Dementia care: no place like home.

The founder of Sutton Homes explains the concept

Twelve years ago I found myself in a situation that more and more people are confronting these days: my mother was an apparent victim of Alzheimer's disease (I say "apparent" because Alzheimer's is still not a definitive diagnosis). Living alone in an apartment, she was continually locking herself out, leaving the burners on day in and day out, and more. Yet, physically, she was still strong and in good health, still gregarious and outgoing and, in my opinion, still a long way from being a candidate for admission to a nursing home.

I wanted a controlled environment for her, but a nice controlled environment. And so I invented one.

I leased a comfortable four-bedroom home in an upper middle-class suburb of Denver, furnished it new, invited four more women with Alzheimer's to live there to keep each other company and staffed it with a full-time caregiver. It was secured with a magnetic door (on which more in a moment) and with fencing around back. It worked very well, by and large. Families of the other women told me how pleased they were with the arrangement and with how well their mothers seemed to be doing. After about a year, it occurred to me: this could be a solution for other people in my situation.

Today Sutton Homes is a franchise operation with 34 homes in seven states. Details on how this is set up can be found in the accompanying sidebar ("Anatomy of a Franchise"). For the purposes of this article, I wanted to discuss the concept of Alzheimer's care in the residential home setting and some of the lessons I've learned along the way.

Perhaps at the heart of the concept is the aim of reducing stress all around - the stress experienced by families who are unable to cope with home care of their loved ones but unwilling to face nursing home placement, and the stress experienced by Alzheimer's victims, who now can feel safe and comfortable and remain reasonably active within a home environment. To enhance these feelings, the furniture, carpeting and drapery colors selected are soft and muted with simple patterns, and personal items and furniture are encouraged in the residents' bedrooms. Bathrooms are equipped with handrails and stairways are gated - or, in most cases, are nonexistent, since these homes are usually one-story ranch structures. Indeed, all of the amenities of home, including cooking facilities, are present.

Needless to say, the homes are staffed around-the-clock. They are not, however, staffed by nursing assistants, who in my experience have not had the training and background to cope with this level of Alzheimer's disease. Rather, in the seven homes I operate, and encouraged in all the franchise homes, is staffing with caregivers who have college degrees in psychology, sociology or gerontology - the sort of people who can work creatively with moderately-impaired Alzheimer's victims in a supervised but unstructured environment.

These staffers are what the Department of Labor calls "professional exempt." Only one is on duty at any one time (a staffing ratio of 1:5), working a schedule of three days on and four days off - scheduling that I have found necessary for these individuals to simply relax and recharge their batteries.

I mentioned that this is an unstructured environment, and that refers specifically to how activities are conducted. Not all residents - even among as few as five - are equally capable of or interested in specific activities. Some may simply want to look at a newspaper and discuss current events. Others find satisfaction in doing a little kitchen cleaning or folding of laundry, and still others may prefer to walk around the home and in the back yard a bit. The staffer on-duty simply attempts to engage them at the appropriate level of activity and to monitor them to make sure that they remain safe.

Obviously, this must be a secured facility. Though I had some early disagreements with local building officials over this, it was imperative that the front door remain locked at all times. Wandering is too great a risk otherwise. Even so, there had to be ready egress for residents during an emergency. We resolved this by equipping the front door with a magnetized lock that could be disconnected only by a staffer or automatically by the activation of a fire alarm or heat detector. This proved workable and, indeed, the State Department of Health ended up creating a new regulation for "secured environments" to accommodate our rather unusual facility.

The "facility" is, of course, in a residential neighborhood, and we have had our share of difficulties with local zoning and neighborhood convenience authorities. Fortunately, under the Fair Housing Act and other Federal and state laws, the pendulum has swung toward allowing the handicapped elderly to enjoy a decent lifestyle in a pleasant home. Also, neighbors come to find that the homes pose no threats to their families or neighborhoods and many take a friendly interest in the residents.

We do not, by the way, call this "assisted living." These residents need far more personal attention and care than the typical assisted living resident, though the environment might be described as an assisted living model. By the same token, we do not provide medical care. Staffers are certified to provide routine medications such as pills, eye drops, nose drops and so forth, but the appearance of medical symptoms will trigger a call to a physician or to the family to make a medical appointment, just as in any residential setting. We do have emergency protocols, prepared for us by a physician, but we also call 911 and turn it over to the paramedics as soon as they arrive. In short, if your mother needs a nurse, this is not an appropriate placement for her.

By all accounts, this program works. Though there have been no formal studies done of it, we have found residents experiencing fewer behavioral problems as time goes by; most are able to reduce their medication intake and a few go off medications altogether. Families relax to the point that they are virtually unrecognizable as the stressed, exhausted, guilt-ridden middle-aged adults who first sought admission for their loved ones.

All of this adds up to the goals that we wanted to achieve, starting with yours truly and the mother for whom he wanted the best.

Joseph Sutton is President of the Sutton Home Franchise Corp., based in Englewood, CO. For further information, 303-220-7989.