| Building Memory Care Facilities Takes a Focused Approach | https://www.providermagazine.com/Articles/Pages/Building-Memory-Care-Facilities-Takes-a-Focused-Approach.aspx | Building Memory Care Facilities Takes a Focused Approach | <p><img src="/Issues/2021/May/PublishingImages/CF3_SeanMockbee.jpg" alt="Sean Mockbee" class="ms-rtePosition-2" style="margin:5px;width:146px;height:185px;" />Sean Mockbee, chief executive officer of View Point Senior Care, tells <em>Provider</em> that when making the decision to build and manage standalone memory care units, separate from assisted living communities, it is key to consider a few unique elements among the standard pros and cons of starting a new business in the long term and post-acute care space.<br></p><p>Mockbee first came into operating standalone memory care facilities in 2013 when his company bought a dedicated building, which led to buying a second mostly memory care assisted living community, and the opening of a third fully memory care unit that opened in March.<br></p><h2>A Competitive Challenge</h2><p>Despite the supply-demand pressures in the state of Arizona where View Point Senior Care operates, the competition for clients is only one supply challenge.<br></p><p>“I think operating memory care is not as lucrative as it has been in Arizona. We are not a certificate-of-need state, so there are beds galore and a lot of new development in the last three and a half years,” he says. There is also a lot of competition for staff, since the worker pool has not grown along with the supply of senior housing in the state.<br></p><p>“We are fighting for the same med techs, same nurses as everyone else and have had to increase wages like crazy to stay competitive,” Mockbee says. <br></p><p>When providers look at memory care-only, they should also know the ratio of staff to resident is much higher than in traditional assisted living, around a 6:1 ratio, he says.<br></p><p>“You cannot have a hallway of one or two for 25 people. Our labor rates are very high and maybe double what assisted living would require. It is all pure labor and workforce costs in memory care,” Mockbee says.</p><h2>Capital Needed for Memory Care</h2><p>In addition, there is the physical plant difference between memory care buildings and regular assisted living, he adds, with much more upfront capital requirements in play from the get-go.<br></p><p>“To keep memory care residents safe, you have added items like exit alarms, special locks, more cameras, and additional sensing around the campus so nobody can get out when wandering,” he says. “There is also the replacement cost of furniture. It is just a fact that memory care residents are harder on the furniture. There are also more incontinence issues, which lead to more replacement costs.”</p><h2>Why Get Started?</h2><p>With all of these challenges, there are of course more reasons on the reward side to get started in memory care. Mockbee points to a couple, one based on the culture of care and one based on the dollars and cents.<br></p><p>“For me, getting into memory care is about the residents and their families almost feeling more appreciative of what we are doing. These people need our help. The quality of life and quality of the setting that we have arranged specifically for those with dementia and Alzheimer’s is something the families and residents can see the benefits of doing,” he says.<br></p><p>On the business side, the memory care operation is mostly private pay. While there are operators who take Medicaid residents, many do not.<br></p><p>Mockebee’s campuses are also not small, with beds ranging in the 90- to 115-level, but for those operators that have memory care as a carve-out of a larger campus, the memory care space is usually a small slice of the pie.<br>“In a CCRC [continuous care retirement community] with, say, 250 assisted living beds, you may have 30 beds for memory care. The standalone buildings have a higher bed count,” Mockbee says.</p><h2>Focusing on Memory Care</h2><p><span><img src="/Issues/2021/May/PublishingImages/CF3_GeraldHamilton.jpg" alt="Gerald Hamilton" class="ms-rtePosition-1" style="margin:5px;width:145px;height:186px;" /></span>Nearby to Arizona is where Gerald Hamilton, owner and operator of Bee Hive Homes in Albuquerque and Edgewood, N.M., and Mesquite and Henderson, Nev., says he runs mainly assisted living communities, with one of the four facilities in Nevada a memory care-only community.<br></p><p>Only in operation since August 2020, the memory care building is still in fill-up mode, he says. Hamilton says he started the unit, which has room for 15 residents, because of the specific and different needs that those with dementia and other related diseases have in their day-to-day lives.