Developing a Memory Care, Senior Living University. All rights reserved. Reproduction or translation of any part of this work, by whatever means, beyond that permitted by Section 107 or 108 of the United States Copyright Act without permission of the copyright owners is unlawful. Inquiries regarding permission for use of material contained in this publication should be addressed to: Senior Living University, 830 Cherry Drive, Hershey, PA 17033
Acknowledgments Thanks and acknowledgment for contributions to this publication are offered to the following: William Keane, MS, MBA, Co-author Deb Price, RNC, MSN, CS, Co-author Joan Hyde, Ph.D., Senior Editor John Zeisel, Ph.D., Senior Editor Diane Byrne, MS, Subject Matter Expert Carol Edelstein, Subject Matter Expert Delores Moyer, Subject Matter Expert Lin Noyes, RN, MSN, Subject Matter Expert Julie Thomas, RNC, BA, Subject Matter Expert Karen Wayne, Contributor David D. Peete, Contributor David M. Goldberg, Contributor iii
Table of Contents Introduction: About This Book 1 Who This WorkBook Is for 3 The Language of Assisted Living 4 The Assumptions of the WorkBook 4 How to Use This WorkBook 8 Phase Elements 10 Intended Outcomes 10 Key Information 10 Key Words 10 Are You Ready to Move on? 10 Phase One: So Why Do You Want to Get Into This Business? Pre-Planning Phase 11 Intended Outcomes 12 Key Information 12 Are You Ready to Move on? 14 Phase Two: If You Are Still With Us, Let s Get Started With Building the Foundation Basic/Background Research 15 Intended Outcomes 16 What Happens as We Age? 17 Factors That Influence How We Age 19 Healthy Aging Is Normal 20 Let s Take a Closer Look at Older Adults 20 Looking at Age in Other Ways 21 Normal Physical Aging 22 What About Other Changes That Occur in Aging? 26 What Do We Mean by Ageism? 29 Developing a Memory Care v 1.0 v
What Is Delirium? 29 What Is Depression? 30 What Is Dementia? 30 How Does Dementia Affect a Person? 32 Pseudo-Dementia 33 Irreversible Dementia 34 What Is Alzheimer s Disease? 37 Causes of Alzheimer s Disease 37 Who Develops Alzheimer s Disease? 38 At What Age Does Alzheimer s Disease Develop? 38 How Does Alzheimer s Disease Affect a Person? 39 How Is a Person Diagnosed with Alzheimer s/dementia? 39 Diagnosis of Alzheimer s Disease 40 Can Alzheimer s Disease Be Cured? 40 Designing for Disease Effects and Progression 41 Understanding Alzheimer s Disease Progression in Stages 42 What Services Are Available for People With Alzheimer s/dementia? 47 What Is the Role of Assisted Living in Dementia-Capable Care? 50 Specialized Dementia-Capable Care in Assisted Living 53 What Services Are Available for People with Dementia and Their Families? 55 Key Words 57 Are You Ready to Move on? 58 Phase Three: How Do You Know If There Is An Assisted Living Opportunity in Your Market? Market Research 61 vi Intended Outcomes 62 Key Information 62 Task 1 Getting Started 63 Task 2 Forming the Leadership Team 67 Creating a Work Plan From Your Personal Mission Statement 69 What About Using Consultants on the Project? 70 Task 3 Consumer Market Profile 72 Task 4 Consumer Market Analysis 76 Define Resident Characteristics/Qualitative Issues 77 Task 5 Regulatory Analysis 83 State Certificate of Need Process 84 State Licensure Process 85 State Regulatory Process 85 Local Licensure Process 88 Local Regulatory Process 88 Federal Regulatory/Oversight Trends 89 Industry Oversight and Accreditation Trends 89 Task 6 Comprehensive Site Option Assessment 90
Task 7 Comprehensive Service Inventory 94 Task 8 Competitive Assessment 95 Task 9 Payment/Managed Care Analysis 99 Task 10 Market Demand Scenarios and Critical Success Factors for My 102 Are You Ready to Move on? 107 Key Words 110 Phase Four: Now that You Know Your Market, You Are Ready To Define Your and Mission Statement! Key Elements of Definition 111 Intended Outcomes 112 Key Information 112 Your Location 113 Who Will You Serve? 114 What Are the State and Local Licensing Regulations? 115 What Is Aging-in-Place? 116 Full Disclosure of Dementia-Capable Services 116 What Is Negotiated Risk? 120 Negotiated Risk Questions to Answer 122 Your Dementia-Capable Team 123 Dementia-Capable Education and Training for Your Team 124 Your Philosophy of Dementia Care and Service 124 What Is a Mission Statement? 