Caregivers at Senior Star Wexford Place in Kansas City know that the only way to help residents with dementia/Alzheimers is with a hands-on approach.
The facility closed to the public on March 13 as a precautionary measure due to COVID-19. Only medically essential visitors are allowed in the facility so is not accepting new residents — for now. Re-admissions are being considered on a case-by-case basis.
The independent living unit has been there since the late 1980s. When the memory support unit opened five years ago Amber Alexandra, community relations, soon joined the staff so that she could get to work directly with the residents.
“We owned all this land and we weren’t sure what we were going to do with it,” Alexandra said. “We decided we were going to put in assisted living memory support for continuing care for residents because they wanted to stay in independent living. We have an overall philosophy that residents can stay in each level of care as long as it’s appropriate and safe.”
The memory support community differs from independent living since people who progress in their dementia are unable to process information in the same way and when everything is skewed through a dementia lens they sometimes interpret things differently. Even though care such as nursing services can be brought in for people with dementia living in independent living their environment needs to be changed and they need a place where they can be successful.
“Memory care offers a different environment from out in the world, it is designed to meet people where they are,” Alexandra said. “So the rooms are larger and they have small spaces within this larger space. As dementia progresses they become more me-focused and me-centered, so they navigate their environment more with their senses instead of just their ability to see what’s going on. So they’re using all their senses in order to try to figure out what they’re supposed to be doing. The environment helps set them up for success.”
At Senior Star Wexford Place the living room, dining room and kitchen are set up more like a home so that people can share these common areas. Their apartments are set up like bedrooms but residents are not isolated and are encouraged not to stay in their rooms all day.
“There are a lot of things that will give them clues like nice big windows to let them know that the sun is shining and it’s daytime,” Alexandra said. There are people around and caregivers that are out in the open so they know who to ask for help. Caregivers are listening all the time and they can also engage with different residents to find out if it’s lunch time.”
Staff devote time to residents
Amber Alexandra works in community relations at Senior Star Wexford Place.
“We’ve had residents that have owned their own restaurants and they get a tremendous amount of pleasure out of rolling our silverware here,” Alexandra said. “And they help sweep the floors. They might not do a great job at it but we still let them help and do things. They’re contributing in the kitchen and that’s what’s important. We have former nurses who help our nurses do their charts.”
Alexandra said she might not know everybody’s names but they all know she works there and she can help them. “One of the patients I saw today came up and said she hadn’t seen me in a long time – it had been about two weeks,” Alexandra said. But even if I had seen her this morning and she would have said she hadn’t seen me in a long time I would have said, ‘yes it’s so good to see you.’ But she knows that I’m here and if she needs anything I will get it for her.”
When residents come into the memory care environment it takes them three to four weeks to acclimate fully and staff begin immediately trying to build a trusting relationship. They also work with the residents’ family members to help with the transition so they don’t feel like staff is taking over.
“We kind of partner with them and learn the history of that resident so there are common things we can talk about,” Alexandra said. “If somebody’s been a fisherman all their life we know that, so we can say something about going fishing or we can say ‘If I go fishing should I use this kind of pole or that kind of pole.’ We can say something like ‘Bob I hear you like fishing,’ and then maybe he can tell us a story about when he went deep sea fishing or about the boat he used to have. Something that we can use to be able to start another conversation with him.”
If a resident is non-verbal there are sensory stimulators that help them interact such as pictures on the walls and photos in personalized memory books that staff can use to encourage them to reminisce. The memory support unit also uses personalized iPods filled with the favorite music playlists of residents.
“If somebody is a big-band person we get their playlist individually ready for them versus somebody who likes classical music who might not want to listen to big-band music,” Alexandra said. “When some of the non-verbal people listen to their playlist they even start singing. It strikes a chord with them and they are connecting to a familiar environment.”
Senior Star is the first senior living provider in the U.S. to partner with BikeAround, which provides technology in an innovative way to help seniors take a virtual ride using Google Street View with a stationary bicycle to pedal through any location in the world.
Residents can bike down the streets of their hometowns or places they have visited while they reminisce and talk about their experiences.
BikeAround also allows residents to explore places anywhere in the world they want to learn more about.
The cycling experience motivates residents at Senior Star to exercise.