<br></p><p>Like Mockbee, he points to the physical plant needs as a priority for those providers looking to enter the space, noting the costs can run fairly high when it comes to making the move into memory care-only. </p><h2>Building From the Ground Up</h2><p>One thing Bee Hive Homes did with their one standalone memory care building was to start from scratch, since Hamilton says modifying an existing building to take care of the security and monitoring needs in memory care is cost prohibitive when compared to building a new facility. <br></p><p>“Generally speaking, and each state is different. Memory care needs to have a limited access protocol to get into and out of the building. Most have keypads with electronic locks on the door and a combination to be able to get into the building and to exit,” he says.<br></p><p>Another consideration is the fencing needed around the campus. “You have to construct these so residents can get outside and enjoy the sunshine and fresh air without getting away from the building. We don’t have those considerations for general assisted living,” Hamilton says.<br></p><p>It is these costs and the staffing that generally lead to memory care getting 30 to 40 percent more on base monthly rates.<br></p><p>“If you renovate or remodel or build, you can get paid back fairly quickly with the increased rents that go into having memory care rooms,” he says. “It is all mostly private pay, but that depends on the state. I know of memory care owners in the Midwest who can do Medicaid as well, but in my state the Medicaid reimbursement rates are far below our private rates,” he says.</p><h2>Growth Prospects</h2><p>The outlook, Hamilton says, is positive for memory care-dedicated businesses, at least once the pandemic clears and operations and admissions return to some sort of normal.<br></p><p>“In another year or two when the sector stabilizes, there will be good growth opportunities,” he says.<br>In the end, the attraction for consumers is there when it comes to memory care because the families of those with the special needs recognize their loved ones require unique attention.<br></p><p>“They need a different environment and level of training from staff, and it takes more attention from more staff because residents often cannot communicate what their needs are on things like pain for example,” Hamilton says. “They may not be able to tell you that, and the provider has to know the resident and look for clues in their patterns and behavior.” <br></p> | ‘Getting into memory care is about the residents and their families almost feeling more appreciative of what we are doing. These people need our help.’ | 2021-05-01T04:00:00Z | <img alt="" src="/Issues/2021/May/PublishingImages/CF3_facilities.jpg" style="BORDER:0px solid;" /> | Memory Care;Architecture | Cover Feature | Patrick Connole | 48 | 5 |
| Designing Spaces for Memory Care | https://www.providermagazine.com/Articles/Pages/Designing-Spaces-for-Memory-Care.aspx | Designing Spaces for Memory Care | <p>COVID-19 has affected people and health care systems in multiple ways. Previous flu seasons and outbreaks have demonstrated the challenges of infection control and prevention for vulnerable populations living within the parameters of a closed community.<br></p><p>Meg Sutton, director of interior design at Direct Supply, says that while isolation was also felt during previous flu seasons, it has been a larger issue during COVID, which has led to more client focus on safely visiting family.<br>In her role within the design and construction arm of the company, Sutton works on technical and creative development, professional development of her team, business development and quality control, and memory care interior design.<br></p><p>“What we have seen come out of COVID in terms of design has to do with this idea of dividing\conquering, or creating smaller environments from larger environments,” says Sutton. <br></p><p>Generally speaking, memory care design has always been about limiting exit points and limiting the risk of elopement. “Here that’s still a concern, and it’s still something we incorporate into the designs we do, but now it’s also about how do you get people safely in and out of the building,” says Sutton. </p><h2>Changing Dynamics</h2><p>A priority nowadays for Direct Supply design clients has been how to enter spaces without traveling through other parts of the building, which is something that was not seen before. “Our challenge was how do you create an environment that allows you to see your family regardless of what’s going on in the outside world rather than having this locked-down mode,” says Sutton. <br></p><p>For memory care specifically, having separate entrances available for not only staff but also for families and visitors when allowed to enter into those sections of the building has been critical. “It’s been really important, and one of the ideas that we’ve come up with and that we’ve seen implemented in some areas is this idea of a transition space for memory care,” says Sutton. “This space should be adjacent to the exterior of the building, so again you’re not traveling through other areas of the building to get there.”