Susan Robbins, Regional Director of Dementia Training for The Arbor Company, joins us to discuss the different Dementia Care Neighborhoods available based on residents' cognitive needs and what residents can expect when staying in one of our specialized assisted living communities.

Video Transcript

-Hello everybody, and welcome into Senior Living Live. My name is Melissa. As always I hope you are having a great day today. Susan Robbins is here with me today to help describe, simply tell us about what a normal day looks like for someone receiving dementia care in Senior Living. Our examples today are what residents in Arbor communities experience each day. Susan, she is our expert on all things involving cognitive decline whether it's dementia or Alzheimer's. She is our go-to person to help train our staff at the Arbor Company. Susan, how are you?

- Doing great, thank you for asking.

- No problem, very good to see you. You are our expert and the perfect person for this topic today. And for those who may not know about you or are now seeing you for the first time, give us a little bit about your background and what you do for the Arbor Company.

- Well, Melissa, I have the pleasure of being able to work with all the Arbor partners, our care staff staff, and actually all of everyone in our community to understand dementia, because dementia is so much more than memory loss and it's helping people understand all the facets of dementia. Also here to always support family members and the public at large, we have the opportunity to share through these webinars and other educational programs that we offer to help people understand dementia, because there's so much out there that'll give you the clinical, but not what do I do? And when you're looking for help, you need to know what to do.

- Yeah, and that part is obvious when we have webinars and I say this to everyone, our normal bimonthly webinars are an hour long. Every time we have you on board for a dementia based webinar, it's 90 minutes plus because so many people have so many questions, they wanna be heard, they want someone to help them out, they want someone with experience that can help them and you have been able to help so many people whether they have somebody within an Arbor community or not. And that's the fantastic part about those webinars and this video today. So when it comes to Arbor communities, take us through the different names of neighborhoods for residents who have maybe the beginning stages of dementia or late stages and what each of these neighborhoods provides in terms of cognitive care for the stage that that individual happens to be in.

- Okay, well, our communities have separate neighborhoods based on what people's cognitive needs are, not necessarily just their physical needs. Our assisted living is kind of our what we call our diamonds, we use a gym level process to understand it's a much warmer way to express where somebody is on their journey with dementia, but this is the very early stages, and sometimes we have people living in assisted living that maybe in the early stages may not be diagnosed or maybe they don't and they're there for physical needs. But they're still socially the same and able to enjoy each other's company. In the beginning stages in a lot of our assisted living neighborhoods, what happens first is my frontal temporal lobe is what happens. That's my judgment and my reasoning and that little voice that tells us the things that we think we should not say out loud. One of those beginning signs you will see is when somebody starts to say things that they normally would have said out loud in the past, it's not necessarily wrong thoughts, it's somebody's opinion, but some things are best left unsaid. And I no longer have that ability. But with our staff, they're trained not to take those things personally and also how to validate those things for somebody. 'Cause if I'm saying it, it's how I feel about someone. So it's making sure that people are living in the right neighborhood to be successful and be validated and heard. Validation in all of our neighborhoods is one of the biggest keys to success. Then we have our Bridges, Bridges neighborhood, which is kind of that in between. I certainly don't need full oversight that happens in a Memory Care neighborhood, but I don't respond so well when somebody's filter is not working and I may over respond to that or may get my feelings hurt really easily. And I do things that can be upsetting to people in AAL and it doesn't work. So I don't feel good and they don't feel good. So we found this need to have that in between neighborhood. And if it's not a neighborhood, then it's a program so that they're able to enjoy the things they enjoy with their cognitive peers. And then as dementia progresses even further, you are more successful in a Memory Care neighborhood where it's more hands on, we're guiding you through the day, we're providing step by step, both visual and verbal cues, we're using less words and positive reinforcement to help someone be successful. But all three neighborhoods all have the same programming but which for things to entertain, things that give you purpose in life. So all those things still happen in all three neighborhoods, but they're adjusted to meet my cognitive ability to enjoy those things. And we have found that people, sometimes it's difficult to move through the different neighborhoods, which is normal. We don't want to see the decline, but we find that the person living with dementia is so much happier when they're in the right neighborhood.

