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Facilities evolve to meet changing clinical needs

Seniors heading to assisted living facilities present different clinical needs than they did years ago.

“We’re seeing people come in much more frail, needing much more supervision, guidance and structure in their day,” says Laura Hollenbeck, director of assisted living for St. Ann’s Community, which cares for seniors in facilities in and around Rochester.

That frailty results from the greater frequency of chronic illnesses—from diabetes to Alzheimer’s disease—among those who walk through the facilities’ doors. In response, these sites have physically expanded or added new programs to help their charges continue to live as independently as possible despite their ailments.

The advance of years always brings some form of decline, no matter how healthy a lifestyle might be.

“All of the organ systems tend to lose their reserve over time and become more fragile,” says Dallas Nelson M.D., medical director of the UR Medicine Geriatrics Group.

At the same time, advances in medicine have driven up the average lifespan, giving age-related ailments greater opportunities to develop or emerge.

“As people are living longer, our seniors are going to have more chronic conditions,” says Jeff Sweeney, director of assisted living and memory care for the Village at Unity, a Rochester Regional Health System affiliate that provides residential care for local seniors.

Senior citizens as a group experience higher rates of heart disease, osteoporosis, diabetes and other chronic physical ailments, including those that cause cognitive dysfunction. According to the National Institute on Aging, 5.1 million of the 5.3 million Americans estimated to suffer from Alzheimer’s in 2015 are 65 or older.

Residential communities that provide some form of care for seniors fall into three basic categories: independent and assisted-living communities and skilled nursing facilities. Assisted-living communities serve those who can no longer live completely independently, but do not need the intensive personal assistance and medical care that skilled nursing facilities offer.

“Anybody who moves into assisted living is looking for assistance with medication management, daily activities such as meal preparation, housekeeping, laundry services, as well as personal care assistance,” Hollenbeck says. “They can take advantage of all, or just a few, of those items.”

Facilities generally offer on-campus apartments or cottage homes where residents can use a range of assistance amenities. Aides and other staff are available 24/7 to take care of residents’ immediate needs and monitor them for changes in their medical or mental conditions. While most assisted-living facility residents retain their own primary care physicians, other medical professionals are either on-site or available nearby.

In addition to striving to meet their residents’ physical needs, assisted-living communities also try to provide the kinds of social and physical activities that can make their stay more pleasant and beneficial. St. Ann’s, for example, brought a wellness coach aboard about two years ago to enrich the days of all of its residents.

“We focus on health and wellness and preventing those plagues of old age: boredom, loneliness, isolation,” Hollenbeck says. “Daily, we try to do mind stimulating, physically stimulating and emotionally stimulating activities.”

Assisted-living communities have increasingly focused in recent years on helping seniors who are suffering fromdiseases that attack the brain. According to Sweeney, the Village at Unity features 20 apartments for those in need of memory care, many of which are occupiedby those who suffer from Alzheimer’s or cognitive impairments related to Alzheimer’s.

“There’s a lot of forgetfulness,” he says. “They need more structure, there’s a lot of reminding, and a lot more personal care attention is provided to them.”

St. Ann’s 24-bed Rainier Grove Memory Care Center is another facility that offers the kind of environment needed by those suffering from cognitive diseases. While the center’s residents might retain many of their capabilities, its exits are alarmed to prevent them from wandering.

“They’re up and around, they can feed themselves, enjoy the lifestyle, enjoy activities, but yet would be unsafe if they were to go outside for a walk,” Hollenbeck says. “They wouldn’t find their way back.”

Rainier Grove’s primary care aides help its residents in ways that often transcend those found at mainstream assistive living care—for example, by respectfully reminding them to engage in simple daily tasks.

As important as such assistance might be, the aides and other staff try to avoid doing too much for its residents. Instead, they encourage them to perform simple personal tasks.

“We try to promote as much independence as possible,” she says.

Such assistance is labor intensive; Rainier Grove operates with about double the staff of St. Ann’s mainstream assisted-living facility.

Other Rochester-area assisted-living communities also encourage their residents to engage in simple tasks such as folding laundry or setting the table for meals, which were once part of their lives.

“You work to preserve skills,” says Nancy Smyth, executive director of the Rochester Presbyterian Home Inc. “Allowing them to do as much as possible is one way.”

Since Smyth came to the Rochester Presbyterian Home nearly 20 years ago, the institution has greatly increased the number of assisted-living beds available for those suffering from dementia on its main campus in Rochester.

“When I first started, we had one 22-rooom floor that was for folks with dementia,” says Smyth, who refers to her charges as “elders.” “Now I have three floors. That’s 65 elders with early to mid to advanced dementia.”

That is also more than double the population of the facility’s mainstream assisted-living residence. A second, separate community in Chili, Memory Care Residences at Cottage Grove, provides care for another 52 residents who have been diagnosed with dementia. The increased availability of such care appears to reflect profound changes in the way the residential care community views seniors who are suffering from such illnesses.

“Twenty years ago, none of the folks had memory problems, because they all would be in nursing homes,” Smyth says. “Now, we are able to provide memory care at the assisted-living level.”

Those in assisted living also benefit from the philosophy that guides the Rochester Presbyterian Home.

“Our elders are engaged in defining the way life is lived, rather than having the institution dictate the routines,” Smyth says. “They come here to grow and to live and to feel connected and to have what may be their final years be fulfilling.”

Memory care is not the only change that assisted-living facilities have made in recent years. About two years ago, St. Ann’s became licensed to provide enhanced assisted living for qualified residents. Since then, the institution’s assisted-living staff members have been able to perform simple routine maintenance—cleaning and the like—of residents’ oxygen equipment, catheters and other devices. As a result, those who have such devices need not go to skilled nursing facilities.

“These people can still enjoy the lifestyle here, at assisted living, with that being their only need,” Hollenbeck says.

Other sites also have obtained enhanced assisted-living licensure, but the focus on providing help to those suffering from diseases like dementia remains on the forefront.

“We’re just in the process of developing this memory-support program,” says Lloyd Theiss, executive director for the Highlands at Pittsford and Ferris Hills at West Lake, two University of Rochester Medical Center affiliates.

Mike Costanza is a Rochester-area freelance writer.

7/17/15 (c) 2015 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email rbj@rbj.net.

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