<br></p><p>Think of a space where a resident, family member, an art teacher, or a visiting physician can enter the memory care space from the outside. “Your exterior space in general and outside space is your first line of defense,” says Sutton. “How you enter this transition space has become really critical to maintaining relationships outside the building.”<br></p><p>In an assisted living community, one may see a discovery room, a closing room, or even a hospitality suite. “Any of these could potentially be converted or otherwise adapted to that transition space,” says Sutton. “It doesn’t have to be large, and it needs to be occupied by only a few people, but it needs to be accessible from inside and outside.”<br></p><p>Another example is a community that has a transition lobby between the assisted living portion and the memory care portion. “Again, that was originally focused on elopement, but that type of space can also be converted into a receiving lobby where people are coming in directly from the outside, depending on where those places are located,” says Sutton.</p><h2>The Great Outdoors</h2><p>When thinking of spaces where there is a low risk of spreading illness, an outdoor space like a courtyard comes to mind, but there are caveats. While outdoor dining has been a trend for some time, often, seniors don’t use outdoor space because it’s uncomfortable—either too hot, cold, or windy for a fragile population. <br></p><p>“You can’t just take an outdoor patio and throw some chairs on it and call it a rest in space and expect residents to take advantage of it,” says Sutton. “You really need to make sure that it is well-shaded and well-protected from the elements as the best way to encourage people to use it, especially when you are dealing with a fragile population in assisted living or memory care,” she says. Then comes programming—activities that draw people to the space and help everyone understand how it’s being used. </p><h2>Staying Ahead</h2><p>In a challenging year of COVID, collaboration and coordination have taken a different tone for Sutton and her team, which is spread all over the country. The team meets weekly to talk about what’s going on, what the trends are, and how to stay creative. One of the ways is offering a review to help clients stay safe and ahead of the curve.<br></p><p>“We offer our clients a COVID review,” says Sutton. “We take a look at their floor plan—either an existing one that needs refreshing or floor plan upcoming. We talk about how we can divide and conquer the population given their issues with COVID.” Indoor air quality is a large component to the health and wellness of a building, and it is frequently discussed among clients. </p><h2>Future Focus</h2><p>Expect to see a big uptick in renovation and repositioning in the future, such as adding additional beds or adding memory care into assisted living or independent living, says Sutton. This pertains most to providers that were doing well before the pandemic and are continuing to do well, picking up failing communities or aging assets and adding them to their portfolios.<br></p><p>Changes in ownership play into that shift and will lead to marketing communities in a different way, such as marketing separate entrances for staff and visitors. <br></p> | Memory care design has always been about limiting exit points and limiting the risk of elopement. | 2021-05-01T04:00:00Z | | Design | Cover Feature | Amy Mendoza | 48 | 5 |
| Memory Care and COVID: A Clinical Perspective | https://www.providermagazine.com/Articles/Pages/Memory-Care-and-COVID-A-Clinical-Perspective.aspx | Memory Care and COVID: A Clinical Perspective | <p><img src="/Issues/2021/May/PublishingImages/CF2_Karlawish.jpg" class="ms-rtePosition-2" alt="Jason Karlawish, MD" style="margin:5px;width:137px;height:174px;" />Jason Karlawish, MD, is co-director of the Penn Memory Center, which provides evaluation, diagnosis, treatment, information, and research opportunities related to symptoms of progressive memory loss, along with accompanying changes in thinking, communication, and personality. <br></p><p>The Center is supported in part by the National Institute on Aging (NIA) and offers diagnosis, treatment, and research, focusing on individuals with dementia and mild cognitive impairment caused by Alzheimer’s disease and other age-related progressive diseases.