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Can You Design a One Stop Shop Assisted Living Building?

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Is it Possible to Design an Assisted Living Building to be a One Stop Shop?

The answer is yes, it is possible in theory, however the better question is, can a one stop shop design offer the best quality of life to most of the residents? I would venture to say no, because to design a community to fit your resident’s needs, you have a clear picture of who your resident will be, and design for their needs and preferences.

Who Lives in a One Stop Shop Design Building?

 

Many Assisted Living Communities attempt to be home, for a wide range of seniors, with a wide range of needs. This spectrum includes seniors with no to early mild dementia and no care needs, seniors that require ADL assistance ranging from standby to full assistance, as well as seniors in the late mild to late moderate dementia. Although these communities can market to a broader senior population, are all their residents getting the most of their community? Let’s break the spectrum into 4 groups of seniors and explore this further.

The Design Element of a One Stop Shop. Let’s Break It Down.

I am listing just a few of the preferences as well as needs, for each of the four groups, that a one stop shop building will need to accommodate.

Group 1 (independent senior that still drives some)

  • Large floor plans, full kitchens (this group has no care costs to incur now)
  • Multiple Dining Venues such as a bistro where you can get a sandwich (so they can come and go without missing a meal)
  • Flexible Dining Times
  • A Bar for Happy Hour
  • Computer Classes
  • Lots of Exercise Classes such as dancing and yoga, an Exercise Facility with exercise bikes
  • Lots of different community amenities throughout- completely fine with a multi-story building, if it means more amenities

Group 2 (needs stand by ADL assistance)

  • Less expensive smaller floor plans options (this group is incurring some care costs)
  • Transportation offered by the community
  • Exercise Classes such as chair exercises
  • Multiple Dining Venues
  • Amenities and Activities near their own living quarters

Group 3 (Seniors who need hands on ADL assistance)

  • Less expensive smaller floor plans options (this group incurring the most care costs)
  • Visiting medical professionals (limited mobility makes traveling difficult)
  • Amenities very near to living quarters, as well as mobile amenities that can come to them
  • Amenity areas they can use- this group can no longer enjoy an exercise bike, or a pool

Group 4 (Senior with late Mild-Moderate Dementia)

  • Smaller floor plans to minimize confusion. Also incurring care costs at this level
  • Set meal times in one place (we know structure is key to those with dementia)
  • This one dining area should be fairly close to living quarters to minimize confusion
  • Dementia friendly amenity areas such as a multi-purpose activity room (computer lab or a library are no longer an important amenity for many of these residents. Many of these residents are no longer able to drink so a bar is not important)
  • Visiting medical professionals
  • Smaller building design to lessen the confusion. (this group can no longer safely navigate a large building and find spread out amenity areas)

Is There Some Overlap with Needs and Preferences between Some of the Groups?

Although some of the needs and preference to overlap, there becomes a point that the preference of one group of seniors are the opposite of the preferences/needs of another group of seniors.  Group 1 wants active, spread out amenities, in and outside the community. They want to do these activities in amenity areas through out the building. Group 2’s preferences do somewhat overlap with group 1. However, when you get to group 3 and 4, you notice no overlapping, but on the contrary conflicting needs and preferences. Another area where needs and preferences come to a head for the 4 groups is dining. Group 1 wants flexible dining times and multiple venues. Group 2 may also use these, but when you get to group 3, who is not able to get to these venues without assistance that preference diminishes. In many cases group 3 needs assistance with dining, such as making sure their foods are cut up, salad dressing is open, so a grab and go bistro is no longer a needed amenity. When you get to group 4, you notice a conflicting need with groups 1 and 2.  Group 4 likes to eat at the same time, in the same place, with the same people for the most part. Also notice that the amenity preferences decrease as the care needs increase.  Group 1 are the most active seniors, who also have the most amenity preferences.

 

The Take Away..

There are many areas where design needs and preferences overlap for some groups. They overlap for groups with similar physical and cognitive deficits. Group 1 had some similar preferences as group 2, but very few if any of the same preferences of group 3 and 4. Also once you got to Group 3 and 4, some of the preferences turn into needs due to physical and cognitive deficits.