125 Developing a Mission Statement 126 How Can You Revive Your Existing Mission Statement for Dementia-Capable Care? 127 Rights and Responsibilities of Dementia-Capable Care 129 Resident Rights 129 Are Rights for Residents With Alzheimer s/dementia Different? 130 Family Rights and Responsibilities 131 The Rights of the Dementia Care Staff 132 Measuring the Success of the Dementia-Capable 133 How Does Assessment Lead to Continuous Quality Improvement? 136 Daily Evaluation of the 136 Key Words 139 Are You Ready to Move on? 140 Developing a Memory Care v 1.0 vii
Phase Five: Building Leadership and the Dementia-Capable Team Recruiting, Hiring, and Staffing the 141 Intended Outcomes 142 The Role of the Dementia Team Leader 143 Qualities to Look for in the Leader 143 The Leader Must Be Commited to the Dementia-Capable 144 How Do You Define Leadership? 144 How Does the Leader Inspire a Shared Mission? 145 How Does the Leader Foster Team Spirit? 145 How Can You Encourage Individual and Team Accomplishments? 146 What Is Modeling in This Context? 148 How to Model Choice 148 How to Model Dignity 149 How to Model Individuality 149 The Management Team 150 Should Your Have a Medical Director? 153 The Role of the Resident s Primary Care Physician 154 What Qualities Should You Look for in the Management Team? 154 The Dementia-Capable Resident Assistant or Caregiver 155 The Dementia-Capable Caregiver s Approach 155 Caregivers Approach Each Resident as an Individual 156 Caregivers Should Help Plan Resident Care 157 Who Fills Other Key Support Positions? 158 Developing Dementia-Capability With Existing Staff 159 Effective Recruitment Strategies for Your Dementia Care 160 How Should You Educate the Team and Build Their Dementia-Capable Skills? 162 Successful Staff Development Techniques 163 Guest Speakers 164 The Role of Orientation for Dementia-Capable Team Members 165 What About Ongoing Education for the Team? 165 What Training Resources Exist for the Dementia-Capable? 167 How Can You Retain the Dementia-Capable Team? 168 How Can You Ensure Team Satisfaction? 169 Team Building in Dementia-Capable s 169 Performance Evaluations 170 Key Words 172 Are You Ready to Move on? 173 viii
Phase Six: Designing The Essential Components 175 Intended Outcomes 176 Family Involvement From Pre-Admission on 176 Touring the Residence Before Move-In 178 Full Disclosure of and Services 180 What About the Resident Who Has No Family? 180 Pre-Admission Resident Needs Assessment 181 What Does a Needs Assessment Include? 181 The Family Interview 182 What About Move-In Day? 184 On Move-In Day 185 What Happens After Move-In Day? 185 The Needs Assessment Builds the Individualized Service Plan 186 How Does the Individualized Service Plan Help You? 187 Planning Resident Care The ISP Meetings 189 Continuous Care Planning to Meet Residents Changing Needs 190 What About a Resident Who Has Coexisting Illnesses? 190 Assistive Devices Common to Assisted Living 196 What Should I Know About a Resident s Changing Condition? 198 How Do I Critically Observe Residents? 198 What to Observe 198 Health Care and Wellness in Your Dementia-Capable 200 How Do You Meet Residents Nutritional Needs? 200 What About Medication Management? 203 Medications That Slow the Progression of Alzheimer s/dementia 205 What Are Psychotropic Medications? 207 The Life Enrichment for Dementia Care 208 Helping a Resident and Her Family Plan for the End of Life 214 Community Challenges for the Dementia Care Team 215 What Triggers Challenging Behavior? 217 Safety and Security Issues for Your Dementia 220 Wandering 221 What About Resident Transfers and Discharges? 222 Evaluating Continuing Care 222 Transfer and Discharge Timeline 224 Key Words 225 Are You Ready to Move on? 226 Developing a Memory Care v 1.0 ix
