| Silverado Senior
Living and its new Alzheimer's community operate under a unique concept
that allows residents to control and take responsibility for daily
activities. As a result, residents are given a sense of "life
purpose" that keep them interested and involved and leading
happier, more fulfilled lives.
To stimulate cognitive and physical
capabilities and to make each day a satisfying experience, the
Escondido, California, facility provides individualized activities
consistent with the normal routine and rhythms of others in the same age
group. These include intergenerational programs and music, care of
on-site pets and vegetable gardens, and the use of a country kitchen and
workshop for hobbies. Residents are responsible, with the help of the
staff, for feeding the pets, watering the plants and performing other
daily activities.
Some programs, such as the morning session
when residents review the day's news, have a set time. However, many
activities, from light exercise to folding clothes or working in the
hobby shop, are set at a pace and schedule that meets the individual's
needs and desires on a day-to-day basis. Residents are also encouraged
to help each other, as they often develop a better sense of confidence
and improved self-esteem from assisting others.
Less Medication, No Restraints
"Many assisted living centers are not
designed to deal with the significant behavioral and physical problems
that often accompany Alzheimer's and other forms of dementia," says
Loren Shook, president and chief executive officer. "We do not
restrain residents, and we are working diligently with our residents'
physicians and families to minimize the use of medications."
The staff are taught that by giving residents
choices and meaningful activities to do, they can often distract the
residents from feelings of frustration. By working with a resident in
the garden or by helping a resident bake cookies, a staff member not
only helps that person find something enjoyable to do but also creates
an outlet for personal energy. This adds to the resident's quality of
life, contributes to his or her happiness, and helps the individual
control behavior. 
Interactive gadgets distract AD residents from behavioral problems
without necessitating drugs or restraints.
Since the community's opening in June 1997,
Silverado's unique approach has already resulted in several success
stories. One gentleman who came to the facility had not walked for
several months after having hip surgery. At his previous facility, he
had been fully restrained and placed on high dosages of psychotropic
medications in order to control behavioral problems. He was never
restrained at Silverado and was standing within two days of admission.
Within a week, he was walking and psychotropic medications were reduced
by half within a month.
"Our results are spectacular but the action is simple -
when people are in a positive, caring environment where they find a
sense of purpose and are expected to succeed, great things
happen."
"Silverado expects progress from its
residents and never gives up on anyone," says Stephen Winner,
administrator. "Families bring loved ones who have not responded
well to therapy or who have had severe behavioral problems at other
facilities. Our results are spectacular but the action is simple-when
people are in a positive, caring environment where they find a sense of
purpose and are expected to succeed, great things happen."
"There is a myth that once an Alzheimer's
patient reaches a certain point, you can't do anything with them,"
says Winner. "That's not true. These men and women just need extra
encouragement and interaction. Otherwise they may sit alone in their
rooms and become the forgotten people. You have to look; and when you
do, you will see how much of this person is still left. You can continue
to give them responsibility and purpose for their lives up until the
very final stages of the disease."
Silverado accepts many people who are beyond
the capacity of traditional assisted-living facilities and residents
with walkers or wheelchairs are welcome. By providing 24-hour licensed
nursing care, Silverado ensures that the health of residents is
maximized and that they are allowed to age in place. With extra support
and hospice assistance available, Shook expects that 90% of Silverado's
residents will be able to live the remainder of their lives under the
community's care. This is a relief to families who understand the trauma
caused by moving a resident in the advanced stages of Alzheimer's
disease.
Research and Innovation
Silverado's programs and residents benefit from
the expertise of Dr. J. Edward Jackson, director of University of
California at San Diego's Alzheimer's Disease Diagnostic and Treatment
Center. The center offers the finest expertise and most updated
information in the area of Alzheimer's care and treatment. Additionally,
the university's dementia experts work in conjunction with Silverado's
staff to establish clinical outcomes measurement. Silverado also works
with Seniors Only Care, a program that provides comprehensive assessment
and treatment plans administered by a team of highly skilled geriatric
specialists. This thorough evaluation identifies current and potential
problems and makes realistic recommendations for assistance and
treatment.
Intergenerational programs and enclosed garden paths allow residents
to continue leading meaningful lives. Many
of Silverado's programs and care techniques are highly innovative
concepts in the care of people with Alzheimer's and other dementias.
Others are simply common sense. The founders developed a set of core
values to which the company is committed. Each of these elements
provides a conducive, less confusing environment and more affordable
alternative for the care of loved ones living with Alzheimer's or
dementia.