- Yeah, these don't happen overnight. There's a lot of research that goes into this and it just seems that you've really captured especially with the Bridges neighborhood, a whole sector of of dementia care that hadn't been tapped into before. And so it really is that wonderful in between as you mentioned that maybe we didn't see 20 years ago or 10 years ago in Senior Living and we have it now. So now we've really kind of listened to and heard what the care feels like, what it looks like. And we talk about that quite often when we have these discussions, but what we don't really discuss is what a normal day to day looks like in the morning, at lunchtime, at dinner time, in the evening. So can you share with our viewers what that looks like for somebody who is receiving memory care whether it's Bridges or in the full Memory Care community?

- Well, one of the things that as people decline with dementia, they are not able to schedule their own day, follow a schedule and routines get mixed up, and sometimes I don't even know what time of day it is. So we set the routines based on their needs, you know, there's a morning time to get up. But one of the wonderful things that Arbor offers is if I don't wanna get up real early, I don't have to. So we try to gear it towards what person's actual needs are and sleep patterns are. So we're gonna work with that, so I'm gonna get up in the morning, I'm gonna get assistance, I'm gonna get more assistance with step by step cuing in Memory Care, and maybe in Bridges you're just gonna lay my clothes out because I don't remember what I wore yesterday. So you wanna make sure that I'm dressed appropriately and weather appropriately for Bridges 'cause I forget those things, but in Memory Care we're just gonna pull those things and give you choices. Do you want this or that? And help me get dressed. So we're gonna get dressed. We're gonna enjoy breakfast with as much help as needed, but also as much independent as possible. Eating meals should still be a very social happy event. And that I'm sitting with tables with my cognitive peers. People I'm gonna enjoy being around, my friends. So it's not an assigned seat that you have to sit here, but people tend to gravitate to who they wanna sit with. And then the morning structure is we're gonna have some exercise classes, maybe some music, maybe some arts and crafts, but each neighborhood will have these opportunities, some people will enjoy them, some won't, maybe Memory Care, I need a quieter environment because I'm overstimulated for whatever reason. And overstimulate is stimulation is where we get into behavior, what we call behavior concerns because I just can't take anymore. So we'll have parallel programming in our Memory Care neighborhood for a high sensory or low sensory and that can flow. But again, it's mimic the same events happening throughout the community, but set up based on what my needs are.

- Yeah, great, and you know, one other aspect that we also don't talk a lot about is how do these neighborhoods affect our senses? You know, what do these neighborhoods look like if I were to walk in with an aging parent, what would I see? What would it sound like? How are these neighborhoods visually different from say Independent Living or Assisted Living?

- Well, Assisted Livings and your Independents are usually larger areas, because with dementia, the bigger the environment, the harder it is for me to navigate my environment. Sometimes my apartment if it's smaller, then I can navigate and find the things that I need to find. And this happens with both Bridges and Memory Care, and lots of times those two neighborhoods mimic each other as much as possible from a physical perspective. We take pay attention to lighting. Lighting is very important, if you want me to be active, we need to have lots of bright lights, as much natural light as possible, but also inside lights to keep me engaged and focused. But there are times during the day that you may walk in and the lights may be dimmed because it seemed like we needed a little quieter environment for those residents to be success. So you may walk in and it may be high energy, and you may walk in and it may be low energy. And this is scheduled to give people that normal flow of the day because you know, a lot of us at three o'clock, I need a snack to refresh myself, but I know to go get that snack. And what we do is we watch the body language of our residents to help us adjust the flow of the day, music might be very stimulating and sing along or it might be music that's very quiet, and it's based on what that need is, so we may adjust it. But there's a set schedule but we make those adjustment. And usually in Memory Care, the adjustments are bigger and some people to stay focused can't handle loud noises, so we may have people sitting in different areas that are quieter and they maybe more apt to nap because they need those naps in order to enjoy the rest of the day and the things they're enjoying