One building can be designed for a spectrum of needs, but when that spectrum gets too large, some group will be left out from enjoying the entire community. Although it is easier to lease up a building with a larger pool of prospects, it is very difficult to cost effectively design a space that meets such a large spectrum of needs. The design element of a one stop shop is difficult to manage, although this element is a piece of cake compared to the care and engagement piece. It is almost impossible to provide care and engagement in a one stop shop community, and to do it well for everyone.

Visit http://stage-osl.daveminotti.com/category/blog/ to view future posts about providing care and engage00001196852_awment in a one stop shop building.

The Need for Dementia Sensitive Primary Care

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What was the Inspiration behind this post?

Last week I had a doctor’s appointment with my primary care doctor. It was a 3 pm appointment.  Here it was almost 4 pm and I was just getting called. When my doctor saw me, she immediately apologized and told me the reason for the delay. She said that today many of her patients had dementia, and those appointments take longer than the other appointments, yet they are scheduled for the same amount of time. My doctor knows I work in senior living, so she felt comfortable telling me her feedback of her experience with dementia patients.  My Doctor told me that she spends a large part of the appointment counseling her dementia patients and their families. She also told me, the most frustrating part of her appointments with those with dementia, is explaining to them, that there is little she can do medically to alleviate the symptoms caused by dementia. She said many family members for instance notice their loved one with dementia has suddenly lost weight, and they want a prescription to combat that. She then has to give them the disappointing news that weight loss caused by dementia is a comprehensive symptom and can’t be fixed over night with a prescription. Needless to say, she was very excited to hear about Orchard’s Brand New 4 Tier Nutrition Therapy Program coming in 2018. For more information about Nutrition Therapy for Dementia please visit: http://stage-osl.daveminotti.com/final-stages-of-nutrition-therapy-development-for-dementia-residents/, as well as http://stage-osl.daveminotti.com/nutrition-therapy-at-each-level-of-dementia-care/

What Does Dementia Sensitive Primary Care Mean?

Dementia Sensitive Primary Care, are primary care services that are provided solely to individuals living with dementia. These services are provided by professionals that specialize in dementia, and in many cases only treat those with dementia. This type of care can be provided in a clinic or by a mobile service, by a medical professional ranging from a Nurse Practitioner to a Doctor. This clinic and or professional is designed to replace a person’s primary care provider that they had prior to the dementia.

What is an Example of Dementia Sensitive Primary Care Center?

The Integrated Memory Care Clinic, located in Atlanta, is a nationally-recognized patient-centered clinic that provides primary care for someone living with dementia. The clinic provides a variety of services to meet the challenging needs of those living with dementia. Whether the patient living with dementia has a cold, needs a vaccine, or has a change in behavior, the clinic can help. Dementia and other chronic conditions are managed exclusively by nurse practitioners who collaborate with geriatricians and neurologists on the team. The nurse practitioners have advanced training and specializations in dementia, geriatrics, and palliative care. A clinical social worker is also a vital member of the team. I personally know people that are patients at The Integrated Memory Care Clinic, and I know some of the professionals that manage it. I can say this clinic does an absolutely amazing job, and I would recommend it to anyone who is looking for Dementia Sensitive Primary Care.

Can Dementia Sensitive Primary Care be done outside of a clinic?

The answer is yes. I personally work with several medical groups that provide concierge dementia sensitive care in a person’s home. They can go to someone’s home or to their community. The group I work with closest has a team of professionals that provide the care. Their team is made up of a Geriatric Psychiatrist, a Nurse Practitioner and a Doctor trained in dementia care, as well as an Occupational and Speech Therapist. These professionals work as a team to define the patient’s cognitive, functional and behavioral profile, and create a care plan to manage their care. The extent to which each specific professional sees the patient depends on the patient’s needs and their profile. These services are offered in a person’s home, and at the Orchard, or another community.

Why do we need Dementia Sensitive Primary Care for those with Dementia?

Currently, 50-90% of all dementia gets misdiagnosed or gets missed all together until a crisis happens.  Even if Primary Care Professionals start to more accurately recognize dementia, the quality of management of the disease after the diagnosis is usually sub optimal. Even if a PCP can diagnose dementia, in many cases they do not have a plan for follow up management. After dementia is diagnosed, there needs to be a plan of care set up to address potentially starting dementia-specific drug treatment to slow the decline, assessment and management of Behavioral and Psychological Symptoms of Dementia (BPSD), safety issues in and out of the home, side effects of psychotropic drugs, as well as the stress of family care givers. Most Primary Care Professionals today are not equipped to provide follow up dementia care. These PCPs are missing the coordination of primary healthcare partners,7730d221ef4d4b91dffa4c2100dde11e--flowers-wallpaper-hd-wallpaper as well as the implementation of support for both people with dementia and their caregivers. Hopefully in the next few years, more Integrated Memory Care Clinics will spring up, and more people with dementia will receive the Dementia Sensitive Primary Care they need.