Phase Seven: Enhancing Your Through a Creative Environment Physical Environment/Design 227 Intended Outcomes 228 Design Considerations for New Construction 228 The Physical Environment for Dementia-Capable 231 Recreating the Resident s Home 234 How Does the Dementia Care Mirror the Traditional Home Setting? 235 Maintaining Dignity Through Physical Design 236 Offering Resident Choice Through Design 237 Should You Build Private Bedrooms or Shared? 238 Promoting Individuality Through Design 239 Enhancing Independence Through Physical Design 240 More About Using Outdoor Space 242 Additional Design Considerations for New Construction 242 Retrofitting Your Existing Assisted Living Residence 244 Adding a Specialized Dementia Care to Assisted Living 245 Retrofitting an Institutional Facility 246 Key Words 248 Are You Ready to Move on? 249 Phase Eight: The Role of Your for the Family and the Greater Community Family and Community 251 x Intended Outcomes 252 How Are Families Your Partners in Care? 254 Families Views of Quality Care 254 Families as Customers 255 The Needs of Families 256 The Assisted Living Decision Process for Families 257 Nurturing the Family-Staff Relationship 259 How Do You Involve the Family in Your? 261 The Changing Role of Family Caregivers 261 How Do You Help Families Stay Involved? 262 Family Support Groups 263 The Family Council 265 What Are Family Activity Clubs? 265 Fostering Family Communication 266 What Is a Memory Book? 267 What About Personal Notes From Family Members? 267 What Is a Family-Friendly Assessment Tool? 268 The Role of Your in the Greater Community 271
How Do You Develop a Dynamic Volunteer? 272 Who Is Responsible for the Volunteer? 273 What Qualities Do Your Volunteers Need? 274 What About Children as Volunteers? 275 Types of Intergenerational s 276 What About Volunteer Pet s? 277 The Contributions Volunteers Give to Your 278 Key Words 279 Are You Ready to Move on? 280 Phase Nine: Now That You Know Your Stuff, How Do You Build and Finance Your Dementia-Capable? 281 Intended Outcomes 282 Key Information 282 How Do Ownership and Governance Influence Your? 283 Who Owns Your Organization? 284 The Organizational Structure of Your Residence 285 The Business as a Whole 285 The Responsibilities of the Governing Board 286 The Role of Ownership and Management 287 Communicating Your to Financial Partners 289 How Do Lenders and Investors Evaluate Your Strengths? 289 Organizing Your Team 290 The Assisted Living Business Plan 291 Market Studies and Appraisals 292 Financial Forecasting 293 More About the Assisted Living Regulatory Environment 293 What About Special Permits and Zoning for Assisted Living? 294 Defusing Community Opposition to Your Dementia Care 295 Financing Options 296 Choosing Financing Based on Your Mission 298 What About Refinancing Nonprofit Organizations? 300 Your Financial Strategy Preparing Your Presentation 301 Why Do Some Projects Fail? 303 Key Words 304 Are You Ready to Move on? 305 Developing a Memory Care v 1.0 xi
Phase Ten: Building an Effective Marketing and Communications Plan 307 Intended Outcomes 308 Key Information 310 Product Definition/Strategies/Goals 310 External Environmental Summary 313 Internal Environmental Summary 315 Competitive Summary 317 Alzheimer s/dementia Critical Success Factors 319 Target Market Summary 321 Marketing Action Steps 325 Action Step Options 326 Marketing Action Plan 327 Summary 329 The Next Generation: Ongoing Research and Evaluation 330 Researching Aging and the Causes of Alzheimer s/dementia 330 Links to Alzheimer s in Normal Development and Aging 330 Genetic Links to Alzheimer s Disease 332 Better Methods of Diagnosing Alzheimer s Disease 332 Brain Scanning 333 Psychological Assessments 333 Improved Medical and Behavioral Treatments 334 Advances in Behavioral Approaches: Dementia-Capable Assisted Living 335 Seeking the Best in Behavioral Approaches 336 Trends in Dementia-Capable Assisted Living 336 Trends in Environmental Design 337 Customer Satisfaction and Resident Outcomes 337 Trends in Staff Education, Training, and Ratios 338 Managed Care s Impact on Dementia-Capable Care 338 Regulation and Accreditation of Dementia-Capable Assisted Living 358 The Ongoing Dynamic of Dementia-Capable Care 339 xii
Appendices Glossary A: Glossary 341 Glossary B: Bibliography 351 Glossary C: Contributors 353 Developing a Memory Care v 1.0 xiii