For dementia patients, the best medicine often is a structured day with plenty of human interaction and one-on-one contact with caregivers.
Introducing activities into their day brings meaning, joy, hope, purpose and a sense of normalcy to their lives — whereas boredom, loneliness and isolation can exacerbate the disease progression, according to the Alzheimer’s Association, and become a cause for wandering and agitation.
Keeping a patient with Alzheimer’s or other dementias active takes a lot of planning and staff. Even daily personal care like eating, bathing going to the bathroom requires more diligent planning than their counterparts in residential care.
It comes as no surprise, then, that a report out of Portland State University by Dr. Paula Carder and others on her survey team found that memory care facilities in Oregon tend to be more expensive than residential care and assisted living facilities, but that doesn’t seem to affect demand. Their research found some memory care facilities in Oregon are growing rapidly — up 79 percent this year compared with 2006 — and they tend to be more full than other types of long-term care.
Similarly, Wildflower Lodge Assisted Living and Memory Care in La Grande has experienced greater demand for memory care with noticeable admission increases in autumn, because families want their loved one in a safe home-like community before winter approaches.
“Wildflower Lodge has the ability to care for 30 residents in Memory Care,” said Jenna Wright, director of sales and marketing, last month. “Our occupancy is at 96 percent, and this is a steady figure for the season.”
On the state level, at least 62,000 Oregonians age 65 and older currently are living with Alzheimer’s disease, a number that’s expected to grow to 84,000 by 2025, according to the Alzheimer’s Association.
To prepare for this eventuality, Oregon’s Department of Human Services commissioned Portland State University and Oregon State University to prepare annual reports on the availability, cost and other characteristics of long-term care in the state.
“We’re looking at this critically and trying to make sure we have a system that will support those people in the coming years and decades,” Ashley Carson Cottingham, director of DHS Aging and People with Disabilities, told attendees at an event unveiling the research earlier this fall.
Portland State University’s data came from surveys of memory care, residential care and assisted living facilities, together referred to as community-based care.
According to the university’s report, the average monthly stay in a memory care unit in Oregon costs $5,410, including extra services like health monitoring, assistance with daily living and laundry. The same services at a residential care facility cost $3,770, and at an assisted living facility, it’s $3,667.
For memory care at Wildflower Lodge, “Families should expect to pay anywhere from $4,500 to $6,000 a month,” Wright said.
The high cost of memory care is driven by the time and attention required from staff members. The university’s research found memory care staff members in Oregon spend 3 hours and 52 minutes per day with each resident, on average, compared with 2 hours and 55 minutes in residential care and 2 hours and 2 minutes in assisted living.
Wildflower’s Wright noted that in addition to the extra time required for daily needs such as eating and bathing, the patient also requires quality personal contact on a daily basis. That can be challenging depending up the ratio of staff to patient.
“The state endorsement requires us to make sure that each of our memory care residents receives at least 30 minutes of one-on-one care a day,” Wright said. “In a community of our size, however, our staff is able to easily double that.”
Patients who feel they are not receiving enough one-on-one attention from staff may tend to wander or become aggressive to other residents or staff. For this reason, memory care facilities install more advanced security systems and safety features throughout their buildings, which could also add to the cost.
Staff at Wildflower Lodge offer a variety of activities that center on wellness. But even with best practices, aggression among memory care residents does happen, though Wright said it is a rare instance at Wildflower Lodge.
“Wildflower Lodge is designed and the staff is trained specifically to help people with a dementia diagnosis to feel safe and at home,” Wright said. “In my four years here, we have only cared for two residents who I would say were consistently aggressive, and they both had underlying health and mental health diagnoses that contributed to their behaviors.”
Of the community-based care facilities Portland State University surveyed, 18 percent said they had issued move-out notices to residents within the past 90 days because they had either hit or acted in anger against another resident.
Staff members at Wildflower Lodge try to prevent conflicts, Wright said, by knowing their residents, recognizing triggers and preventing or redirecting conflict as it arises. Memory care residents are vulnerable, and that’s why trained staff are responsible for their safety.
Technology plays an important role in keeping residents in the memory care community safe.
“Every (Wildflower) resident has a pendant that they can wear as a necklace or watch,” Wright said. “If the button (on the pendant) is pushed, the staff is notified that the resident is in need of assistance and where they are in the building.”
Of course, as the dementia disease progresses, resident often lose their ability to properly operate their pendants, and that’s why staff members check on the residents every two hours to ensure their safety and comfort. In addition to these measures, safety precautions such as a keypad entry are installed at the building.
In contrast with full-time memory care, assisted living communities are often more of an apartment complex with perks. Residents are regularly checked on by staff, but one-on-one time with each resident has significant variables. Patients may come and go in the assisted living community or go out for the day with relatives.
Rooms in assisted living facilities are private, with the exception of a spouse or other immediate family member who wants to share an apartment. Some residents receive services such as lawn care, snow shoveling and housekeeping.
Oregon law requires all community-based care facilities to employ or contract with a nurse. Of those that responded to the Portland State University’s survey, 68 percent employed at least one full-time registered nurse and 20 percent employed at least one full-time licensed practical nurse or licensed vocational nurse.
“Wildflower Lodge employs one full-time registered nurse and one full-time licensed practical nurse,” Wright said.
In the state of Oregon, nurses in assisted living and memory care facilities do not provide direct nursing care like they would in a hospital or nursing home.
“Their duties in a setting like ours include clinical oversight and training of the staff that provides care,” she said. “They analyze positive and negative behaviors in order to promote well-being among our residents and monitor changes in our residents’ health conditions.”
Oregon State University also prepared a report on nursing facilities in Oregon, which in most cases provide transitional care to people before they return to the community after a hospitalization. Occupancy in nursing facilities has been decreasing in Oregon, from 72 percent in 2000 to 66 percent in 2016. Oregon has one of the lowest nursing facility occupancy rates in the country, the report found.