It’s manicure day, and a group of women gather in a sunny, comfortable room to talk, enjoy some pampering, and show off their personal style. The women live at The Grove, the memory support program at San Joaquin Gardens in Fresno, Calif. And the people chatting away with them as they strip off old fingernail polish, massage the women’s hands, and paint on fresh color are the staff members who initiated this weekly ritual. 

Manicure day is just one of many ways ABHOW’s four Grove programs help their residents continue activities they have enjoyed all their lives and — even more important — feel the sense of safety, security and pleasure that comes from being surrounded by friends.

The Grove serves people with Alzheimer’s and other types of dementia. Since ABHOW pioneered the program in the mid-1990s, person-centered care has been its hallmark. Over the last year and a half, dementia care expert David Troxel has helped The Grove strengthen and consolidate that philosophy with the highly respected Best Friends approach he developed with Virginia Bell.

ABHOW recently became the first multisite organization in the nation to receive CARF-CCAC accreditation for dementia care, and the organization’s evaluators frequently mentioned Best Friends as an exemplary practice.

The Best Friends model is a radical departure from the institutional approach that once constricted the lives of people with dementia. Like many revolutionary ideas, it’s based on a simple insight, the belief that what someone who struggles with loneliness, disorientation and fear may need most is a best friend, a caregiver who knows him or her well.

To illustrate, Troxel recalls sitting down for lunch at The Grove at Plymouth Village in Redlands, Calif. He noticed the woman next to him wasn’t eating her spinach, and he asked whether she liked it. She said she did, but then elaborated, “I’m from the South, and in the South we like a little vinegar on our greens.” The staff promptly bought her a 99-cent bottle of vinegar, which not only encouraged her to eat more vegetables but also helped her feel special and cared for.

Attention to such seemingly small things can foster happiness, cooperation and trust, says Troxel, who co-authored with Bell four influential books, including The Best Friends Approach to Alzheimer’s Care. When staff members know a resident’s life story – his or her likes, dislikes and areas of expertise – they can tailor activities accordingly. 

Take for instance Olga Nasstrom, 85, who has lived at San Joaquin Gardens for four years, two of them at The Grove. Earlier in her life, she enjoyed parties, eating out, exercising at Curves and being involved with her church. Grove staff members approached her daughter, Tricia Matthews, to ask if they could start taking her to the gym on site two or three days a week.

“It was awesome,” says Matthews. “Of course I didn’t mind! It’s so exciting that they took a personal interest in her health and wanted to get her more active.”

Since the gym visits began, Matthews has noticed a marked improvement in her mother’s mental and physical health.

Nasstrom also goes regularly to Sunday services at the community’s Fellowship Hall, and earlier this year she attended a Super Bowl party that Matthews says was just like one she might have hosted in her own home. For a while, she even had her dog with her at The Grove.

Staff members “go out of their way to continue the lifestyle many of the residents used to have,” Matthews says.

Staff knowledge of residents’ life stories can have a deep impact, says Paul Jepson, ABHOW’s assistant vice president of care services. “For residents with dementia, having someone really focused on them, and feeling that it’s a relationship and not just a caregiver, is very important to them. It provides the element of emotional support — it’s a sense of security for them.”

Now, Troxel is helping ABHOW establish a daily program called Touch the Spirit. He believes that because people with dementia have lost much of their cognitive power and so tend to be “in the moment,” they often draw particular benefit from spiritual activities, broadly defined to include prayer, creative endeavors, time in nature and connections with family.

Besides those at San Joaquin Gardens and Plymouth Village, ABHOW has Grove programs that incorporate Best Friends principles at Valle Verde in Santa Barbara, Calif., and at The Terraces of Phoenix, Ariz. By 2014, the company plans to meet a rising need by creating similar programs at each of its continuing care retirement communities. The Alzheimer’s Association predicts that the number of new cases diagnosed each year will grow from about 400,000 in 2000 to more than 950,000 by mid-century.

Kay Kallander, ABHOW’s senior vice president for strategic planning, first conceived a different approach to dementia care while working towards an MBA at the University of Redlands. A nurse, she was appalled to see people with memory issues confined to patient rooms on long hospital corridors and kept sedated with psychotropic medications. Her research led ABHOW to develop The Grove, where private rooms surround a comfortable living room and kitchen, and where the staff relies chiefly on an interactive, social approach to resident care.

The Best Friends approach was a perfect fit for Kallander’s idea of person-centered care. “Best Friends really looks at each person from a holistic point of view – the spiritual piece, the physical piece, the entertainment piece,” she says.

Best Friends emphasizes preserving each resident’s dignity, while using personal knowledge and the staff ingenuity Troxel calls “knack” to work with the challenging behaviors that sometimes come with memory loss. “The knack is defined as the art of doing difficult things with ease,” he says. “ABHOW staff do that every day with humor, flexibility, patience and love.

“Knowing their life stories, creating a warm and homey environment, and offering creative activities like Touch the Spirit reduce the challenging behaviors that sometimes come with Alzheimer’s disease. They help us go from a no to a yes.”

Best Friends training helps Grove staff members develop strong bonds with those they care for. Tricia Matthews says the caregivers treat her mother as they would their own. “She even kisses them goodbye when I take her for an outing. Who could ask for more than that!”