Glenn Delich has worked in the field of aging services for 40 years, and he remembers the days when Alzheimer's patients were physically restrained and overmedicated to help control their aberrant behaviors.
“Obviously, it was not a dignified way to live,” he said.
Today, Delich is the administrator of Southminster Place at Presbyterian SeniorCare in Washington, which became a pioneer in dementia care in the United States with the development in the early 1990s of Woodside Place at Oakmont, one of Southminster's sister facilities.
“The Woodside Place philosophy of care was really groundbreaking when it happened and revolutionized the way care is provided,” Delich said. “It is the most powerful care in terms of the impact it has on people. I'm blown away by their quality of life.”
With its flexible programming, architectural innovations and nontraditional staffing structure, the Woodside model was designed to meet the physical, social and psychological needs of people living with dementia. It was created by George Pruitt, former president and CEO of Presbyterian SeniorCare, who discovered upon visiting similar facilities in England, Australia and Asia that their delivery of care to an aging population with Alzheimer's disease exceeded the care offered in the United States.
Woodside Place has received national and international recognition for its contribution to dementia care, and communities worldwide have replicated its model of care.
“One of the hallmarks is that it was unstructured and unregimented,” Delich said. “It's been proven that when people with Alzheimer's are exposed to a less restrictive environment and have more flexibility, they respond much better. They need less medication and are less agitated. We never want to get into a contest of wills. It's what they want to do.”
That's one of many things Suzanne Bitsko of North Strabane Township finds so attractive about the Woodside program. Her 93-year-old mother, Anna Cowan, has resided in the Woodside neighborhood at Southminster Place for four years.
“It's the hardest and best decision I ever made,” said Bitsko, straining to talk loud enough so she could be heard over the boisterous sing-along being held in a nearby dining room by Jody Mullis of Washington, a blind pianist who regularly visits Southminster Place to entertain residents in the Woodside program.
For years, Bitsko tried to care for her mother in Cowan's home, which was just a few doors away the Bitsko residence, but it became increasingly difficult as Cowan's dementia – and her resulting Sundowner's Syndrome – worsened. Cowan refused to take her medication and made repeated calls to the police department complaining about her daughter. Neighbors would call Bitsko to tell her that Cowan was wandering, and once she tried to get into a stranger's van that was parked near her home.
When Bitsko and her two brothers tried to convince their mother to move into an assisted living facility, Cowan became so belligerent that her children were forced to leave the home. Later that night, during a thunderstorm, Cowan walked around the neighborhood knocking on doors. By the time someone answered, Cowan was soaked and told the neighbor she was afraid to be alone.
Bitsko said she visited at least 12 assisted living facilities and called another dozen before deciding on moving her mother to Strabane Woods of Washington. Cowan stayed just four days.
“She never wanted to be anywhere but her own home,” Bitsko said.
Eventually, though, Cowan moved to Southminster Place, where, despite some initial unnerving moments, she has adjusted nicely.
“They called her Houdini,” said Bitsko, explaining that Cowan kept removing her security bands, regardless of whether they were on her arm or leg. “Nobody knew how she escaped them. She would get so mad, she'd get out of them.”
Then there was the time she became angry and combative, knocking a woman out of her wheelchair because she was taking something out of the refrigerator. Bitsko had told her mother that Southminster Place was her new home, and Cowan didn't like anybody getting into “her” refrigerator.
Bitsko credits her mother's adjustment to a caring staff and friendly visitors.
“I can't say enough good things about this place,” Bitsko said. “My mother is calm. She's lost that anger. She's as happy as she probably can be in her state of mind.”
The Woodside neighborhood at Southminster Place, which opened 12 years ago, can accommodate 20 residents, and caters to dementia patients who are still mobile but need a secure environment.
It is designed in a U-shape, with residents' rooms along the hallways that embrace the common areas, including the dining areas, kitchen and “family room,” that are situated in the center of the unit. A spacious, secure courtyard, where residents grow vegetables and flowers in raised beds, can be accessed from this area. Benches dot the walkways, where residents can just sit and relax.