Senior Star also assembles dementia sensory activity boxes, or coping boxes, which are given to residents and local hospitals and include adult coloring books, colored pencils, hand lotion, fidget spinner, spike ball, stress balloon, bubble kit, Buddha board and lavender sachet for stress reduction and sensory stimulation
“When people get sick and they have to go to an emergency room that really triggers a lot of anxiety and acting out and a lot of behavioral problems,” Alexandra said. “Families don’t understand what to do and they end up in a hospital setting where the staff is not trained to deal with dementia. They don’t know how to engage and slow down and help people to just look at the things that are right in front of them. So these boxes help them cope. Dementia isn’t just about a loss of memory, they lose the ability to have their attention focused on something for long periods of time.”
For people who suffer from dementia with an attention span of five or six minutes, sitting in an ER waiting room can be stressful and confusing and after a short time they want to leave. The boxes help them focus and they are more likely to wait to see a doctor.
“The spiky ball in the box is something they can roll around,” Alexandra said. “Sometimes they just like to touch things because of the feel of them. We can talk about the color, we can talk about the spikes and the person can focus on how it feels, and not have to focus on anything else in that moment, so they’re not focused on all the chaos around them in the emergency rooms.”
The boxes also help family members who have trouble interacting and finding things to do with residents. And a lot of times lack of interaction causes family members to stop coming to see their loved ones.
“We try to educate them and help them try to use things that we have to help build connections with their loved ones, even something as simple as the yarn that we have,” Alexandra said. “I talk to a mother and daughter and the mother used to be a knitter. They pick out the color of the yarn they are going to work with that day and then they make yarn balls. And while they’re doing that the daughter talks about her children and grandchildren, and she and her mom tell stories and sometimes they sing songs together while they’re making the yarn balls. So that gives them 30 to 45 minutes every time they see each other to interact. And even if the mom doesn’t hold on to those memories the daughter does.”
Since dementia changes from day to day family members often don’t know what to do if their loved one is having trouble talking and doesn’t remember things. Many times it’s harder on family members because they’re trying to interact with a loved one but the resident doesn’t remember who they are.
Since dementia is progressive Senior Star focuses on what they call the 7 areas of Wellness for their residents, which include spirituality, inner strength, expression, nourishment and health, exercise and movement, socialization and brain power.
“We all need them in our lives from the time we’re little people,” Alexandra said. “We have to give Alzheimer’s patients a sense of purpose. Someone that’s in a higher level of ability helping someone in a lower level of ability. We make sure to keep a mixture of people living close to each other of all abilities.”
Dementia is being looked at in a completely different way than it was in the past and Alexandra said in the last six to eight years there have been many innovations in the treatment of dementia, Parkinson’s and Alzheimer’s.
“People with dementia aren’t just put in a room anymore and expected to entertain themselves,” Alexandra said. “Dementia is being studied much more now - they have to because dementia is on the rise. And people are getting younger and younger that get it. People live in the memory care unit that are in their 60s. We partnered with the University of Kansas last year focusing on the Mediterranean diet and how that’s one of the best diets to help avoid Alzheimer’s.”
Senior Star Wexford Place is number four in the U.S for raising money for studies on dementia and Alzheimer’s.
The Alzheimer’s Association provides Senior Star with virtual dementia training for staff which provides short sessions that demonstrate first-hand what it’s like to have dementia.
“The training session lasts for eight minutes to know what it feels like to have dementia and gives us a way to emphasize with not being able to interpret information and understand things that are going on,” Alexandra said. “It doesn’t feel the way you think it’s going to feel. You feel like a failure when you’re finished. And you can’t be successful. So going through that and understanding what these people have to go through, it’s only eight minutes but it seems like forever and at the end you feel like that’s only been eight minutes of your life and you can’t imagine doing that for the rest of your life. It has to be exhausting. So you get a completely different perspective on how you engage with people that have dementia and you have more respect for them.”
Mild dementia progresses and for people who stay in their homes it can cause dangerous situations when they don’t have family and friends checking on them.
While dementia care continues to make great strides forward people still want to stay in their homes for as long as possible. But many people with dementia are unable to see how their quality of life at home has plummeted and are unable to make good decisions on what to do. Their families often don’t know how memory care could help them.
“They’re floundering behind closed doors,” Alexandra said. “Nobody knows what’s going on. They are not getting the medicines they need or food and nutrition. They’re on a downward slope. Based on the things they’re doing you would think that they need to be in a psychiatric ward.”
Once they’re stabilized with their medications and they’re having more appropriate behaviors in the memory support unit they can go from a 10 on a scale - being completely unable to care for themselves back to a 3 or 4 because of implementing the 7 Areas of Wellness in a secure environment that is not overwhelming. They can stay that way for years.
“To be able to fit into this big huge world and to be able to navigate it, we’re creating a world for our residents where they can be successful,” Alexandra said.