Guardian Angel,” is assigned to the new resident for the first 24 hours. That staff member orients the new resident to other residents and staff members, determines the resident’s capability during meals, assesses vital signs/weight/height, and helps get clothing labeled and organized. Thus, the Guardian Angel is able to supplement information about the resident’s condition and preferences that family members don’t know or forget to share. Also, one of the family members noted that The Cottages is very careful in matching roommates so as to encourage camaraderie.
- A culture of respect - The staff members are indoctrinated into a culture that calls for treating each resident with dignity and respect. The goal of The Cottages’ care is to use redirection to get the behaviors that are wanted from residents, as opposed to using medicines or physical restraints. Staff members interact regularly with the residents and also try to maintain a calm atmosphere, especially in the community room. Residents, including those who are in Hospice care, are encouraged to remain out of their rooms so that they can interact and be stimulated.
- A culture of innovation – The staff members are continuously looking for ways to ease residents’ anxieties. For instance, water stimulation from showering causes many residents to become angry. The staff members take the approach that they aren’t asking residents to go into the shower. Instead, they take the residents to the shower and talk them through a process that makes the residents feel safe and secure. Snacks and toys, such as rubber ducks, are also perks for going into the shower.
- A focus on maintaining and training of staff members – The Cottages administrative staff told me that 75% of the facility’s employees are tenured and The Cottages rarely experiences turnover. Staff members receive five days of specific training in working with residents who have Alzheimer’s and other dementias. In addition, there are regular meetings and in-services. Staff members are taught to recognize and help with the special needs of each individual, as well as to use redirection as their primary approach.
- Engagement of the family - A family member noted that the staff members are always smiling and welcoming, but offer a level of honesty to the family members without being over-solicitous. Family members are welcomed to visit at any time. Activities are arranged to inform family members about caregiving and Alzheimer’s issues. Special events also are planned periodically. For instance, one of the family members I interviewed said The Cottages’ staff planned a surprise 50th wedding anniversary for her and her husband, who lived in The Cottages. Family members and friends were invited to the event, and the Hospice chaplain performed a wedding ceremony.
- A multitude of activities – The Cottages offers many activities daily and residents are encouraged to join in (and not remain in their rooms). The staff has found that residents will respond to activities that reach their various senses. For instance, a music session opened a window to a resident who went to The Julliard School. This resident no longer speaks, but responds to music.
These seven traits, I believe, distinguish The Cottages from other Alzheimer’s communities. However, these traits are all replicable and shouldn’t cost a fortune for other facilities to implement. Instead, I believe The Cottages’ approach has a lot to teach other Alzheimer’s facilities throughout the world and also gives caregivers a good list of what to look for when searching for a facility.