Orange County, CA, January 1, 1998 — Silverado Senior Living and its new Alzheimer's community operate under a unique concept that allows residents to control and take responsibility for daily activities. As a result, residents are given a sense of "life purpose" that keep them interested and involved and leading happier, more fulfilled lives.
To stimulate cognitive and physical capabilities and to make each day a satisfying experience, the Escondido, California, facility provides individualized activities consistent with the normal routine and rhythms of others in the same age group. These include intergenerational programs and music, care of on-site pets and vegetable gardens, and the use of a country kitchen and workshop for hobbies. Residents are responsible, with the help of the staff, for feeding the pets, watering the plants and performing other daily activities.
Some programs, such as the morning session when residents review the day's news, have a set time. However, many activities, from light exercise to folding clothes or working in the hobby shop, are set at a pace and schedule that meets the individual's needs and desires on a day-to-day basis. Residents are also encouraged to help each other, as they often develop a better sense of confidence and improved self-esteem from assisting others.
Less Medication, No Restraints
"Many assisted living centers are not designed to deal with the significant behavioral and physical problems that often accompany Alzheimer's and other forms of dementia," says Loren Shook, president and chief executive officer. "We do not restrain residents, and we are working diligently with our residents' physicians and families to minimize the use of medications."
The staff are taught that by giving residents choices and meaningful activities to do, they can often distract the residents from feelings of frustration. By working with a resident in the garden or by helping a resident bake cookies, a staff member not only helps that person find something enjoyable to do but also creates an outlet for personal energy. This adds to the resident's quality of life, contributes to his or her happiness, and helps the individual control behavior.
Interactive gadgets distract AD residents from behavioral problems without necessitating drugs or restraints.
Since the community's opening in June 1997, Silverado's unique approach has already resulted in several success stories. One gentleman who came to the facility had not walked for several months after having hip surgery. At his previous facility, he had been fully restrained and placed on high dosages of psychotropic medications in order to control behavioral problems. He was never restrained at Silverado and was standing within two days of admission. Within a week, he was walking and psychotropic medications were reduced by half within a month.
"Our results are spectacular but the action is simple - when people are in a positive, caring environment where they find a sense of purpose and are expected to succeed, great things happen."
"Silverado expects progress from its residents and never gives up on anyone," says Stephen Winner, administrator. "Families bring loved ones who have not responded well to therapy or who have had severe behavioral problems at other facilities. Our results are spectacular but the action is simple-when people are in a positive, caring environment where they find a sense of purpose and are expected to succeed, great things happen."
"There is a myth that once an Alzheimer's patient reaches a certain point, you can't do anything with them," says Winner. "That's not true. These men and women just need extra encouragement and interaction. Otherwise they may sit alone in their rooms and become the forgotten people. You have to look; and when you do, you will see how much of this person is still left. You can continue to give them responsibility and purpose for their lives up until the very final stages of the disease."
Silverado accepts many people who are beyond the capacity of traditional assisted-living facilities and residents with walkers or wheelchairs are welcome. By providing 24-hour licensed nursing care, Silverado ensures that the health of residents is maximized and that they are allowed to age in place. With extra support and hospice assistance available, Shook expects that 90% of Silverado's residents will be able to live the remainder of their lives under the community's care. This is a relief to families who understand the trauma caused by moving a resident in the advanced stages of Alzheimer's disease.
Research and Innovation
Silverado's programs and residents benefit from the expertise of Dr. J. Edward Jackson, director of University of California at San Diego's Alzheimer's Disease Diagnostic and Treatment Center. The center offers the finest expertise and most updated information in the area of Alzheimer's care and treatment. Additionally, the university's dementia experts work in conjunction with Silverado's staff to establish clinical outcomes measurement. Silverado also works with Seniors Only Care, a program that provides comprehensive assessment and treatment plans administered by a team of highly skilled geriatric specialists. This thorough evaluation identifies current and potential problems and makes realistic recommendations for assistance and treatment.
Intergenerational programs and enclosed garden paths allow residents to continue leading meaningful lives.
Many of Silverado's programs and care techniques are highly innovative concepts in the care of people with Alzheimer's and other dementias. Others are simply common sense. The founders developed a set of core values to which the company is committed. Each of these elements provides a conducive, less confusing environment and more affordable alternative for the care of loved ones living with Alzheimer's or dementia.
