Select elder care facilities around the world are developing innovative memory care buildings, which can also be referred to as “neighborhoods.” In a recent article in The New Yorker, journalist Larissa MacFarquhar paints a picture of one such facility just outside of Cleveland, Ohio. Residents have traditional apartments that feature a space in the hallway resembling a front porch. The common spaces are like main streets with storefronts and include items that are designed to resonate with the upbringings of most of its residents. MacFarquhar also profiles a memory care model in Amsterdam, Netherlands set on a campus of buildings to include additional aspects of a real neighborhood such as a theatre and a grocery store.
MacFarquhar reflects on the feelings the facility elicits. “While the central area didn’t feel like outdoors, exactly, it didn’t feel like a room, either—it was halfway between the two, at once enclosed and public. People who spent time there found themselves referring to the hallways as streets, and the suites as houses. And although the unit was conceived as a kind of nostalgic stage set, a harkening back to an America of eighty or ninety years ago.” Fantasies are created in part to offer a soothing environment to individuals living with agitation, confusion, and moments of lucidity dependent on the stage of their disease.
Another critical goal of facility care is to allow caregivers a break or respite from their duties while allowing them to retain some aspects of their personal relationships with their loved ones. One caregiver stated that prior to her husband transitioning to a memory care facility, the majority of her time was focused on ensuring his safety. “By the time where I can sit down on the couch and hold his hand, I’m so completely drained mentally and physically that I can’t even go through a photo album with him. I’m hoping now I can hold his hand and go for a walk and just have that husband-wife relationship. We still have it; it’s just that we haven’t been able to really experience it in a long time.”
The creation of streetscapes within memory care facilities have also been accompanied by other innovations that aim to have a comforting impact on residents’ senses. Lighting can replicate the evening sky, and orient residents to the time of day even while spending most of their time indoors. A simulated beach can be created with devices such as wave sounds and heat lamps.
MacFarquahr changes gears in her piece to next question the overall philosophies of facility care: is the fabrication of an environment with the intention of nostalgia truly a best practice in memory care? MacFarquhar explores the history of dementia care and the lack of consensus on the best practices. Historically, questionable practices such as the use of physical restraints and tranquilizer medications were used for dementia patients. Federal law passed in 1987 limited the use of physical restraints. More recently, Simulated Presence Therapy to include prerecorded audio recordings to simulate one side of a phone conversation from a loved one has been shown in some patients to be more calming than the use of tranquilizers. MacFarquhar further explores the debate over best practices in dementia care by posing a series of thought-provoking questions. “If a woman asks for her husband, having forgotten that he is dead, should you tell her the truth and cause her terrible grief, knowing that this fresh bereavement will likely repeat itself, over and over, day after day? Or should you just tell her that he is at the office? And is direct lying different from various forms of passive lying—encouraging delusions, or allowing existing delusions to persist? What is more important—dignity or happiness?”
Schools of thought noted in this article include reality-orientation, validation therapy, as well as the conflicting theories of Penny Garner and Graham Stokes. While Garner believed in improvisational conversations with patients and always refraining from questioning them, Stokes felt that passive lying was an unethical approach which would lead to increased confusion. Important consideration should also be given to facility staff training and continuity in their communication with residents to break down instances of heightened confusion and distress.
The article concludes with a short profile of one international theory of residential memory care. De Hogeweyk, a nursing home focused on dementia care, is located just outside of Amsterdam, Netherlands. Unlike the Ohio facility with a single building, De Hogeweyk is comprised of a 3.5 acre campus of multiple 2-story buildings. Aides accompany residents to a grocery store on campus. Residents have individual, small homes decorated and designed to replicate lifestyles that they have had in their past prior to their diagnoses.
To read the complete article in The New Yorker, titled “The Comforting Fictions of Dementia Care,” visit https://www.newyorker.com/magazine/2018/10/08/the-comforting-fictions-of-dementia-care.
At Weatherby & Associates, PC, our life care planning model includes a comprehensive geriatric assessment and ongoing care management from a social work professional. We partner with families to advise around home environment options for their loved ones living with dementia. We work to get to know your goals and to educate you on the local care options available. To learn more about our life care planning law firm, contact our office at (860) 769-6938.
