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Magic or mayhem: What's ahead? Part 2

December 12, 2011
by Richard L. Peck, Contributing Editor
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Editor's note: Last month, Long-Term Living readers were treated to five of Richard Peck's predictions for the industry in the coming years (Long-Term Living, November 2011, page 26). Here are more of his forecasts.

DESIGN: ‘HOMELIKE’ ARRIVES

It's been a long time coming, but homelike LTC design is starting to become mainstream. According to Margaret P. Calkins, PhD, president of the design consulting firm I.D.E.A.S and long a spearhead of

Long-Term Living's design coverage, the once groundbreaking “household” concept is no longer exceptional, particularly for the newer not-for-profit facilities. “We're still seeing linear hallways, side-by-side rooms and amorphous social spaces in for-profits,” she says, “but the household of private rooms clustered around common social and dining areas is now generally seen as promoting resident comfort and staff interaction with residents, leading to better quality of care.”

And the private room itself isn't going away, Calkins says, despite apparent economic constraints versus shared rooms. “My research five years ago showed the added cost could be amortized at $2.50 a day over 30 years,” she notes, “while the reduced turnover from the increased staff satisfaction would lead to savings of $13,000 per rehire-$16,000 per rehire if you include staff training.”

Economic reality being what it is, though, there's no escaping the fact that most aging facilities lack funding for major makeovers. Gene Guszkowski, AIA, principal of the Wauwatosa, Wisc.-based LTC design firm AG Architecture, notes that “of the 392 CCRCs in the nonprofit world, 38 percent opened before 1986 and 35 percent are 10 to 25 years old. By today's standards, these older communities appear dated and tired. But a new generation of seniors is coming and owner/operators know it-they're showing an intense interest in upgrading. Still, even though some are incredibly clever in improving living units by combining apartments and incorporating high-end millwork enhancements, when you approach it from the outside it still looks like an old building.”

Guszkowski is seeing more and more requests from owners not only for modest renovations but for master plan updates. “That's because we're going to need another 400 CCRCs alone in the next 10 years, and the for-profits are very aware of this and are gearing up.”

Meanwhile, Calkins has seen hard evidence-from the world of code regulation-that the household concept is settling in. Thanks to an ongoing collaboration by the Pioneer Network, the Rothschild Foundation's Rob Mayer and a coalition of leading LTC associations, the National Fire Protection Association Life Safety Code for 2012 (see page 30) will feature four breakthroughs in code-acceptable LTC design: (1) kitchens may have residential equipment and hoods as opposed to commercial-grade, may be open to sleeping compartments (as in the Green House model) and may serve as many as 30 residents, as long as the buildings are sprinkled and contain smoke detectors; (2) gas fireplaces are to be considered as heating devices, not as solid fuel, and as such can be located in the same smoke compartment as resident rooms; (3) furniture is allowed in hallways, although it must be confined to one side of the hallway and allow six-foot clearance; and (4) the percentage of wall space allowed to be covered by non-treated, potentially flammable wall decorations is to be 30 percent rather than 20 percent, not only for rooms occupied by four or fewer people, but for hallways and spaces with higher occupancies.

Such enlightened building and fire codes may signal a breakthrough era for LTC design, a fortunate and timely development for future generations of LTC residents.

DEMENTIA CARE: THE DRIVE TO PERSONALIZE

“New drug found to cure Alzheimer's!” That's a headline the world yearns to see-particularly with Alzheimer's cases projected to increase 85 percent by 2050, affecting 16 million Americans and costing more than $1 trillion. There seems little reason to believe we'll see it any time soon, though, as the basic pathophysiology of the disease continues to defy scientific understanding. The medications we do have, while briefly slowing progression, are costly, and the antipsychotics used to control its behavioral manifestations have come justifiably under a cloud.

All of which leaves the field open, now and for the foreseeable future, to behavioral interventions. And here, LTC facilities are making inroads with behavioral interventions of various kinds. The underlying approach has been summed up most eloquently by the Beatitudes facility in Phoenix, Ariz., a pioneer in Alzheimer's management, which states: “To listen, let patients make their own decisions, and show them love.”

The programs come with various “flavors,” including Montessori-based intervention focusing on residents' fine-motor skills to maintain cognition; behavior-based ergonomics therapy using customized audio/visual interventions to calm and positively stimulate residents; brain fitness programs to stave off mental deterioration; and Snoezelen, a highly tactile sensory stimulation program involving all the senses.

The challenge to facility care lies in the staffing required to provide these modalities. The successful memory care unit will have staff who appear to be doing nothing but hanging out with individual residents all day. It's what works. The question for LTC providers: Is it workable?

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