Giving People with Alzheimer's a Place to Call "Home"
by Camille Pauley
© 2012 Healing the Culture
Pioneer Place is a remarkable and beautiful place to live – but you have to have dementia to live there.
Years ago, John Merz and Marvin Rogers shared a vision to build a home for people with Alzheimer's or dementia that would break the custom of trying to rehabilitate people with these diseases, and simply allow them to live in comfort, security, and peace.
"We are on the cutting edge of this kind of care," said John, who spent a lot of time researching dementia. "People used to mix populations in nursing homes, where they need reality orientation. But for people with dementia…you can't bring them back to reality. You have to validate where they are and meet their needs."
So John and Marvin created a home in Tacoma, Washington, and incorporated strategies that fill the special needs that people with these illnesses have. They were the second home in Washington state to be an exclusive facility for people with Alzheimer's and dementia. Now there are 75 or more.
So what makes Pioneer Place so special?
"This is their home," John stressed. "Instead of trying to bring people with dementia into our world, we enter into theirs." I visited Pioneer Place to find out exactly what he meant.
The first things that struck me was how incredibly peaceful the place was. The residents seemed genuinely happy, as did the staff. It was also incredibly quiet. Having worked in medical settings before, I immediately noticed the lack of intercom paging. No overhead voices telling Susan she has a call on line 1. John explained that when people with Alzheimer's hear voices coming from nowhere overhead, they sometimes think it's God. So all paging is done through individual paging devices, rather than being broadcast for everyone to hear.
People with dementia often enter the rooms of other residents and steal items that don't belong to them, mistakenly believing that the items are theirs. So there are several locations throughout the home where "Lost and Found" cubbies are stocked with hats, canes, books, and pipes. When residents are seen wandering into a room that isn't theirs, looking for a lost wallet or purse, staff members gently take them to one of the cubbies to retrieve the "lost" item. At the end of the day, the staff gather up the lost items and restock the cubbies.
Elderly women with dementia sometimes wander into the kitchen, wanting to bake or make dinner. This obviously presents safety concerns as ovens or stovetops would often be left on for hours with strange mixtures boiling or burning away. So Pioneer Place installed a special kitchen for residents, where anyone can go and make anything they like. None of the electrical appliances work, and inedible concoctions are thrown away by staff at the end of the day.
Another problem in the kitchen were the floors, which are frequently colored in alternating black and white tiles. Dementia can cause people to see these alternating light and dark tiles as steps, and residents would sometimes stand still in the middle of the floor for long periods of time, confused about how to overcome the maze of steps. Pioneer Place uses only one color for flooring, completely eliminating that problem.
On the other hand, if the walls in one room are the same color as the doorway and walls in the next room, people with Alzheimer's will frequently lose depth perception and think there is only a solid wall with no way out. So Pioneer Place made sure that every room is painted in a different color.
Many of the male residents remember working on cars or electronics, and would sometimes cause problems trying to take things apart – such as staff members' cars. So Pioneer Place acquired old cars and electronics from the time periods their residents are most familiar with, and allows residents to "work on" the machines, taking them apart and putting them back together again.
Another issue is dressing. Clothing is frequently put on in the wrong order, with shirts and pants on the inside, and underwear on the outside. To mitigate this, Pioneer Place installed special cabinets with tiered bars that allow residents to access their clothes in the order they should be put on.
John also told me about something called a "therapeutic fib." Say, for example, a resident becomes concerned because it's time to feed the baby and she can't find her child (who is now grown and living with his own family), or her husband (who has long since passed away).
In past models, the procedure was to explain to the resident that she is elderly now, and that her children have all grown up and her husband has died. But because people with dementia live outside of reality and cannot be rehabilitated to remember these facts, they would only experience the grieving process over and over again, thinking that they were hearing the tragic news for the first time.
With therapeutic fibbing, the resident is gently told, "Your husband has fed the baby and they are doing just fine." This answer is almost always satisfying.
In another scenario, if a person escapes out of the home, and says, "I want to go home," past models of reality orientation would have a staff member tell the resident, "This is your home now."
"That's the wrong answer," John explained. "It just dashes their hopes and puts them into mourning and shock all over again." Instead, John's staff are trained to say something like, "Okay, you can go home, but let's have breakfast first," just to get the resident to come back inside. Then, because of short term memory, they will forget and be at peace again. "You can then telephone their daughter or another living family member, let them know Dad got out, and let Dad talk to family as a connection to the home he was trying to return to."
For more information on Pioneer Place, visit www.pioneerplacealzheimer.com.