Alzheimer’s / Memory Care Facilities
In 1906 Dr. Alois Alzheimer, noticing cell shrinkage in the brain of a woman who had endured the frightful aspects of memory loss — anger, paranoia, occasional violence and loss of personal identity — referred to his discovery as “this peculiar disease.” More than 100 years later that affliction, known the world over as Alzheimer’s Disease, is big business.
Along the Front Range and across Colorado, developers and operators are busy constructing new memory-care facilities, adding many units to the state’s supply of “secured” units for those with Alzheimer’s or advanced dementia. In a secured memory-care setting, residents are locked in, limited to their living quarters, common areas such as dining and living rooms and access to an enclosed exterior patio and yard.
Money, or more specifically, profit, is the primary motivation for the increase in Alzheimer’s/Memory Care secured units. The average rent for unsecured assisted living units in the Denver metro area is about $4,000 per month, but the average monthly cost for a secured unit is often thousands of dollars more. With the exception of payroll, all other operating costs of secured and unsecured facilities are comparable.
Based on a 2010 tabulation, there were 17,044 assisted living beds in Colorado, of which 2183 were secured assisted living beds. Three years later, there are 18,516 beds, of which 2,756 are secured. Currently, there are 17 new assisted living facility applications pending. Licensed beds for those 17 assisted living residences total 540. Of those 540, 181 secured beds have been requested.
This rapid growth is concerning. As a developer, I have an obvious concern with overbuilding. When supply exceeds demand, all struggle to maintain a strong enough census to ensure profitability. In addition, I wonder if all of the new units will even be needed down the road. Today we are witnessing aggressive research in the causes of Alzheimer’s along with the development of promising new drugs, so there is reason to be optimistic that Alzheimer’s will become much more manageable before too long. Take for example a recent study by the University of South Florida focusing on the signaling protein released by rheumatoid arthritis that dramatically reduces Alzheimer’s disease pathology. Researchers found that the protein GM-CSF likely stimulates the body’s natural scavenger cells to combat Alzheimer’s amyloid deposits in the brain. GM-CSF is also known as Leukine. Leukine is already approved by the FDA as safe, having been successfully used to treat cancer patients by boosting their immunity.
We all should also be concerned about ensuring quality of care for memory-care residents as well as quality of life, which deteriorates as the disease progresses. At the same time, the challenges for caregivers and family increase. Alzheimer’s professionals identify three basic stages: early, middle and late. Each brings special challenges for caregivers and family members. In the early stages of Alzheimer’s, a person may function quite independently. He or she may still live in their home, drive, work and take part in social activities. At some point behavorial issues will crop up. Aggression and anger, hallucinations, anxiety and agitation, depression, memory loss and confusion, obsessive compulsive behaviors, suspicions and delusions, wandering away from home, and physical and verbal abuse are all possible behaviors that must be managed. Events or changes in a person’s surroundings often play a role in triggering behavioral symptoms.
Change can be stressful for anyone, and change is especially difficult for a person with Alzheimer’s disease. In my experience, normal elderly individuals can take weeks and even months to adapt to a new environment. For an Alzheimer’s person, this adaptation is much more difficult and can take considerably longer as they try to make sense out of an increasingly confusing world. Situations that could trigger negative behaviors include moving to a new residence or nursing home, changes in caregiver arrangements, or simply being asked to bathe or change clothes. Identifying what has triggered a behavior can often help in selecting the best approach to deal with it.
People with late-stage Alzheimer’s are the primary target clients for Colorado’s new wave of secured units. The late-stage patient usually has difficulty eating and swallowing, has greater difficulty walking, needs full-time help with personal hygiene, is more vulnerable to infections, especially pneumonia, and often loses the ability to communicate with words.
The federal government and the Colorado Department of Public Health and Environment, recognizing the additional caregiving challenges of Alzheimer’s, established a higher Staff-to-Resident ratio for licensed facilities — 1:6 as opposed to 1:10 — for memory-care facilities. This is helpful, but I think it falls short what is required for truly top-notch care. I strongly support special training for secured-unit staff. I would like to see more memory-care employees with behavioral sciences degrees in fields like psychology, cognitive science, psychobiology, neural networks, social cognition, social psychology, semantic networks, ethology and social neuroscience. The insights that better trained employees can offer will help maintain a therapeutic environment for all the residents in a secured unit, and this favorable environment, in turn, will help prevent problems and avoid the sad, avoidable episodes of elder abuse that periodically grab headlines and damage the reputation of all elder-care facilities, which, of course, leads to more regulations and more cost.
We are blessed to have an excellent Alzheimer’s Association chapter in Colorado. It can be found on the web at: http://www.alz.org/co. If you need specific information on a particular facility, don’t forget to check in with the Ombudsman for that facility.
Robin Avery is a Gerontologist, Consultant, Developer and Operator of assisted living communities, with a Masters Degree from The Naropa University. He can be reached at ravy2003 @ msn.com.