We don’t see ourselves as aging with dementia – and neither did senior housing providers. Chew on this thought from a senior housing strategist [3], who encourages providers to "look at entryways differently," Traci Bild says. "You often see a lot of furniture where people sleep in the lobby. Instead, make it a place where people can congregate to talk, rather than to sleep, by placing high top tables." Meanwhile, back at the reality ranch, where sitting at high-top tables, uh, may not work so well -- the average age of resident move-in to assisted living is now 87 -- says Allison Guthertz, Vice President, Quality Resident Services at Benchmark Senior Living [4]: "These days when residents move in, they already need help with three to five activities of daily living (ADLs) [5]."
Okay – now is the right time, but wrong building, wrong staff, wrong vision. So buildings that were designed quite recently feature long hallways (ending 5 or 6 units away from a nurse’s station), as well as soft-cushioned furnishings that incontinent and frail residents can become trapped in while watching a movie. We see dementia units (notable by the presence of locked doors) in which those residents who are up and about gravitate towards alarm-blaring doors; where activity programs are designed for bingo and dancing – neither of which match the needs of wheelchair-bound residents with dementia. Says Victor Regnier, a professor of architecture and gerontology -- in an understatement -- times have changed. A decade ago, says Regnier, he was consulting with a large assisted living provider who was "shocked" when he recommended including a dementia unit adjacent to or within the community that was being designed. Shocked, eh? But an NIH study that ended in 2003 [6] (oops, that WAS a decade ago), indicated that 1 in 7 Americans age 71+ had dementia. So coincidentally that’s when many independent and assisted living buildings were on the drawing board. And still the industry seems startled that so much of their future requires an expertise and an environment that they did not foresee. One that requires redesign, retrofit, and retraining.
What you see may not be what you need – or what you get. Today Professor Regnier acknowledges that memory care units may turn out to be 80% of the business of assisted living providers. Surely this is also because they are so profitable -- an average of 42% price increase [7], but without a comparable increase in service. So providers are marketing to family members who are depressed at seeing so many sleeping 89-year-olds in the lobby, but maybe they would worry more if they’re falling off the chairs tucked under the high-top tables? And are PERS devices or fall detectors provided on move-in day? Not exactly. Nor are cameras, sensors, or much of any other technology. In fact, what exactly, should family expectations be for dementia units or even for assisted living in general? Well, it depends on what state you’re in – services are not standardized [8] -- nor is training, so expectations for an average 2-year stay cannot be properly managed.
Will the real consumer profile please stand up? The assisted living industry has been vocal over the years that they are NOT nursing homes [9]– and therefore they should not be regulated as such. But with the availability of locked 'memory' units, hospice care, the rise of move-in ages, the presence of numerous wheel-chair bound individuals, and with an average age 89, who is kidding whom? Transparency matters in all things, and those who design and configure assisted living today must acknowledge the characteristics of the consumer and manage the expectations of families. That is the only way we will shrink the disconnect between expectations, decor and real need.