Assisted Living Centers Can Do More for Dementia Patients, Experts Say
U.S. assisted living facilities often have activities to keep seniors socially engaged -- but a new study says they need to ensure that residents with dementia are not left out.
Researchers observed residents and staff at four assisted living communities over the course of a year.
They found that a few factors stood out as key to keeping residents with dementia socially and mentally engaged day to day. Getting to know the residents as people -- and not only dementia patients -- was "foundational."
Basic care and safety are always essential, said lead researcher Candace Kemp, a professor at Georgia State University's Gerontology Institute.
"But we also want to treat people like people," she said.
That means knowing something about residents' backgrounds, like their occupation before they retired -- as well as their interests, likes and dislikes. Beyond that, Kemp said, it means observing individuals during daily routines, and noticing how they respond to different situations or try to communicate.
In one example from the study, a staff member said, "When Emily's about to get really fretful about something, she'll sit there biting her nails. ... Then she's looking out the window. Then she wants to get your attention."
Kemp's team found that when staff, volunteers and family members were able to "be in the moment," and change up activities or discussions when needed, residents benefited. And residents, themselves, underscored the importance of meeting them "on their terms," the researchers found.
One resident said, "If I see where I can do it successfully, I'll do it. If I see I can't do it successfully, I'll just turn it down."
Group activities and outings are part of life at many assisted living facilities. The communities in the study regularly offered arts and crafts, live music, games, religious services and chances for residents to exercise, talk or watch movies.
"But what's meaningful to one person may not be to another," Kemp said. "With group activities, it's hard to get everyone engaged."
Dementia adds another layer, she pointed out. People may be frustrated by a game, or find music too loud, or feel uncomfortable in a large group.
"So residents with dementia can be left behind," Kemp said.
Small-group activities can be one way to address that. But informal interactions between residents and staff and volunteers, or with each other, are vital, too.
"In my opinion, meaningful engagement is less about the formal activities, and more about the spontaneous daily interactions," said Sam Fazio, senior director of quality care and psychosocial research at the Alzheimer's Association. He was not part of the study.
The association has laid out recommendations for assisted living residences and nursing homes on how to achieve "person-centered" care. Fazio said the new findings align with those guidelines.
"It's no longer appropriate to just pull everyone into the room when it's Bingo time," Fazio said.
Informal interactions involve everyone, he noted, not just activity staff.
"Walking to the dining room can turn into a conversation about your time as a professor before you retired," Fazio said.
It sounds simple, he noted. But the importance of seeing the individual, Fazio said, can get lost when staff are focused on basics like dressing, medication and meal times.
The process of getting to know a resident can begin with a meeting of staff, family members and the person with dementia. But it's not just "one and done," Fazio said.
For one, what family members have to say about a loved one's likes and dislikes may not tell the whole story. And, Fazio said, people's preferences and needs change over time, as their dementia progresses.
Assisted living residences can vary widely from one to the next. In this study, the smallest had six residents while the largest had more than 100.
Similarly, staff training varies, Kemp said. And whether information about individual residents is disseminated among staff -- and put to good use -- would vary, too, she noted.
The pandemic has, of course, complicated everything. Restrictions intended to protect vulnerable elderly at care facilities have had the unfortunate effect of cutting them off from family and volunteers.
Those policies are starting to change, but much depends on where the facility is located, Fazio said. States regulate assisted living residences, he noted.
As things reopen, Kemp said, it will be even more important to focus on meaningful engagement for seniors who have been isolated over the past year.
The findings were recently published in the Journal of Applied Gerontology.
The Alzheimer's Association has advice on choosing residential care.
SOURCES: Candace Kemp, PhD, MA, professor, Gerontology Institute, Georgia State University, Atlanta; Sam Fazio, PhD, senior director, quality care and psychosocial research, Alzheimer's Association, Chicago; Journal of Applied Gerontology, March 3, 2021, online