Two women with mild dementia enjoy an occasional ride through their retirement community at the back of a golf cart. One day they pass a tree in bloom, and it fascinates them. The color of the blossoms reminds one woman of the other’s high school prom dress. They talk of how lovely each other looked that night many years ago, and they recall their prom dates and the joy of the dance.
The memory delights them, although they never went to prom together. In fact, they only met recently.
“Reality is overrated,” says Kay Kallander, senior vice president of American Baptist Homes of the West and founder of the company’s acclaimed memory support program, The Grove. “Feelings are more important than reality. Untrue stories, which come with dementia, can provide sweetness and comfort.”
Rather than correct the stories, staff at The Grove enter the world of the residents, Kallander says. There is no need to be right. The intent is not to fix residents. Here, the focus is on abilities rather than disabilities – and the ability to tell a good story is a great place to start.
“We believe that rational thought is not the only way to experience or measure a good life,” Kallander says. “The stories that people with dementia tell convey feelings, and these feelings are a meaningful form of expression. So we enter their stories in a gentle way.”
ABHOW’s unique approach to caring for people with Alzheimer’s and other dementias has captured the attention of senior living leaders in the U.S. as well as international researchers who are struggling to address the symptoms of a disease for which there is no known cure. These leaders are intrigued by ABHOW’s model because of the results: improved physical health, decreased wandering, less agitation, better sleep patterns, stronger interpersonal relationships, and less use of medications to control moods and behaviors.
More than five million people live with Alzheimer’s in the U.S. As 78 million baby boomers enter their sixties, the prevalence of Alzheimer’s will skyrocket. According to a recent report, the Alzheimer’s Association estimates that someone in the U.S. develops Alzheimer’s every 72 seconds. By mid-century, the overall number could reach 16 million. That means someone will develop Alzheimer’s every 33 seconds.
“Families are desperate to keep their loved ones safe and cared for,” Kallander says. “Many search helplessly for an alternative to physical restraints and the fog of medications. But until now there have been few choices. The Grove is a sign of hope.”
Searching for An Angel
The seeds of The Grove were planted more than 20 years ago when Kallander joined the staff of ABHOW’s Plymouth Village community in Redlands, Calif. First as director of nursing then assistant administrator, Kallander encountered a huge need for dementia care. Caregivers were worn out, and large skilled nursing facilities were not set up to handle the special issues of residents with dementia.
In 1991 Kallander returned to the University of Redlands to pursue an MBA. Her research focused on developing a special care unit at Plymouth Village. “I was determined to create a financially viable program to meet the needs of residents while providing dignity, care and support,” Kallander says.
Upon completion of her degree, she was promoted to executive director. But funding was not available for the vision. “However, that did not stop me,” she says, “and I began speaking at every service group, church and anyone who would have me to tell the story and why we needed to build this special place.”
In 1994, President Reagan’s announcement that he had Alzheimer’s raised the nation’s consciousness of the disease and opened up new conversations. Still, advances in special care settings were minimal and funding was scarce. After two years of beating the bushes, aware that she had other community issues to attend to, Kallander threw up her hands in frustration. “I said, ‘OK, Lord, I have tried to do this and I just can’t. If you want this built, you will have to send me an angel with a checkbook. I give up.’”
That very afternoon a stranger came to visit Kallander. He wanted to thank Plymouth Village for the care given to his father, then a resident of The Health Center. He wanted to give a gift, which Kallander assured him was not necessary, but he insisted. So Kallander reached inside her desk for the wish list. “He said, ‘Put that away. Tell me what the most important thing in your heart is,’” Kallander recalls. “Without hesitating, I heard myself say, ‘I want to build the special care unit to take care of residents with Alzheimer’s disease.’”
The man asked what she needed, and Kallander said $150,000. “If I gave you $50,000, would that help?” the man responded. Kallander’s answer was a definite yes. The next day, the man returned, saying he’d been thinking about what she said. He handed her an envelope with a check inside – for $150,000. “Tears came to my eyes when I realized he was an angel with a checkbook,” she says.
The donor didn’t want any recognition for his gift, but Kallander pressed him to reconsider. He finally agreed on a small plaque in the building to honor his parents. Kallander found other ways to recognize the gift. The man had followed in his father’s footsteps as a Redlands citrus grower. Hence, the name: The Grove. And when the center opened in July 1996, six small orange trees were planted outside to remind the community of one man’s generosity.