Whatever vegetables they harvest are used in meal preparation, and residents have two entrées each day from which to choose. They are shown the entrées before making their choice so they know what they will be eating.
All but two of the rooms are private, and each has a private bathroom with a sliding door for privacy and a walk-in shower. Dutch entry doors help provide a sense of recognition for residents who may not remember their room number.
Each bed is equipped with a silent pad beneath the mattress that will alert the staff whenever a resident gets out of bed at night. The staff will check on the resident to ensure he or she doesn't fall.
“This is life-changing for them,” said Kelly Mercurio, director of sales and marketing. “Before they move in, they've been really isolated.”
But the safety measures that have been implemented for residents' physical well-being are only part of the beauty of the Woodside program. Their psychological well-being is just as important, and is addressed 24 hours a day, which, Julie Elling said, is what makes the program unique.
Elling, who is director of resident services and manager of the Woodside program, said if a resident gets up at 2 a.m., staff members are available to engage them in an activity.
“Dementia patients have their nights and days mixed up,” Elling said. “Sometimes they do not necessarily need a structured activity.”
Although Woodside offers an agenda of designated activities throughout the day, residents are not obligated to participate, and the activity can be switched depending on residents' moods.
“We direct them only when there are safety issues,” Elling said. “They set the pace for the day: what time they get up, what time they go to bed. We respond to what their clock is. It works beautifully in the unit.”
What the staff focuses on, she said, is “the quality of the moment because this is a horrible, horrible disease. They will not remember it a minute later. Some are higher functioning than others, and we adjust the care they need to the different levels.”
Added Delich, “By virtue of the philosophy of care, residents spend the better part of their waking hours together.”
Although residents respond well to children and animals, music engages them more than any other activity, Elling said. She recalled a woman from Macedonia who spoke less English as her dementia progressed. Even her native language became gibberish. But when they would sing familiar hymns or songs, her English “was as clear as day,” said Elling, noting that it confirms the “first in is last out” philosophy with dementia patients, meaning the last things they forget are the first things they learn as youngsters.
Elling said the staff is so in tune with residents that they often will anticipate their needs. Plus, they often notice cues earlier than anyone else that a resident's dementia may be advancing. Among them are a decline in cognition, weight loss, a decrease in ambulation or patience and a lack of personal hygiene. In these instances, Southminster Place partners with Family Hospice and Palliative Care to help assess the resident's health.
For example, after Cowan broke her hip, her health declined to the point where, according to Kimberly Hawk Huber, a case manager with Family Hospice, her condition was grave. Cowan was placed under hospice care. Bitsko said hospice – and more specifically, Huber – was a godsend, and in less than six months, Cowan had rebounded nicely.
“My mom has good days and bad days,” Bitsko said. “In the last two or three months, she's really perked up.”
Some residents, however, aren't as fortunate and require more advanced, specialized care. When that occurs, they are eligible to move to Southmont on the Presbyterian SeniorCare campus, which has a 14-bed Alzheimer's unit in addition to 151 beds for skilled nursing patients.
“Once residents are inside, this is their home,” Mercurio said.
Even when residents have exhausted all of their financial resources, they are welcome to stay. Delich said Presbyterian SeniorCare is able to subsidize through fundraisers and grants whatever financial assistance residents receive from Medicare or the state. At Southminster Place, he said it costs Presbyterian SeniorCare $800,000 a year to help indigent residents.
In its 54-year history, Presbyterian SeniorCare has “never asked anybody to leave,” Delich said, or has had to help family members find alternate housing.
“It's nice that Julie and I don't have to have that conversation,” Delich said.
Suzanne Bitsko becomes emotional as she talks about her mother’s combativeness when Anna Cowan was still living in her own home.
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Suzanne Bitsko explains the family’s decision to move Anna Cowan into Southminster Place at Presbyterian SeniorCare.
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Kimberly Hawk Huber, a case manager with Family Hospice and Palliative Care, hugs Suzanne Bitsko as Anna Cowan stares into the courtyard. Huber was a godsend to Bitsko when Cowan was placed in hospice care after breaking a hip.
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