New living arrangements for dementia patients

According to caregivers at Memory Care of Westover Hills, there is a night-and-day difference between the new facility and memory-care units of the past.

Linda Carrasco, executive director at the San Antonio-based facility, said that years ago, residents at assisted-living facilities diagnosed with Alzheimer's disease and dementia feared being sent to the memory-care unit. It had dingy, dark hallways filled with wanderers. It was “like being put into a different part of the building,” she said.

But that changed dramatically last October when Westover Hills opened its first facility, a 64-bed, 46,000-square-foot unit dedicated solely to residents with Alzheimer's and dementia. The facility is part of Memory Care America, an affiliate of Midland, Texas-based Trident Healthcare Properties and Georgetown, Texas-based Embree Healthcare Group.

The new Westover Hills facility deploys cutting-edge technology to assist residents. Sensor-driven lighted handrails lead residents from bed to bathroom, and back again. The lighted rails are meant to reduce late-night falls when residents use the bathroom. And in each residential apartment, sensor-driven lights by the window get brighter as the sun goes down, which prevents residents from sitting in the dark.

The rooms themselves are bright and cheery. The facility has separate activity rooms and dining areas where staffers at Westover Hills can focus solely on residents with memory-care needs. “If you're 100% memory-dedicated, families are confident your staff has been trained well,” Carrasco said.

Westover Hills was designed by Gould Turner Group, an architecture company that ranked 33rd in Modern Healthcare's 2016 survey of healthcare-engaged architectural firms. In fiscal 2015, Gould Turner reported just over $205 million in revenue from healthcare-related projects.

Residences designed specifically for memory care have received tremendous support from families, said Linda Marzialo, CEO at Gould Turner, because the special needs of that population are being met in a facility that is more like living at home than in an institution.

The design is central to the changed orientation. Facilities now include hallways that are easily navigated and easy access to outdoor spaces and common areas that promote social interaction.

Construction and design firms report an uptick in demand for dedicated, stand-alone memory-care facilities. The demand is expected to grow as the baby boom generation ages.

For the fourth quarter of 2015, the memory-care industry added 2,027 units, a 2.1% uptick in total units. And for fiscal 2015, the memory-care sector added 7,174 units, a 7.4% rise, according to the National Investment Center for Seniors Housing and Care, or NIC, a not-for-profit organization based in Annapolis, Md., that tracks the availability of senior housing and care. Currently, there are about 12,200 units under construction, according to the NIC.

With an estimated 5 million Americans suffering from Alzheimer's in 2015, and only 100,000 memory-care units across the country, there will be a growing demand for memory-care facilities, said Calvin Schnure, senior vice president of research and economic analysis at the National Association of Real Estate Investment Trusts in Washington, D.C.

The expansion of memory-care living facilities is part of the ongoing evolution of senior citizen residential care, which has seen rapid changes over the past few decades. Few people move directly into nursing homes anymore.

Rather, the first move these days for elderly Americans entering the last stages of life is usually into their own apartments within an assisted-living facility. Only later do they move into a skilled-nursing facility as their care needs expand. “Going from nothing to everything is rare,” Schnure said.

Memory care is the latest wrinkle in the earlier slice of the continuum. About 70% of memory-care units are add-ons to assisted-living facilities. Only about 30% are free-standing, according to the NIC.

There is some concern that tighter household budgets may undermine the expected demand for memory-care facilities. Millions of elderly parents suffering from memory loss live with adult children. Their financial situation is ultimately what determines a family's choices.

“Do they have enough financial means to move them into memory-care facilities, or will they scrape by and keep the parents at home?” Schnure said. Occupancy rates at memory-care facilities were at just under 87% as of the fourth quarter of 2015, according to NIC data.

Abe's Garden, a campus in Nashville, offers care exclusively to Alzheimer's and dementia patients. The 33,000-square-foot, $11 million facility was built by New York-based Skanska USA, the third-ranked construction management company on Modern Healthcare's 2016 Construction & Design Survey, with a dollar volume of $2.1 billion in fiscal 2015. Abe's Garden opened in the fall of 2015, with residents ranging in age from 54 to 105.

Abe's Garden has taken full advantage of evidence-based design, said Andrew Quirk, Skanska's senior vice president and national director of Skanska's Healthcare Center of Excellence. For example, since it is difficult for older adults to adjust to changes in lighting, the project team used screened-in porches and other transitional spaces to help eyesight adapt when moving from outside to indoors. The new building is now being looked at nationally as the leader in direct care to people with Alzheimer's, Quirk said.

The units are all under one roof, but broken up into three houses with different themes. One home is dedicated to nature, another to the arts and another to music and movement.

“With Alzheimer's, people are stuck at one point in their life,” Quirk said. “So when people live there, they can become engaged in activities that support where they are personally.”

The facility contains lots of windows for natural sunlight where residents can gaze out to the courtyard and garden. In the summer, residents may venture out to the garden and pick vegetables to be used in meals. Regular manicures and foot massages are included in Abe's Garden programming.

In the past, dementia-care facilities looked like hospitals, with long hallways and call lights outside of the rooms, said Ruth Givens, a lead care partner at Abe's Garden. The new aesthetic helps to create a more engaged environment for residents and their caregivers.

“When we come to work here, we enjoy what we do,” Givens said. “It's not just a job, we are in their home.”

Computer stations with Internet access have also been spread around the facility. Residents are able to send emails and watch movies on the computers, which have been simplified for use. Opening and closing icons can be difficult for memory-care patients, so home pages were created with words such as “mail” and “movies” in large letters. “Abe's is pretty advanced,” Quirk said. “But the next building might be 10 times more advanced.”

Even though there has been a burst in construction of facilities such as Abe's Garden and Memory Care of Westover Hills, analysts say a number of factors could constrain more rapid growth. While the number of people living with Alzheimer's is expected to increase, total demand will likely be driven more by growth in the elderly population than disease prevalence, said Kevin Tyler, a healthcare analyst at Green Street Advisors, based in Newport Beach, Calif.

Improved diet and lifestyles among aging baby boomers could reduce the proportion of the population that suffers from dementia, for instance. The hope remains that medical breakthroughs may one day reduce the incidence of the age-old affliction.

Evolving tastes in living arrangements, especially among well-off families, could also affect overall demand. Many may opt to pay for assisted care in their own or elderly parents' homes rather than send them to memory-care homes.

Historically, only about 10% of the over-80 population has occupied senior housing. Today, there are only enough memory care-dedicated units to serve 4% of Alzheimer's patients, so eventually that could expand to 10% of the over-80 population in memory care. But “it's hard to say what the right penetration rate of Alzheimer's patients is for memory-care facilities,” Tyler said.

On the other hand, the designs of the new facilities may attract a younger clientele earlier in the progression of the disease. The emergence of chronic traumatic encephalopathy, a degenerative brain disease caused by repeated concussions and discovered in former NFL players, is also being diagnosed in people in their 50s who played soccer and wrestled 30 years ago. The cases put the memory-care industry on the cusp of admitting younger patients, said Mike Gould, CEO of Memory Care America.

The percentage of younger patients will grow, Gould predicted, and stronger caregivers may have to be hired to help care for the influx.

“We would like to admit younger folks and be able to communicate with them while we can,” he said.