Creating A Memorable Home
Paul Jepson was the first manager of The Grove. He guided the staff in creating a homelike feel in an intentionally designed environment for 12 residents. The kitchen and living room are open like a Great Room, allowing residents to engage with each other and staff in meal preparation and other household chores.
Outside each resident’s room is a window box with personal memorabilia: photos and objects that remind the resident this is his or her room. Inside the rooms are other visual cues. For instance, linoleum is extended a foot beyond the bathroom door to signal the entrance to the bathroom. Closets are built to help residents with the sequence of dressing.
In this setting, staff members celebrate the normal activities of living: friends, meals, familiar chores. “Our aim is to create a setting that makes residents feel safe and comfortable plus plays to their strengths,” says Jepson, now ABHOW’s assistant vice president of care services.
The Grove provides increased opportunities for socialization because it’s a much more relationship-based program, Jepson explains. Relationships are nurtured between residents as well as between residents and staff. For staff, that means being available and flexible. The typical nursing schedule doesn’t work here. The activity program is really 24-7. “The day is theirs to live, not ours to schedule,” Kallander says.
“In the past, if you woke in the night, staff would give you drugs to help you go back to sleep,” she explains. “Now, we enter your world. We’re on your schedule rather than expecting you to be on the staff’s schedule. Instead of complicating a person’s life, we’re participating in it.”
ABHOW has learned there is no value in reorientation for someone who is confused. “I don’t care what day it is, who the president is, because it won’t stick,” Kallander says. “I won’t remember. So, again, we enter the world of the resident. If they believe it’s 1949, we enter into that.”
The Grove is a social model rather than a medical model. As such, the program requires a unique staff, Jepson notes. A heart for residents is more important than specific medical training. Once they are hired, new employees are oriented to The Grove’s philosophy of care. At the top of the list is the belief that every human being is “valuable, precious and unique” – and therefore deserving of dignified care.
Because the program focuses on abilities instead of disabilities, The Grove customizes its activities around “overlearned skills,” habits cultivated throughout a lifetime. For instance, matching socks is an overlearned skill. So when folding the laundry, staff members enlist residents in pairing the right socks.
Overlearned skills often connect to the jobs or passions residents once had. One man was a university department chair who hired faculty each fall. At The Grove, he enjoyed the task of interviewing residents and staff. Another resident slept in until the staff learned she had been a gracious host. Given that role at The Grove, she woke up each day and got ready to greet people.
Grove staff learn another important principle: joining the residents’ reality, wherever that might be, is an opportunity and privilege for staff and families. “Once we train employees in these concepts, they own The Grove,” Kallander says, “and they create home for these residents.”
Seeding the Future
Ten years after founding The Grove at Plymouth Village, ABHOW is seeing the fruits of its labor and planting seeds elsewhere. When The Grove started, no one had a social model for dementia care. Kallander couldn’t find any examples for her thesis, so she had to envision something entirely new. Now, the model is sprouting up in many places.
Senior living industry leaders in California and at the national level have drawn attention to the program. Researchers from Japan traveled to Redlands to observe The Grove. Three years ago, Kallander went to Australia as part of a Rotary International-sponsored trip to tell ABHOW’s story. She was invited to address the ambassador of France.
ABHOW itself has introduced The Grove at four additional locations: Valle Verde in Santa Barbara; San Joaquin Gardens in Fresno; The Terraces of Phoenix; and Thomas House in Washington, D.C., which is now operated by another company. The latest project is in development at Judson Park in Des Moines, Wash.
“A memory support unit is a special program that supports not only the resident but also their families,” says Russell Akiyama, Judson Park’s executive director. “It is another opportunity for Judson Park to be of service to our community.”
As ABHOW grows its model, Jepson says it will be important to ensure the same level of quality in each location. “One of our goals is to monitor our current programs to maintain a high standard both in terms of staffing and buildings,” he says. Toward that end, the company is standardizing its training for Grove employees. Later this year ABHOW will test an online training program for three of the communities.
The bottom line for ABHOW is that The Grove is working. The unique approach is less expensive than traditional nursing care, according to Jepson. And the quality of the experience reduces stays in skilled nursing. Financial, program, and building components have proved successful, Kallander adds.
Above all, residents and their families have found a setting that enhances quality of life by affirming this time in life. Perhaps no feature of The Grove at Plymouth Village better symbolizes ABHOW’s philosophy than the beautiful enclosed garden with a wide, fully lit circular walking path. No matter which way you head out, the path always brings you back home.
“For all those whose lives are touched by severe memory loss,” Kallander says, “The Grove is a blessing. It truly brings home peace of mind.”
