CREJ - Healthcare Properties - October 2017
What are the guiding principles of managing a successful program for individuals with memory loss? An individual with dementia always is a unique adult with unique life experiences. As each experiences steps and plateaus through the memory loss progression, they are best served by environments that access individual interests and abilities, that draw on the skills and talents of staff, volunteers and involved families. This focus can create a safe, adaptable and structured environment full of good physical and emotional care. This is possible! Here are four key factors to start with. • Key Factor 1: Avoid “secure unit isolation syndrome.” While memory care clients may need to reside in a secure unit, resist the tendency to separate this area in every way. Rather, make deliberate efforts to connect the residents to the outside world and the staff to the rest of the organization. Memory care units need volunteers and friendly visitors throughout the year, not just during the holidays. Make the unit a priority for budgeting entertainers and therapists, especially art and music providers. Create a welcoming feeling for volunteers and interns, with a short, straightforward training on how to interact, what to expect and ways to connect to reduce the fear and stress of being in this special area; then, don’t abandon them as they ease into contributing. Residents on the unit, when able, want to make contributions, volunteer and be part of the wider community. Consider walking programs in which residents accompanied by staff go out from the unit into the rest of the building or campus. While behavior is socially acceptable, allow memory care residents to attend the wider building events, or allow their families to bring them to the dining areas or other parts of the campus. Allow supervised flow and movement to help overcome the perceived barrier of the secure doors and help prevent “secure unit isolation syndrome.” • Key Factor 2: Secure units are not “out of sight, out of mind.” Secure units sometimes become dumping grounds for underperforming staff and for difficult residents, whose emotional or physical needs exceed the criteria. Do not assign to memory care a staff member who has poor emotional intelligence, lacks confidence and problem-solving skills or has questionable accountability or integrity. Rather, memory care units need your best staff, with the greatest savvy, imagination, humor, warmth, flexibility and compassion. Memory care staff need each other, a sense of team, and input from management to feel successful and to understand that what they are providing is highly needed and specialized. Nursing leadership, marketing staff and administrators need a strong presence, need to know people by name and need to take time to listen to the stories of what is going on in the space. These interactions help reduce stress, increase retention and help staff feel they are part of the company and mission. • Key Factor 3: It’s relentlessly about the details. Operating memory care requires excellence in detail management. These residents can no longer navigate many aspects of their daily lives. Their behaviors may make it more challenging, such as dismantling or hiding their belongings, or rummaging in other residents’ rooms. The manager and staff in this space must be the type of people who care doggedly about the details. For instance, where is Mr. Smith’s lost set of teeth? Why is Miss Ellen not drinking at meals? Who is banging on the doors at night and how can we redirect that? Managing the details requires that communication increase among all parties – with families, with staff and with departments that work in this area of the building. Informal communication needs to be as reliable as formal channels of communication. When you keep addressing the little stuff and immediately work to make it right, it helps prevent the bigger issues. Families who are paying top dollar for their loved one to live in memory care have concern whether the staff will take care of their vulnerable elder; they will not appreciate any of these details being ignored. This is a relentless issue in memory care. • Key Factor 4: Memory care often takes longer to fill. Intensive development has changed the landscape of memory care, with more facilities, increased competition and differentiation developed on facilities’ reputation for care. It is no longer realistic to expect a new memory care unit to fill within six or 12 months; this may actually require 18 to 24 months. Families have options that help keep someone home longer, for longer periods of time, such as adult day care, home care services and better education of caregivers. This can lead to new residents who are farther along in their progression, which heightens their care needs, makes it more difficult for them to integrate and ultimately results in their stays being shorter. By allowing a slower rent-up of a new memory care facility, you avoid creating defeat from the starting gate. You allow residents to move in and integrate more fully with staff and each other. Programming develops based on who lives in the space, and staff can get more seasoned and build a culture in a more systematic, calm way. Families will feel this and make decisions to move in. In turn, word-of-mouth will spread about the building’s competencies and your capacity to care for residents, moving the census in the right direction without desperation. Memory care can feel light, warm and special, or can feel really depressing, dark and alienating. Use these key factors to assess your programs and operations to help move them in the right direction.