Special needs

Keeping residents across all stages of dementia engaged, satisfied and safe in their surroundings is a top priority for quality-focused senior living operators. This focus on resident engagement is essential given that half of all assisted living and skilled nursing residents have some degree of cognitive impairment.

Providing the most effective resident-centric memory care programs takes a sophisticated and multi-pronged approach that marries robust staff education and interdisciplinary collaboration with activities and technology-based applications that tap residents’ unique histories, interests and strengths.

“All residents, even those in end stages of cognitive decline, can become more engaged and fulfilled, and they deserve to live in communities that are committed to providing that,” notes Kathy Greene, the senior vice president of programs and services integration for Silverado.

Experts agree the efforts will pay big dividends by improving resident quality of life and giving operators a healthy competitive advantage by helping residents at even the most advanced stages of dementia age in place longer. Improved resident engagement also can help prevent elopement and falls triggered by agitation and confusion, as well as isolation and subsequent depression.

Despite growing awareness surrounding memory care programming, some operators still aren’t spending enough time each day to reach residents with dementia in meaningful ways, says Charles DeVilmorin, the CEO of Linked Senior.

“On average, residents get only 11 minutes of activity a day, and the people who need it most tend to get it the least,” he says.

Misconceptions surrounding dementia are often to blame. Because those with dementia often have shorter attention spans, some mistakenly assume a few minutes of activities is adequate when, in reality, it is possible to engage them longer with more creative, person-centric approaches. This underscores the need to keep targeted staff education at the core of memory care programming.

“Staff education needs to be ongoing and not just something that happens during an annual inservice,” says Kelly Carney, Ph.D., ABPP, CMC, the corporate director of memory care services at Acts Retirement Life Communities. Although some online training or traditional teaching approaches can be beneficial, especially when introducing employees to dementia basics, she stressed the value of more robust, hands-on training that lets staff apply what they learned.

Also essential is interdisciplinary collaboration that draws valuable insight about each resident from various members of the care team. This can be especially helpful for difficult-to-reach residents by allowing staff members to pool their knowledge in an effort to improve care and planning. A recreation coordinator, for example, can share important details about a resident’s history and current interests, and nursing aides can offer insights into a resident’s routines or any perceived changes, whereas a mental health provider can provide cognitive screening to determine resident strengths and deficits, Carney says.

“Our care philosophy is, no matter how advanced a person is with this condition, that person is still in there, and it’s our job to reach them in a meaningful way. It may be through a pet visit or another activity of particular interest to that resident,” Carney says. “The more information we have, the better we can meet those unique residents’ needs.”

Silverado communities also engage residents through high-touch, purpose-driven programming. Resident volunteer programs allow individuals in early and even more advanced stages of dementia to give back to their communities. Resident in earlier stages of dementia have volunteered offsite by feeding the homeless and serving the local Humane Society, for example, whereas those experiencing greater cognitive decline can volunteer for their onsite communities by making floral arrangements, baking cupcakes or sanding and staining signage for Silverado events, Greene says. Since Silverado began tracking volunteer hours six months ago, volunteers logged a combined 4,000 hours across 14 communities, and volunteers are being recognized and rewarded for their service.


Resident clubs also keep memory care residents engaged and enriched. Cooking, gardening and travel clubs are just a few that are available to residents, and themed clubs provide a positive sensory experience for residents with even end-stage dementia. The Good Fellas Club for men, for example, involves placing warm towels and shaving cream on men, and allowing them to smell cigars, while the seasonal Wedding Club might include flower petals, veils and residents’ own wedding photos to allow for sensory-based reminiscing. Residents with end-stage dementia who cannot verbalize their experiences still participate in the Travel Club at the sensory level. If Italy is the country of focus, residents can smell the simmering sauce, enjoy Italian music and even feel pasta between their fingers, Greene says.

Innovative, intuitive and flexible technologies can further promote resident engagement and enrichment, and some can help slow the progression of cognitive decline. Carefully selected solutions also can help caregivers stay better connected to their mission, which can increase employee satisfaction and reduce turnover – both of which can lead to more engaged and acclimated residents.

“Engagement technology is an innovative approach that provides older adults options that inspire autonomy, freedom from boredom, and opportunities for social integration and interactions,” says Juliet Kerlin, director of research and program partnerships for It’s Never 2 Late.

Person-based technology allows senior living residents with diverse backgrounds and personal histories to stay engaged by allowing activities and rehabilitation professionals to focus on their resident interests, needs and strengths while encouraging self expression, creativity and personal development, she adds.

“Residents undergoing cognitive decline often lack opportunities for success, which are essential in improving self esteem, enhancing confidence and reducing isolation,” Kerlin continues. “Engagement technology allows senior living professionals to improve resident quality of life and care by focusing on their remaining strengths instead of relying on the labels we have so often relied on in the past.” Equally important, it allows senior living professionals to embrace the belief that wellbeing encompasses all the dimensions of personhood – mind, body and spirit.

Technology also can help build deeper connections between caregivers, residents and family members, says Ted Teele, CEO of Touchtown Inc. “Imagine working with a family member to build a biography on the resident so a caregiver can bring up that information quickly on a tablet, computer or phone. The caregiver can then easily start conversations with the resident about their hobbies, interests or even where they went to school to bring up fond memories.” Touchtown Community Apps are customized application modules that help those in their communities stay engaged with services and programs. The apps can include brain fitness games that can be played on computers, smart phones or tablets and can help preserve cognitive ability, according to Teele.

Older technologies still can offer significant value — and without breaking the budget. Acts Retirement Life Communities still uses the Wii gaming system to enhance motor skills and let residents participate safely in formerly loved activities, such as bowling or tennis. The communities also have added iPods to their toolbox to deliver resident-specific playlists that already have proven successful with residents with dementia.

Sometimes, residents may appear disengaged and uninterested, when diminished hearing is to blame. To overcome this challenge, Silverado recently began renting senior-focused wireless headphone systems from Eversound to amplify sound to its residents.