The Situation:
Wanting to maximize the opportunities and changes that a new, state-of-the-art 420-bed skilled nursing facility would bring to the lifecare retirement community of John Knox Village, leadership of the health services division decided to examine multiple care delivery models.
The Solution:
In addition to touring a number of new facilities in the United States, John Knox Village executives formed a partnership team with faculty from Central Missouri State University and the Swedish Gerontology Institute in Jonkoping, Sweden (Ken Bast and Sandra Grant were both members of this team). One outcome of this partnership was a 10-day tour of services and care options for the elderly in Sweden. The team reviewed both day care and 24-hour care for patients with progressive dementia. They visited independent housing apartments for the elderly, skilled nursing level hospitals, service houses and a geriatric assessment center. (Service houses are somewhat similar to assisted living except that residents live in a residential rather than institutional setting and have lockable doors) Meetings with researchers, physicians and other Swedish health care practitioners provided insight on how care might best be provided to older adults in a community setting.
Two care options reviewed in Sweden provoked the team*s interest. At that time Sweden was de-institutionalizing care for the elderly. The government purchased small homes in residential neighborhoods and moved elderly patients and their caregivers into the homes. At one of these, which was used as a day care facility for individuals with progressive dementia, the team noted that the participants appeared to act normally and were more able to carry out day-to-day functions than would have been expected due to the stage of their disease. Swedish researchers pointed out that undesirable behaviors declined in dementia patients when they were cared for in small groups and in a home-like environment where they could continue life patterns they had established earlier in their lives.
In service houses visited in the Jonkoping area and in Stockholm, the team again noted a high degree of functioning among the elderly residents. Special features designed into the apartments permitted protective oversight of the residents without intruding on their privacy and allowed the residents to continue to live independently even when strength and the ability to ambulate was declining. The architectural layout of the buildings and the placement of hardly-noticeable seating installed along corridors and in elevators permitted residents to remain independent even when their ability to ambulate had declined substantially.
Following this tour of Swedish facilities, the team returned home and began meeting with architects to design a portion of the planned skilled nursing facility into an Alzheimer*s unit and to develop independent and assisted living along the lines of the Swedish service houses. The Alzheimer*s unit was designed as a cluster of bedrooms surrounding a living room, dining and kitchen area (for resident use). The Alzheimer*s unit was divided architecturally to give the feel of two small group homes rather than one large unit. It included a private garden and all activities were designed to allow residents to continue to do those activities they had enjoyed earlier in their lives.
Six months after the opening of the new Alzheimer*s unit, staff reported that residents were calmer, easier to manage and required less medication than formerly.