Design Center: Carlson Boyd Place at Mather Pavilion at Wagner Evanston, Illinois.

          TYPE OF FACILITY SETTING:   Memory Support Program
              CHIEF ADMINISTRATORS:   Mary Kay Holmes, RN, MBA, LNHA,
                                      Executive Director, Mather
                                      Pavilion at Wagner; Mary Leary,
                                      President and CEO, Mather
                                      LifeWays
 ARCHITECTURAL AND INTERIOR DESIGN:   Mithun, [phone]
                       PHOTOGRAPHY:   Hedrich Blessing (renovation
                                      photos)
                    RESIDENT UNITS:   37 beds
TOTAL AREA OF RENOVATION (SQ. FT.):   13,000
             TOTAL COST OF PROJECT:   $1,057,912
   TOTAL CONSTRUCTION COST/SQ. FT.:   $58.00 (excluding architectural
                                      fees and furniture costs)

ADMINISTRATOR'S COMMENTS

Kathleen Ustick, manager of dementia services, Carlson Boyd Place at Mather Pavilion at Wagner:. "In Carlson Boyd Place, a traditional skilled nursing unit has been transformed into a more natural home environment for older adults with memory impairments. It features two unique neighborhoods, each with its own decor and 'at-home' amenities. In the older type of skilled nursing center, you have residents in a medical model setting who are wondering why they're there. They're not sick and they just want to go home. And you have these big nursing stations that seem to say, in so many words, 'Stay away!' This is not an environment that is supportive of the residents' abilities. They just want to get out, and this leads to unnecessary behaviors on their part that are difficult to manage. We wanted to change this environment to one that would relieve their anxieties and focus on those things that they can still do well.

"We converted a 41-resident unit to a home for 37 residents by eliminating two semiprivate rooms. We also converted from one to two dining areas, one for each neighborhood, located along the outside walls, and added windows to the walls to bring in more natural light. These residents have spatial and perceptual difficulties, and natural light has been found to reduce risk factors for falling, colliding with objects, etc.

"With the renovation, we wanted to create a home, and so we have a natural, homelike flow going from the foyer, to the living room, to the dining room and kitchen. Our 'back hallway' leads to the resident rooms, with adjustable recessed lighting and wall colors to cue the residents as to where they are. A 'back porch' serves as a transition area between the two neighborhoods, with unique flooring and a glider where residents can sit and socialize on their way to and from the neighborhoods.

"In fact, we created several 'nook-and-cranny' areas where people can slop and rest and interact with families or small groups of friends. Our families really appreciate these, as it gives them visiting areas besides 'Mom's room.' And the areas are also usable for small group activities.

"Although we have steam table kitchen service, we do have kitchen areas where residents can do cooking exercises and help prepare meals--cutting vegetables, helping with dessert--just as they would in their own homes.

"Bathing is, of course, a major issue, and it was a high priority for us to create a sense of warmth and comfort in the bathing area.

"The lighting that I mentioned earlier has an adjustable feature that can be used to counter the effects of sundowning. The lights are turned up bright in the morning and gradually dim as the day goes on, then brighten again around dinnertime, and again gradually dim to darkness throughout the evening hours. This change in lighting intensity cues people throughout the day and helps normalize their environment.

"The whole point of a community designed like this is to give people a sense of purpose, of safety, and of normalcy. After we opened last November, we received many comments from families noting how quiet and pleasant it was, without that noise and tension you get when people just want to get out. And we're able to deliver person-centered care, where staff--we have about a one-to-seven staff-to-resident ratio--really get to know who these people are and what their personal histories were, and can use this information to promote a lot of small group and one-on-one interaction among residents. This is the type of environment that is caring and supportive, and could benefit all memory-impaired residents in a long-term care setting."