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20 paths to dementia care homes away from home

Loren Shook not overmedicated

It’s time to transform care for people of all ages who live with the Alzheimer’s disease and other dementias – they deserve better than what they’re getting.Family care partners need more support, education and skills to meet the challenges they face every day.

The long-term care facilities in which we warehouse old people must be re-imagined.  We need people-focused environments well staffed by trained care workers who are devoted to providing the best possible end-of-life chapters to our elders.

The requisite dementia care revolution is slow in coming, but there are beacons of hope.I’m encouraged by people like Loren Shook, Co-Founder & CEO, Silverado, who is one of few change agents in the eldercare industry.

“The way (dementia) care services have historically been delivered is wrong,” he says. “People should not be slumped over and drooling in ‘feeder’ chairs. They should not be put in some corner, they should not be misunderstood, and they should not be overmedicated.

“Yes,” he continues. “There is a place for the proper use of medications. But medications should not be used to control the behaviours (of people who live with dementia) because we don’t know what else to do with them.”

Shook is right. Psychotropic drugs (including antipsychotics) are prescribed to elderly people living with dementia to sedate them into compliance. Experts worldwide agree this practice must stop.

We must take collective action to break down the barriers that stand in the way, and replace sedation with compassion, understanding and engagement. That’s what Shook and Silverado co-founder Steve Winner are trying to do in their facilities.

“When you reduce the medications people take, a lot of the side effects go away,” Winner says. “People who were apathetic, lethargic, couldn’t walk or were even bedridden suddenly awaken from the fog. They’re able to move around, strengthen their legs, and get out of their wheelchairs. The change can be dramatic.”

Addressing the use of dangerous and largely ineffective antipsychotic medications is the first step to better care. Here are 20 ways care facilities can improve their performance:

  1. Make love a core operating principle
  2. Leave the biomedical model behind
  3. Stop giving people with dementia antipyschotic medications
  4. Treat residents like adults, not children
  5. Call people by their names, not “pet” names
  6. De-institutionalize institutional environments
  7. Discover and cater to residents’ interests
  8. Engage residents in age-appropriate activities
  9. Encourage exercise and sensual experiences
  10. Ask residents to bring their pets with them
  11. Care more for people than tasks
  12. Support personal growth
  13. Uplift and celebrate, don’t diminish
  14. Use music, dance and movement
  15. Create a “positive-normal” environment
  16. Make days fun, not endless drudgery
  17. Hire employees based on heart, values and a desire to make a difference
  18. Invite employees to bring their children to work
  19. Be passionate and compassionate
  20. Foster a culture of innovation

Watch these approaches at work in this video by Dr. Cathy Greenblatt, sociologist, photographer, and author of Love, Loss and Laughter: Seeing Alzheimer’s Differently:

Is Silverado perfect? No, of course not.

Sadly, even a strong commitment to the highest standards of care may not eliminate the horror of elder abuse or inevitable accidents.

In 2010, a former Silverado employee was sentenced to life in prison for events related to the death of a resident and the abuse of others in 2007. Tragedies like these occur because it’s virtually impossible to know what happens between residents and care workers without around-the-clock CCTV monitoring, which is something I would support for all long-term care facilities.

Well-intentioned senior executives may be unaware of what really goes on in in their establishments when watchful eyes are averted. Elderly people with dementia are extremely vulnerable and unable to report how they are treated; care is only as good as the individual care workers who provide it, and individual facilities are only as good as the on-site management teams that run them.

No system or place is one hundred percent infallible.

“We had no clue of his actions,” Loren Shook is reported to have said at the time of the former employee’s trial. “In every way he looked like the model caregiver. He had all the characteristics of a sociopath. No one can determine the problems until they see the trail left behind.”

This is indeed an issue. Abuse is usually perpetrated when there is little chance of it being observed, and colleagues who witness it by chance may be reluctant to report fellow workers for fear of reprisals.

Also in 2010, a resident was found in walk in refrigerator after having “gone missing” at a Silverado facility. Accidents like these become more likely when facilities stop using physical and chemical restraints. The risk, in my view, is worth the benefit of people being enlivened rather than diminished.

Perfection is impossible.

That doesn’t mean we should stop striving to achieve it.

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4 thoughts on “20 paths to dementia care homes away from home”

  1. Great post with a great list of areas to focus on. I believe Silverado is a great and well-intentioned organization with far more positives than negatives. I recently attended my fourth Wine and Watercolor event with them where they auctioned artwork created by their residents. They have also started a program specifically to help maintain cognitive abilities with residents. In fact, I may also start volunteering for them soon – yea.


  2. Great article and am so impressed with their approach to working with all dementia types but am discouraged as they have no facilities here in Florida and no plans as of now to approach this market. Not many independent memory care facilities available and about the only ones are the properties run by Brookdale, and I personally am not impressed with their approaches.

    Many thanks for this article!!!!


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