Ten Core Values
- Recognize value and build the human spirit in all we do. Silverado's
staff is trained to deal with residents in positive, life-affirming
ways. "Each person in our community has so much to offer, and
so much of the true person is still there," says Winner.
"Our job is to find that person, enjoy all they bring to our
lives, and help make each day a full and meaningful experience for
them."
- Staff and residents are family. The barriers of the nurses'
station have been torn down and replaced with a country kitchen. Not
unlike a family's home, the kitchen serves as a gathering spot. The
staff can sit down to complete and review paperwork or help a
resident bake cookies. Residents roam freely through the kitchen,
where they are welcome to pick up a piece of fruit or just sit and
talk with the staff.
- Residents respond to expectations. Every opportunity is
taken to give the residents a sense of purpose. Former businessmen
have even put on suits and sat around the table with pads of paper
to brainstorm. By placing the residents in a familiar and productive
setting, the center's experts have found that they can stimulate the
thinking process. Activities such as these also return a sense of
dignity, as the residents find themselves in a setting they regard
as important.
- Getting Alzheimer's (or any long-term disability) does not mean
the end of living. Silverado uses plants, animals and hobbies to
create useful interactive activities that provide life purpose.
Without responsibility and a reason to get up each morning, anyone
would lose interest and become despondent. These activities curb
boredom and provide a sense of value to residents who have tasks
they are expected to accomplish each day.
- Retain and build family unity through understanding and
positive action. A masterlevel social worker assists families in
understanding and living with their loved one's condition. There are
also physician-led support groups, educational seminars, respite
care and opportunities to participate in resident care meetings. The
center offers free meals to family members and private dining rooms
in which to enjoy them. Family interaction is also encouraged
through planned events such as the community barbecue.
- Accommodate behavior as opposed to controlling it. The
staff adapts to live with resident behavior, as opposed to trying to
control behavior with medications or restraints. For instance, the
center has interactive devices on the walls. Some devices allow
residents to listen to a phone that plays music; others have beads
inside, which flow through mazes when a giant wheel is turned. These
capture residents' attention. If a resident is experiencing a
behavior problem, a staff member can redirect the individual to the
interactive device in order to distract them.
- Provide the level of care we would expect for our own loved
ones. Residents often behave in disorderly ways because they are
unable to effectively communicate that they are experiencing some
kind of pain or discomfort. Silverado has extra medical support that
helps to rule out any physical problems that might be causing
problem behavior. Director of Health Services Wendy Hull, RN, has
five years' experience with Alzheimer's care and there is a licensed
nurse on every shift. Few assisted living centers have licensed
nurses on-site at all times or one with Hull's experience.
- Freedom is a right that everyone deserves. Residents are
given plenty of freedom to roam. A consistent trait among
Alzheimer's residents is the need to move somewhat constantly. Every
Silverado facility is a single-story building with open doors that
can be accessed freely and convenient, well-landscaped walking
paths. Extensive outdoor areas are rarely accessible in most
assisted living or nursing facilities, which tend to be multi-story
buildings.
- Cognitive stimulation is essential. Staff work with
residents to stimulate the memory process. Residents work with
memory games, music and photo albums to help them stimulate memory
as much as possible. Outside each resident's room is a memory box,
which contains pictures of the resident at younger ages and mementos
from the past. These boxes are of great assistance in helping
residents remember which is their room and is another attempt to
give them back a sense of control in their lives.
- Little luxuries can mean a lot. Extra measures are made to
make the residents more comfortable, such as providing a spa
atmosphere in the showers and baths, including soothing music,
aromas, plants and decor. Residents are encouraged to decorate their
own rooms and bring in their own belongings. The residential feel of
the community is enhanced by the gardens, patios, gazebo and walking
paths. Indoors is equally inviting with a comfortable family room,
living room, separate dining areas and the country kitchen.
- Weight loss does not have to be an automatic result of
Alzheimer's. In many facilities, weight loss is an ongoing
problem. Because Alzheimer's patients are often restless, it is hard
to get them to sit down and have a substantial meal. At Silverado,
food is available at all times. Fruit, crackers and other snacks are
always available in the country kitchen, which is also available for
residents to cook their own meals, with staff assistance, if they
prefer.
- There is dignity in calculated risk. By creating a friendly
atmosphere and maintaining a ratio of one caregiver per seven
residents, Silverado can offer a sense of personal freedom. Although
this involves inherent risks, it also adds unquestioned quality to
the resident's lives. Unnecessary risks are never taken and the
staff is constantly aware of what each resident is doing.
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