New age care: it's time to focus on the need-driven, market niche of Alzheimer's and Dementia specialty care.

"We're getting into full-service assisted living, but we don 't plan to deal with either incontinence or dementia."

Oh really?

Astute sponsors and owner/operators now know that they must deal with special care Alzheimer's in order to remain market responsive. The reason is simple: The incidence of Alzheimer's disease, or some other form of demenitia, rises rapidly at age 82, when residents are most 'key to move into assisted living. Between ages 75 and 84 the incidence level rises to about 20 percent; at age 85-plus, incidence increases to about 50 percent.

In beginning to offer dementia care, there are two fundamental strategies to address: A special-purpose design with strong programming content. The market positioning challenge is two-fold: Convincing the marketplace you really understand special care and that you provide the special care/Alzheimer's living environment of choice.

As special care units have become better defined, two basic market models have emerged:

* Residential/social models are for those seniors with early stage dementia. These seniors are in relatively good physical health but need sheltered living and moderate levels of assistance with the activities of daily living. The physical product is typically a special design variation of assisted living.

* Medical models are for seniors with more advanced stages of Alzheimer's and other related dementia who also have complex health problems. These seniors require a nursing home-type setting.

The appropriate strategic focus means striking a balance between the resident's needs and the mindset of the principal caregiver--typically the elderly spouse or an adult child. In practical terms, the caregivers are really the market-keeping in mind that the caregiver is not always an adult child but frequently an elderly, sometimes frail spouse.

Hundreds of focus groups and other research have provided some valuable information involving the Alzheimer's caregiver. Understanding them can enhance the success of your community:

* The search for knowledge--Caregivers are hungry for information. They constantly search for options to improve the quality of their lives and those of their Alzheimer's patients. Caregivers frequently mention that their search for alternatives has delivered less than satisfactory results. However, most reported being pleasantly surprised when they became aware of special care Alzheimer's options offered in an assisted living setting.

* Delayed diagnosis--Conclusive Alzheimer's medical diagnosis is complex and many caregivers claimed that actual diagnosis occurred later than was acceptable. For many, this delayed diagnosis created considerable frustration and hardship.

* Diagnosis denial--Many caregivers won't admit that this condition could exist in their family. A common question: "Isn't Dad just getting old?"

* Alzheimer's as a closet disease--The caregiver's early reluctance to accept the fact that a loved one has the disease, coupled with society's current discomfort regarding dementia, has caused some early Alzheimer's situations to be covered up for a time. Many focus group respondents felt this impeded effective, timely treatment of dementia.

* A nursing home state of mind--Many caregivers put up a courageous fight to avoid serious consideration of the expensive and marginally acceptable nursing home option. They delayed their decision as long as possible. For some, the discovery of the special care, residential-social model of special care Alzheimer's is an acceptable alternative.

* If they knew then what they know now--Looking back, caregivers report that they experienced surprisingly little long term guilt after finally making the difficult decision to place their loved one in some form of sheltered living. They gradually realized that the decision was prudent and necessary--both for their loved one and for their own personal health and well being. So if they knew then what they know now, many would have made the difficult sheltered living decision sooner.

Jim Moore is president of Moore Diversified Services, a Fort Worth, Texas-based national seniors housing and health care consulting firm. He is author of Assisted Living 2000 and most recently, Assisted Living Strategies for Changing Markets. He may be contacted at [e-mail].