Escondido, California, June 1, 1997 — A change in atmosphere at the Silverado Senior Living community made a big difference in the lives of residents with Alzheimer’s. When the Escondido, California, community’s institutional cafeteria was converted into several restaurant-style dining areas, residents who had been unable to feed themselves began eating independently and some significant behavioral problems disappeared.
When Silverado Senior Living acquired the facility outside San Diego in June 1997, it inherited a large traditional cafeteria. As part of overall renovations to the property, the company transformed the dining area, giving it a restaurant atmosphere. The ambitious redesign stemmed from the Silverado philosophy, which was envisioned and put into practice by the company’s president and CEO, Loren Shook.
Shook asserts that the environment for those living with Alzheimer’s disease must be designed to celebrate life and promote health and wellness-while enhancing functional abilities and encouraging social interaction with friends, family, staff and the community at large. To implement that philosophy, Silverado set out to create centers of activity that provide choices and promote independence and dignity for the residents.
The large cafeteria was divided into four individual spaces with separate and distinct themes, providing different dining experiences based on the wants and needs of the residents. Shook completed his vision of the dining room with the help of Evans, Harvey & Associates of Irvine, California, the design firm involved with the renovation of the entire property. Together they created the following themes:
A formal library dining room, complete with carpet, Chippendale dining armchairs and elegant chandeliers.
An informal garden terrace dining room with slate flooring, rattan dining chairs and antique brass chandeliers.
A 1950’s-style diner with chrome tables, diner-style chairs, a separate lunch counter and lighting that complements the theme.
An outdoor garden dining area. Creating this area involved demolishing part of the original service drive, relandscaping, installing ornamental wrought iron fencing, and providing outdoor dining tables and chairs complete with umbrellas.
The renovation produced more than just a change in aesthetics. Six people who needed to be fed by staff in the previous environment are now eating independently, and there have been striking transformations in the behavior of some of the residents.
“We believe the creation of less institutional environment creates a different level of expectation,” said Steve Winner, vice president of operations. “This familiar atmosphere prompts old habits. By combining this with the proper attention ad queuing, we have seen spectacular result. A resident who constantly screamed and threw food in the previous dining area totally stopped her antisocial behavior once the renovations were completed. She even requested to sit with other residents, apparently to be part of a social circle while dining. Something in this woman’s mind said, “This is a nice place, so act nice.””
It appears that for many of the residents, including the woman Winner mentioned, changes in atmosphere were the sole cause of improvements in behavior, ability or function. However, improvements have also resulted from Silverado’s personalized approach to care. For instance, instead of opting for the most obvious solution and feeding a woman unable to feed herself, the staff worked with the resident. They found that once the woman’s head was stabilized, she could eat independently. Now, a staff person is assigned simply to assist in holding her head steady.
“We have (also) found it beneficial to have the residents who were having trouble feeding themselves sit with higher functioning residents,” said Wendy S. Hull, R.N., director of health resource. “Based on the results of this program, it appears that sitting with independent eaters motivates those who might otherwise need assistance to feed themselves and provides them with the necessary prompting and modeling behavior.”
Even the higher-functioning residents have benefited from the new dining arrangements. Those who used to leave the cafeteria early now often choose to linger after their meal and enjoy a cup of coffee or tea. Plus, the atmosphere is more enjoyable for family and other visitors, who are encouraged to provide socialization for the residents, while the staff perform any necessary care giving functions. This allows for the kind of social interaction that Silverado believes helps residents maintain their memory, brain function and quality of life.
The new dining facility serves as an element of Silverado Senior Living’s overall approach, which is to design and use its facilities in a way that serves the needs of its residents and their families rather than design the facility around the need of the staff and vendors. Silverado Senior Living preserves dignity in the lives of those living with Alzheimer’s or dementia by allowing them to control and take responsibility for their everyday living activities.
Key Environmental Changes
MADE TO DINING AREAS AT SILVERADO SENIOR LIVING
Adding partitioning to create distinct dining areas allows for the separation of residents by their ability to function, which reduces distractions and provides a quieter dining experience.
Adding a 1950’s-style lunch counter to the dining room offers a comfortable, informal environment for those who prefer a more relaxed atmosphere.
Installing carpeting provides an overall warmth to the dining room and deadens sound.
Lighting the area with chandeliers instead of institutional fluorescent lights provides a much more social and dignified ambiance for the residents.
Making it possible for residents to sit at dining room chairs as opposed to wheelchairs or other assistance devices seems to improve their sense of well-being while dining. As an added benefit, helping residents to get in and out of their assistance devices for dining provides a natural form of exercise.
Converting the nursing station into a country kitchen gives residents free access to snacks 24 hours a day. They can select their own snacks from the refrigerator or fruit baskets. At times, residents who are over-stimulated or not feeling well can dine in this area.
