Orange County, CA, March 1, 1999 — In the early 1990s, when the assisted living concept was relatively new, it became obvious that a segment of the population was still being forgotten. Alzheimer's patients, particularly those in the advanced stages of the disease, had no environment truly designed to meet their needs. Nursing homes could care for their medical needs, but those with dementia have very specific social and behavioral management needs. The assisted living model offered an option, but facilities were being designed more to care for the frail elderly and those who needed daily assistance. Without 24-hour, licensed nursing care, assisted living residences couldn't meet the needs of those in the late stages of dementia.
I knew the industry could be serving those people better. I had a long history in the care industry, having served as president and COO of a worldwide company specializing in psychiatric centers. I grew up on the grounds of a family-run behavioral health facility with what I realize now was, at the time, a state-of-the-art dementia wing. But to design an improved concept in Alzheimer's care was going to take a team of the industry's best. Once I had the initial members of that team, all experts in their fields, we set forth to create Silverado Senior Living.
Before we developed the first Silverado community, the management team wrote out the company's core values and ideologies. We wanted our facility to recognize value and build the human spirit in all we do. Our residents needed to feel useful and important. We knew even those in the advanced stages of the disease could feel the thrill of daily accomplishments. It was our theory that if we could reestablish a sense of dignity and life-purpose within this population, we could reduce behavioral problems, cut back on psychotropic medications and improve physical and mental well-being in a restraint-free environment. We were right.
In June 1997, we purchased an under performing, 90-bed assisted living facility in Escondido, Calif. Within a year and a half, we have achieved solid, measurable results showing that our model works. Twenty-one residents who came to us unable to feed themselves now do so with minimal or no assistance. Thirty-one of those who arrived non-ambulatory are now walking. Some residents have even regained the ability to remain continent. Meanwhile, we have cut the use of most psychotropic medication in half, with one in four residents receiving none at all.
Our clinical outcomes are more impressive when you consider our population. We have become the last stop for many families whose loved ones are considered "problem" residents, the kinds of residents often hard to place because they are disruptive, combative, uncooperative or have special medical needs. At Silverado Senior Living, we call these "miracle residents" because, with the proper care, almost all see some improvement in their condition. More often, families are amazed at how much improvement is possible.
How have we done it? It is a combination of many factors. The facilities are uniquely developed for this population and decorated in a fashion more homelike than I've seen elsewhere. We even did away with the nurse's stations, which can seem fortress-like and pose as barriers to residents. Instead, we have medications hidden away in locked supply closets, and staff complete their paperwork in a country kitchen while still interacting with residents. This might be intrusive on our staff at times, but we want to create a family atmosphere, and family life inherently involves unpredictable interruptions.
We have walking trails specially designed with various textures to create the feeling of covering greater distances. There are attractive diversionary gadgets on the walls, pleasant furnishings and plenty of age-appropriate activities. Yet, none of this would mean anything if it were not for our staff - and we ask a great deal of our staff.
Silverado strives to re-teach its residents to perform daily tasks - for instance, we don't simply dress the residents; the activity of dressing is broken down into small, manageable parts that residents work to accomplish on their own. Non-ambulatory residents aren't wheeled up to the dining tables. With whatever assistance is required, the resident is walked from the wheelchair to the dining room chair, where he or she can sit with dignity. This creates extra work for the staff, but it is often literally the first step toward fully recovered mobility for the resident.
Not all staff understand the importance of this additional labor at first. We have to train them to rethink the way they perform their jobs. Soon, however, they begin to see the results. When you are working with a resident who is a grumpy, wheelchair-bound person, and you see him or her change into a person who walks the halls, interacting with the animals and staff, it is a life-altering experience.
Staff wages are set so they are within the top 25% for the local industry, and benefits are set within the top 10% or more. However, salary is not the reason we have a waiting list of people hoping to work at our facilities. Caregivers at every level await the chance to work for us because they have heard from their colleagues about the team-oriented, life affirming atmosphere we provide.
An important part of our staffing is the 24-hour licensed nursing care. This provides a heightened level of medical care not normally found in an assisted living environment. This, along with hospice beds, is one reason we expect approximately 95% of our residents to spend the rest of their lives with us. Residents aren't moved as the disease progresses, which is a great relief to families and lessens confusion.
The 24-hour nursing, our affiliation with researchers at the University of San Diego and the overall complete nature of our medical care provides an added benefit. Silverado has never been turned down by a long-term care insurance provider, which in itself indicates how different a concept this is from traditional assisted living.
The Silverado Senior Living approach has been a success in Escondido, proving we could find an economically viable way to provide a better level of Alzheimer's care. Now we are taking that same concept into other regions. We have six California communities in various stages of development, and we are looking at new locations.
All of this adds up, in our view, to an answer to question: "Is high-acuity Alzheimer's care compatible with assisted living? It most definitely is."