- And everything you've described, Susan, you know, we are talking about this because we have these neighborhoods at the Arbor Company for your loved one or for yourself or for your spouse. But these are also tips that if somebody is caring for someone with dementia and they're doing the best that they can and maybe they cannot afford or they don't have the funds to be able to move to an Arbor community or any community and they're working on this at home with their loved one who is suffering from this disease, they could take some of these tips too. And so I love everything that you've said. You can incorporate, you know many of the things that you've just said if you are at home taking on this task maybe with friends, with family, by yourself, these are things that you can incorporate as well that can help your loved one. So again, we're here to teach everybody this is what this is all about. Again, it is more geared towards our specific neighborhoods. So I'm glad you pointed some of those out and we're very detailed in what you were saying. So thank you for that, Susan. So we have really covered a lot here, we've covered all the senses and how about pace? Let's talk about Dining with Dignity. It is part of a program we see in our dementia care neighborhoods. But Susan, if viewers watching for the first time and they don't know what that means or what that is. Can you explain how this program works

- Well, we want people to maintain as much independence as possible because you feel that better about yourself. But as you progress through dementia, you lose some of those fine motor skills, and at some point using even a fork or spoon can become overwhelming. So Arbor has this program called Dining with Dignity and we actually take the same meals 'cause nutrition is an important part of our daily life and our needs. And it's the exact same meals that everybody else is eating. But it's designed, is through a ground process that everything that's on the menu can be made to be picked up and eaten with your hands. Therefore, if I can and eat finger foods, I don't have to eat a chicken finger every day or a sandwich because I can still have that roast beef with mashed potatoes and gravy, and sometimes it's put in a puff pastry, sometimes it's processed differently. I think one of the most interesting things I've seen that are absolutely delicious is grits that are actually formed where you can actually pick up grits so I can enjoy my grits and they taste the same. They look a little different but they also look very appetizing and I can enjoy my grits and have what I need from all the different things that I like, and I can still pick it up. And one little extra with that is maybe you're having some dental work done because it's also easier, it's not just picking it up, it's easier to chew, which makes it also easier to digest. So if you're having some dental work done, you're in one of our communities, you can have Dining with Dignity for three or four days and be able to still get the nutrition that you need to heal and enjoy it. And at the end of life, you start to lose your ability to know how much to chew and maybe cheeking food. This process makes it much easier to both eat and swallow which is a great value to somebody in the later stages of dementia.

- Great explanation. And you know, we actually have a video if you're interested, if somebody is watching and wants to see what that looks like, our head chef, Jim Lee, put together Thanksgiving dinner at a puff pastry and we have that on video. It looks very appetizing and it is very delicious, but grits, huh? I had no idea, so they're getting very, very creative. I love that so much. Wonderful. Finally, Susan, you always have wonderful resources for those who wanna learn more about dementia or how they can help somebody living with dementia. Can you direct our viewers to a few of of those resources before we leave?

- Well, one wonderful resource is DAA, Dementia Action Alliance. And it's a great organization that not only helps you but also your loved one. So there's resources for the person living dementia along with the family member or friend of somebody living with dementia. A great book to read is "Keeping Love Alive as Memory Fades". It's one of the five love languages, and it takes a family through the stages of dementia with their mom and how they were able to help her through the different stages. So it's a great read and it's in sort sections, 'cause many of us if you're caring with somebody with dementia, you don't have a lot of time. And the last one that I think is a great resource, again, it can be a quick momentary thing that you need is Care Blazers, it's on YouTube and these are short videos that if you're having trouble getting your loved one to take a shower, some tips on how to accomplish that, won't take your meds for you, or they're just upset that day, there's some great tips in the moment of how to help you through those moments in time. And of course you can always reach out to any of the Arbor communities and we're more than happy to talk you through some problems or get you some resources that way as well.

- I'm so glad you mentioned that. We always seem to forget to leave ourselves off the list, but for some of these resources. Susan, of course you're our special gem at the Arbor Company or when it comes to this particular topic you've helped so many of our viewers and I know you're gonna help someone else even if it's just one person watching this video today. Thank you.

- Thank you.

- Now, for those of you watching, you could also head on over to our website as another resource for dimension care. We have several webinars and informative videos, many of them with Susan at the helm and these topics many other senior living topics all available at our website 24 hours a day, seven days a week. You can watch it from the comfort of your home. As always we thank you so much for being a part of Senior Living Live. Have a great day, everybody.

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