Ten Core Values
1. Recognize value and build the human spirit in all we do. Silverado's staff is trained to deal with residents in positive, life-affirming ways. "Each person in our community has so much to offer, and so much of the true person is still there," says Winner. "Our job is to find that person, enjoy all they bring to our lives, and help make each day a full and meaningful experience for them."
2. Staff and residents are family. The barriers of the nurses' station have been torn down and replaced with a country kitchen. Not unlike a family's home, the kitchen serves as a gathering spot. The staff can sit down to complete and review paperwork or help a resident bake cookies. Residents roam freely through the kitchen, where they are welcome to pick up a piece of fruit or just sit and talk with the staff.
3. Residents respond to expectations. Every opportunity is taken to give the residents a sense of purpose. Former businessmen have even put on suits and sat around the table with pads of paper to brainstorm. By placing the residents in a familiar and productive setting, the center's experts have found that they can stimulate the thinking process. Activities such as these also return a sense of dignity, as the residents find themselves in a setting they regard as important.
4. Getting Alzheimer's (or any long-term disability) does not mean the end of living. Silverado uses plants, animals and hobbies to create useful interactive activities that provide life purpose. Without responsibility and a reason to get up each morning, anyone would lose interest and become despondent. These activities curb boredom and provide a sense of value to residents who have tasks they are expected to accomplish each day.
5. Retain and build family unity through understanding and positive action. A masterlevel social worker assists families in understanding and living with their loved one's condition. There are also physician-led support groups, educational seminars, respite care and opportunities to participate in resident care meetings. The center offers free meals to family members and private dining rooms in which to enjoy them. Family interaction is also encouraged through planned events such as the community barbecue.
6. Accommodate behavior as opposed to controlling it. The staff adapts to live with resident behavior, as opposed to trying to control behavior with medications or restraints. For instance, the center has interactive devices on the walls. Some devices allow residents to listen to a phone that plays music; others have beads inside, which flow through mazes when a giant wheel is turned. These capture residents' attention. If a resident is experiencing a behavior problem, a staff member can redirect the individual to the interactive device in order to distract them.
7. Provide the level of care we would expect for our own loved ones. Residents often behave in disorderly ways because they are unable to effectively communicate that they are experiencing some kind of pain or discomfort. Silverado has extra medical support that helps to rule out any physical problems that might be causing problem behavior. Director of Health Services Wendy Hull, RN, has five years' experience with Alzheimer's care and there is a licensed nurse on every shift. Few assisted living centers have licensed nurses on-site at all times or one with Hull's experience.
8. Freedom is a right that everyone deserves. Residents are given plenty of freedom to roam. A consistent trait among Alzheimer's residents is the need to move somewhat constantly. Every Silverado facility is a single-story building with open doors that can be accessed freely and convenient, well-landscaped walking paths. Extensive outdoor areas are rarely accessible in most assisted living or nursing facilities, which tend to be multi-story buildings.
9. Cognitive stimulation is essential. Staff work with residents to stimulate the memory process. Residents work with memory games, music and photo albums to help them stimulate memory as much as possible. Outside each resident's room is a memory box, which contains pictures of the resident at younger ages and mementos from the past. These boxes are of great assistance in helping residents remember which is their room and is another attempt to give them back a sense of control in their lives.
10. Little luxuries can mean a lot. Extra measures are made to make the residents more comfortable, such as providing a spa atmosphere in the showers and baths, including soothing music, aromas, plants and decor. Residents are encouraged to decorate their own rooms and bring in their own belongings. The residential feel of the community is enhanced by the gardens, patios, gazebo and walking paths. Indoors is equally inviting with a comfortable family room, living room, separate dining areas and the country kitchen.
11. Weight loss does not have to be an automatic result of Alzheimer's. In many facilities, weight loss is an ongoing problem. Because Alzheimer's patients are often restless, it is hard to get them to sit down and have a substantial meal. At Silverado, food is available at all times. Fruit, crackers and other snacks are always available in the country kitchen, which is also available for residents to cook their own meals, with staff assistance, if they prefer.
12. There is dignity in calculated risk. By creating a friendly atmosphere and maintaining a ratio of one caregiver per seven residents, Silverado can offer a sense of personal freedom. Although this involves inherent risks, it also adds unquestioned quality to the resident's lives. Unnecessary risks are never taken and the staff is constantly aware of what each resident is doing.
