The first Sunday of the AHCA (American Health Care Association) annual meeting is dubbed NCAL Day (National Center for Assisted Living). NCAL is the AHCA branch that is specifically focused on assisted living providers (more on this in a subsequent article).

The closing general session was a presentation by Dr. Peter Rabins who is best known as the author of the book “The 36-Hour Day.” He is a highly regarded expert on dementia. He closed his talk with three key takeaways, one of which (the last one) most of my senior living operator and developer readers will likely hate or strongly disagree with. These are not simply his opinions but are based on the best available current research.

#1 – There is modest evidence that psychosocial interventions improve quality of life

This is perhaps the best news of the three. Studies show that good programming does improve the quality of life for dementia residents. He specifically pointed to creating highly structured consistent days for residents and days that are highly personalized for the specific unique realities of each individual resident. He specifically noted that music seems to be a particularly powerful tool for improving quality of life.

#2 – There is no evidence that pharmacotherapy improves quality of life

This is particularly important because drug therapy is not a neutral intervention. The drugs that are commonly being used are powerful and often times dangerous. They are also expensive. They have significant side effects and can kill residents. This is pretty consistent with a broader push to reduce or eliminate psychotropic medications in both skilled and assisted living settings.

#3 – There is no evidence that environmental design improves quality of life

This is one of those areas where he wishes it were different. Many of you who are readers have spent considerable time and effort to design buildings, wings and units that incorporate the best thinking with respect to design for dementia. This includes lighting, colors, floor plans, way finding schemes . . . the list is long.

The proponents of these design elements spend a lot of time telling anecdotal stories about how these elements improve the quality of life for residents. The problem is that there is just no actual evidence that demonstrates they are right. Dr. Rabins postulates that the anecdotal evidence for higher quality of life is essentially the result of the placebo effect (my term not his). That people like working in these innovative environments, which likely means they are more focused on providing quality programs that, in turn, produce higher quality for residents.

The Good News . . . This could be viewed as good news if you are developing a new community and are still in the design phase. Saying that it does not improve quality of life for residents does not mean that dementia specific designs do not have value if they help the workflow and provide comfort to families and marketing advantage to operators.

This can also be great news for those of you who have older buildings that were not built to do special purpose dementia care. You have the ability to create a first-class program that will rival any special purpose-built dementia program.

Your turn, what do you think?

Steve Moran

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