When the Washington County Health Center planned to expand its secure memory unit two decades ago, designers were given a difficult task: How do you create a “home-like” atmosphere that caters to the needs of people with dementia but also keeps them safe?
They responded with an open concept floor plan for walking, activity pods for daily events and games, long sight lines to help the staff keep an eye on residents and large skylights that allow bright sunshine into the sprawling unit.
Every facet of the Washington County Health Center's One West memory unit built in 1999 is designed to improve the lives of the 38 people who reside there.
“A person with dementia often has trouble making sense of the world around them because of the disease,” said Clay Jacobs of the Alzheimer's Association Greater Pennsylvania Chapter. “It's so important to maximize their abilities and promote their safety. You want people to have freedom, but also monitor safety.”
And that's exactly what Judy Keron wanted for her husband, Rudy, when she moved him to the health center in 2012, about five years after he was diagnosed with Alzheimer's. Like many people caring for loved ones, she became “overwhelmed” by the task and could no longer afford adult day care. Keron thought an assisted living facility would be best for him, but the first dementia unit he was placed in on the south wing wasn't suited for his active needs, and his legs became swollen from the lack of walking.
In April 2013, he was transferred to the updated memory care unit on One West, which allowed him to walk freely during the day and get needed exercise. Although he barely can speak and rarely recognizes family members just seven years after being diagnosed with Alzheimer's, Keron says her husband is now in the best place possible to care for him.
“He moves around a lot more ... and I think the bigger area makes a big difference,” she said. “If he has to be in that kind of facility, I'm glad he's there.”
Large windows, skylights and high ceilings let natural light in and provide a comfortable living atmosphere for residents. Two separate sections with chest-high walls allow for activities that both welcome residents to join in or give them space to watch from afar if they don't feel comfortable participating.
“Five or eight people might be too many for them to be around, so they're off to the side or in the doorway of their room … and they're taking it in just as much as the people in the circle of the group,” activities director Cindy Zubchevich said. “They feel more comfortable on the outer edges.”
There's even a small kitchenette with an electric stove – unplugged at all times unless being used strictly by a staff member – that gives residents a chance to help bake goodies or other favorite dishes with their own recipes.
“The ladies and the gentlemen, if they like to bake and cook, are right there helping and supervising us how to do it the 'correct' way,” Zubchevich said. “At home, the kitchen is always a main center of attraction. People gather around the table, they eat, they cook, they bake. So that's the type of home-like atmosphere we try to promote here.”
That “home-like atmosphere” obscures the secure nature of the facility, with all doors and emergency exits locked and accessible by only staff members. Some residents who have early stages of dementia still want to leave the facility and care for themselves, so the staff must “redirect” them away from the doors to activities.
Still, the layout is designed to make residents feel comfortable and allow them to carry on with their day while being kept safe. Little details such as hardwood floors with sitting areas give people the freedom to move wherever they please – or take a few minutes to rest – in the facility.
“It's that constant pace and constant walk,” Zubchevich said. “If you want to actually talk with them, carry on a conversation or try to ask them something, you just join right in with that walk and go along with them. They're not going to stop for you.”
But the physical layout of the unit is just one component intended to help the residents.
Zubchevich said each resident receives a comprehensive assessment so the staff can learn what his or her typical day was like prior to their dementia diagnosis, where they worked and what interested them – whether they had pets or read the newspaper daily, for example. The information allows them to tailor activities to help make them as comfortable as possible, which Jacobs said is extremely important to the overall care and changing conditions of each patient.
“Families might have guilt about the placement, but they share such a big part in that (assessment) process,” Jacobs said.
Zubchevich added each worker must have the right personality to care for the residents, displaying a patient and calm demeanor when directing them. That was evident one recent afternoon when a man standing in the middle of the common area had lost his walker, and was immediately helped by a young woman sitting at the staff's station. She found it just a few feet away on a nearby wall, placed a comforting hand on his shoulder and smiled.
“Residents do not feel closed in and appear less apprehensive during the adjustment period,” One West Manager Diana Fleming said of the layout and staff.
At times, a resident may pack his or her bags to “go home,” prompting others to do the same. It's that gentle demeanor from the staff that helps ensure the situation doesn't escalate.
Judy Keron said the unit helps people differently depending on the progression of dementia. Some people, she said, love to interact in the sprawling common area.
“They'll talk to each other,” she said. “It doesn't make any sense, but they'll smile and laugh.”
For her husband and his advanced Alzheimer's diagnosis, she thinks something as simple as having the room to walk and ability to gaze out the large windows to the courtyard or wooded areas have been most beneficial to him.
“I think more daylight is better for them,” Keron said. “They can see when it's snowing and raining. I think that's so much better.”