</p><h2>Research Branches Out</h2><p>Karlawish also is one of the leaders of the Alzheimer’s Disease Research Center. The theme of this NIA-supported center is to understand the heterogeneity—the state of consisting of dissimilar or diverse elements—of Alzheimer’s disease. Current research projects examine how neuroimaging can show the different ways the disease presents as well as the biomarker measures of the pathologies. <br></p><p>According to Karlawish, in the past 20 years Alzheimer’s has undergone a revolution in how the disease is understood. Specifically, the diagnosis is being transformed from a clinical diagnosis to a diagnosis based on biomarkers only. <br> </p><p>Biomarkers of the two pathologies that cause Alzheimer’s disease can be measured in spinal fluid or using positron emission tomography (PET) scans, he says. These, together with magnetic resonance imaging (MRI) measures of brain atrophy, allow a clinician to “see” Alzheimer’s disease in a person even before she has dementia, even before mild cognitive impairment. “So we’re about to enter a world where it’s possible to be diagnosed with Alzheimer’s disease but not to have dementia, and that’s a result of the biomarker transformation,” he says. <br></p><p>“My group is particularly interested in understanding the translation of the biomarker diagnosis into clinical practice,” says Karlawish. “In particular, how learning one is at risk of developing dementia caused by Alzheimer’s changes a person’s perception of themselves, how others treat them, and the plans and decisions that they make.”</p><h2>Impacting the Infrastructure</h2><p>Researchers at the Center’s COVID caregiving project, which characterizes the practical, emotional, social, and behavioral effects of COVID-19 on care partners and persons with dementia, have found in a recent study that, to no one’s surprise, COVID has been an enormous stress test to caregivers. <br></p><p>“We are using the study as a way to better understand the challenges faced by America’s caregivers so that when the pandemic does end, we can rethink the way that we design long term care services and supports so that they can address the challenges of caregiving in America,” says Karlawish.<br></p><p>For a person living with dementia in a long term care center, he says, COVID has been a particularly awful experience because of its impact on the infrastructure of the care setting. For example, changes made to adult day activities for patients with dementia during periods of lockdown left many patients and family members trying to help fill in the gap. Changes to all group setting activities led to an increase in isolation, but visitor restrictions also played an important part via changing the care model, he says.<br></p><p>“COVID has shown the importance of the informal care network in America, and it was revealed in long term care facilities in particular,” says Karlawish. “Because visiting policies in care centers were essentially shut down, as was the case in hospitals, care had changed. We saw very quickly how effectively removing those visitors from entering long term care facilities had an impact,” he says. <br></p><p>The effects of lockdown practices revealed that some visitors were not just visiting but were an essential part of the care team in a long term care facility, says Karlawish. <br></p><p>“They were helping a patient get up and be active during the day; getting them out of bed and to a meal, helping them stay cognitively connected,” he says. “When those informal caregivers were limited because of COVID, patients suffered mightily.”</p><h2>Rethinking Policies</h2><p>Going forward, research from the Penn Memory Center will encourage rethinking visitation policies in long term care facilities and in hospitals to recognize some visitors are more than just visitors; they are a part of the essential care team for a patient.<br></p><p>“The COVID experience warrants a thorough review of how well we are supporting these caregivers in terms of access,” says Karlawish. The Center is currently analyzing and wrapping up the data into a report for the fall of 2021. <br></p><p>The Center also has an outpatient practice that sees patients for diagnosis of care. Working at the Center since 1997, Karlawish has cared for a number of patients, who he says were among his best teachers. He points out that his experiences at the Center helped shape the stories in his recent book, “The Problem of Alzheimer’s—How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It.”<br></p><p>“The overall point of the book is to explain how science and culture turned a rare disease into a common disease and how politics made it a crisis, and then to lay out what society needs to do to address the crisis, the concrete actions we can take now,” he says. <br></p><p>Another key point in the book is that there are steps that society can take to address the Alzheimer’s crisis and support Alzheimer’s patients, including a rethinking of long term residential care, Karlawish says.<br></p><p>“There is a need to reframe it as a humanitarian problem and take on the full measure of our medical but also social capital to address the challenge of living with Alzheimer’s.” </p><p>Read More: <a href="/Articles/Pages/Resources-for-Care-Providers.aspx" target="_blank">Resources for Care Providers</a><br></p> | According to Karlawish, in the past 20 years
Alzheimer’s has undergone a revolution in how the disease is understood. | 2021-05-01T04:00:00Z | <img alt="" src="/Issues/2021/May/PublishingImages/CF2_memory.jpg" style="BORDER:0px solid;" /> | Dementia;Memory Care | Cover Feature | Amy Mendoza | 48 | 5 |