 

The Subtle Signs of Swallowing Problems for Those with Dementia and Other Diseases

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How does swallowing actually occur?

The oral phase of swallowing requires a complex interplay of chewing, food bolus formation, and push of the bolus to the back of the throat for the process of swallowing and movement to the esophagus and stomach. Multiple facial and oral muscles, such as the tongue, are responsible for this phase. Once the food bolus is to the back of the throat a series of muscular contractions occur to move the bolus into the esophagus and away from the airway. The airway is temporarily closed as the food bolus is pushed past the tracheal opening and into the esophagus. The food bolus then makes its way to the stomach through another series of coordinated muscular contractions within the esophagus.

Sounds Complicated Right? It is and lots can go wrong..

Due to the complexity of the swallow mechanism, a multitude of problems that can arise. The most common cause of oral dysphagia (swallowing trouble) is stroke, with up to 45 percent of stroke patients develop swallowing problems following the stroke. Other neurological diseases such as Parkinson’s disease, Multiple Sclerosis, Dementia, and Alzheimer’s disease are known to cause swallowing difficulties. Lesions, re flux conditions, and cancer have also caused swallowing troubles but to a lesser extent.

There are obvious and less obvious signs of swallowing difficulties…

Everyone knows that if a person coughs up food or gags while eating, they likely have swallowing troubles. However there are other more subtle signs that can go easily unnoticed such as long breaks between bites, being horse, drooling, frequent heartburn,  and acid re-flux.

What can happen if these subtle signs are ignored?

If subtle signs are ignored they can result in choking, where food partially or fully obstructs a person’s airway, aspiration or inhalation of food or liquids, oral secretions or gastric secretions into the airway and lungs. Also gastric secretions may be inhaled without bacteria causing aspiration pneumonia. A person may aspirate not only food or fluids that are introduced into the mouth but also their own saliva or any gastric secretions, which may be re-fluxed into the airway.

What can be done?

In a community setting, all care partners must be trained to carefully observe each resident for not blatant signs such as chocking, but for the subtle signs such as drooling, and long pauses and usually get confused for something other than swallowing challenges. When a person lives alone, the signs of swallowing trouble usually go ignored until they end up in the hospital. In many setting, little attention is paid to dining room observation. Orchard at Tucker understands the importance of monitoring these subtle symptoms and finding the problem while it is minor,Nutella-Stuffed-French-Toast-with-Strawberries and before it causes a resident irreversible harm.

Orchard Senior Living for the 2016 Tucker Small Business Excellence Award in the Retirement Homes

Orchard Senior Living selected for 2016 Tucker Small Business Excellence Award

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Tucker,GA – January 05, 2017 — Orchard Senior Living has been selected for the 2016 Tucker Small Business Excellence Award in the Retirement Homes classification by the Tucker Small Business Excellence Award Program.

Various sources of information were gathered and analyzed to choose the winners in each category. The 2016 Tucker Small Business Excellence Award Program focuses on quality, not quantity. Winners are determined based on the information gathered both internally by the Tucker Small Business Excellence Award Program and data provided by third parties.

About the Tucker Small Business Excellence Awards Program

The Tucker Small Business Excellence Awards recognizes outstanding small businesses that serve the Tucker area. Each year, our selection committee identifies businesses that we believe have achieved outstanding marketing success in their local community and business classification.

Recognition is given to those companies that have shown the ability to use their best practices and implemented programs to generate competitive advantages and long-term value. These are small businesses that enhance the positive image of small business through service to their customers and our community. These exceptional companies help make the Tucker area a vibrant and vital place to live.

The Tucker Small Business Excellence Awards was established to reward the best of small businesses in Tucker. Our organization works exclusively with local business owners, trade groups, professional associations and other business advertising and marketing groups. Our mission is to award the small business community’s contributions to the U.S. economy.

SOURCE: Tucker Small Business Excellence Award Program