Providers Magazine

SPECIALTY FACILITIES, April 18, 2002 — Loren Shook, chief executive officer (CEO) of Silverado Senior Living, a two-year-old assisted living company based in Aliso Viejo, Calif., grew up on the ground of a psychiatric hospital in Washington run by his uncle. “About half of the staff were my relatives,” he says, adding with a laugh “I always used to joke that the other half of my relatives were the patients.”

The hospital, which specialized in dementia care, was out in the country on 20 acres of land dotted with windmills and fishponds. Even back in the 1950-before the days of psychotropic medicines-it diverged from standard fare in some notable ways, allowing peacocks and pheasants the run of the grounds and including horseback riding as part of some residents’ therapy.

When Shook grew up, he went to work for the psychiatric hospital chain that had earlier purchased his uncle’s facility, ultimately rising to be CEO of the company. But a couple of years ago, the frustration of trying to provide quality care under stringent funding restrictions finally got to Shook, and after a period of intense research, he decided that not only could quality Alzheimer’s care be provided in the assisted living arena, but consumers were increasingly looking for homelike yet specialized facilities that could care for people with moderate to severe Alzheimer’s.

“This was back in 1996. Everybody was concentrating on [developing facilities for] traditional assisted living residents,” says Shook. “Some were providing beds for residents with Alzheimer’s disease, but nobody was targeting high-acuity dementia cases. That’s when I realized there was a high need for this level of care.”

With the help of two partners, Shook created Silverado Senior Living and designed it to incorporate plants, pets and children, the same way his uncle’s psychiatric hospital had when he was young.

But in addition to the homelike environment, Silverado’s Alzheimer’s care features health care that goes beyond monitoring and disease management to outcomes measurements. The philosophy of care is that Alzheimer’s residents can often regain some skills that have been lost to them if they’re given one-on-one personal encouragement with tasks like personal grooming or walking.

In two years that Silverado’s 80-bed Escondido facility has been open, psychotropic medications overall have been reduced by 75 percent. But even better, 36 residents who arrived unable to walk “can now walk, and 24 people who couldn’t fed themselves now can,” he says.

Assisted living facilities dedicated to resident with Alzheimer’s care are flourishing, and industry reports released by financial analysts suggest that the future outlook is good for such facilities, both because of the overall demographics and because people with Alzheimer’s, unlike many aging people who just need help with a few activities of daily living, really can’t live alone.

Such narrowly focused facilities can be wonderful for residents whose special needs might not receive such constant attention in more mixed facilities, says Kathleen Griffin, a consultant with Health Dimensions, Duluth, Minn. Residences are being built to cater to population with conditions such as diabetes, traumatic brain injury, post polio syndrome, multiple sclerosis, psychiatric disorders, and developmental disabilities, Griffin says. But because of high staffing costs associated with the high-acuity needs, these niche facilities tend to be difficult and expensive to operate, says Griffin.

Constellation Senior Services, Columbia, Md., has developed programs specifically designed for people with diabetes at its larger assisted living facilities. The company has regional medical directors and registered nurses on-site around the clock at those facilities. The program has been successful, both in terms of keeping those residents healthier than they would have been in other assisted living facilities and in terms of differentiating the Constellation facilities from their competitors.