For residents with dementia, a place of their own.

Like most CCRCs, our assisted living unit at CRISTA Senior Community in Seattle has experienced a significant increase in resident acuity over the past several years. Adding to that is a population of residents whose dementia has increased. In years past, we had to move these residents to other facilities specializing in dementia.

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Our goal became enabling residents to age within our CCRC--and keep rooms occupied. We established the Day Spring Program to meet the needs of our residents with significant dementia. The purpose of this program is to fill each day with structured activities, programs, and personalized care that enable residents to maximize moments of clarity and add quality to their lives when they can no longer do so for themselves.

Our program was born out of need. We were seeing increased dementia in individuals who had lived in the community for a long time. We also had couples with one cognitive spouse and the other with significant dementia. We wanted a program that would allow couples to remain together yet offer diverse opportunities for life enrichment. An in-house dementia life-enrichment program would enable us to extend residents' ability to live in our community.

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Unlike specialty dementia facilities, we are not a locked facility, and our building structure is not conducive to creating one. We bring residents with significant dementia to a centralized location from 9:00 a.m. to 5:30 p.m., where they are overseen by a caregiver whose only function is to manage their daily needs. This person is responsible for ensuring that care is provided (meds, baths, etc.), while a dementia specialist creates programs that change often and continue throughout the day. The primary caregiver's responsibility is to manage the residents' care needs (e.g., assistance with activities of daily living and medications) and take residents to the Day Spring Program. By doing this, Day Spring staff can focus their attention on the emotional and cognitive needs of the residents. The maximum number of residents in the program at any one time is eight. Residents may come to Day Spring all day or any part of the day, and the flexibility in programming has been extremely beneficial for couples, allowing the cognitive spouses time for themselves.

We have created an atmosphere and programming conducive to meeting the needs of this special population. Programming changes every 20 to 30 minutes and includes group singing, exercise, crafts, reading, going for walks, watching movies, baking, sharing memories, word games, and writing life stories. Routine household activities offer an opportunity for those who want to feel involved in homemaking, and the dementia specialist often takes Day Spring attendees to community programs.

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One of the biggest solutions to the challenge of dementia care has been having residents eat together in a private dining area. The main dining room is large with a lot of activity, which is often stressful to those with more significant dementia. Day Spring Program participants now eat their meals together away from the main dining room, reducing stress.

A by-product of the Day Spring Program is that we have been able to increase revenue from enriched care and increased census. By increasing the charges for cognitive management to more accurately reflect cost for one-on-one intervention, we have been able to support the cost of the Day Spring staff. While the facility charges for cognitive management, there is no additional charge for Day Spring, which enables residents to remain in the program.

Since we implemented this program, we have found that:

* wandering issues have been greatly reduced

* anxiety has been reduced

* residents sleep better

* couples have been able to remain living together in a less restrictive environment

* overall quality of life has been enhanced

* area caregivers have been able to focus their time and attention on those needing less cognitive management, resulting in more productive use of time

In the past 24 months, we have served 25 individuals and have been able retain 12 who would have otherwise had to be placed in a locked facility. Since implementing the Day Spring Program, we have only had to discharge one participant, who became a wandering risk.

The Day Spring Program originally was intended to be a "Band-Aid" until CRISTA could redesign its assisted living program. However, the program has proven to be very successful, enabling many with dementia to remain in an unlocked living environment. We have also had dementia workshops for family members so that they have a better understanding of what is happening to their loved ones. This has resulted in family support for the program. Family members are welcome to attend, encouraging residents to come. The Day Spring Program has enabled us to better serve our community and has blessed the lives of many of our residents.

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Robert T. Howell is Executive Director of CRISTA Senior Community in Seattle. For more information, phone [phone] or visit www.cristaseniors.org. To send your comments to the author and editors, please e-mail howe//1106@ nursinghomesmagazine.com.