This may very well be the very best memory care design you have ever seen. What do you think?
A year or so I published an article written by Greg Irwin titled The Best Dementia Design . . . as a way of asking what’s the best memory care design? Greg’s ultimate answer was that it depends . . . on what your program goals are and what your operating philosophy is. Other considerations include site constraints, budgetary issues and what meets the needs of the local marketplace. Until very recently I would have concurred.
What Changed my Mind 
A couple of months ago I attended at presentation by Steven Jaberg the CEO of Cedar Community located in West Bend Wisconsin. Cedar Community a faith based not-for-profit that serves 1,100 residents. They are a part of the Ziegler 100 list of the largest not-for-profit senior housing providers. A few years ago Steven began the process of developing a new memory care community. He looked at the Eden Alternative, The Greenhouse Projects and other dementia communities including the Dementia Village in the Netherlands. Then as chance would have it, he was attending joint convention of LeadingAge and IAHSA (the international arm of LeadingAge) in Washington D.C. where got a chance to sit with four dementia experts from Europe and began a conversation about dementia design.
The Highlights
The video below (NO LONGER AVAILABLE) provides a virtual tour of this new community and describes its unique features better than I can, but here are some of the highlights: • There are essentially no corridors • There is no grand entrance • The programs are all resident centered • The units are designed to be very individualized with front porches that can hold full sized stuff. Here is the video
Still in doubt? Before Steven’s presentation was over, another developer at the conference who was mid-stream on a set of workings drawings for a new memory care community stepped out of the presentation to call his architect and tell him to stop all work until they could revisit that design incorporating many of these ideas. What do you think?
I am the Director of Community Relations for Meadowview Memory Care Village located in Cedar Rapids Iowa. Meadowview is an assisted living community serving 56 memory care residents. I have worked in LTC and AL for 13yrs. Given all of the above I was very interested to view the video tour of Cedar Run.
The community is obviously beautiful and includes many positive features that support Dementia research findings such as; lighting, individualized entrances, freedom of movement, multiple activity Directors. However, I believe we must remember that AL memory care needs can vary vastly from person to person. As the disease progresses you will have 60 residents with 10-20 who are very high functioning, 10-20 who are at moderate stages needing a lot more direction and the other portion very limited in their cognitive abilities. I hope they plan to direct families to cottage neighborhoods where the individuals will be with residents at comparable stages If they are limiting each neighborhood to 20. I don’t believe the Cedar Run environment provides enough visual cues and stimulation though. Meaning aside from activities. Not all residents will have the ability to stay on task for the activity. I think their cottage style on the interior is nice but the entrances are not different from one another so residents will be confused as to where to go. People living with Dementia often have difficulty recalling names and numbers.
In addition, Individuals with early dementia know that they are struggling with their memory and often become apprehensive of socializing and venturing out. Cedar Run has the nice sitting areas etc but nothing visually appealing inside to draw them out of their apartment. They did a great job with the exterior features which will draw the residents eye out but that will often make them want to go out and that can’t always happen depending on the buildings census, staffing and goings on with other residents at that time. So having a purposeful ‘common area’ with multiple uses including wandering would be important.
Don’t get me wrong, the Cedar Run concept is great and much needed in the country. Maybe I’m just partial to my unique community and particular with all the odd scenarios I’ve run in to with dementia patients over the years.
This year alone I have had 3 AL management groups call me to tour our Meadowview Community in hopes of duplicating the concept in other states. I’m certain we will continue to see these pop up over the next few years.
Hi Angie
Thanks so much for your comments. I would love to spend some time on the phone learning more about what you do.
Steve
Steve,
You , and anyone else, are more than welcome to call me anytime at 319-294-9669
Ext 233 or cell 319-540-4787. I would love to share stories and learn from one another.
-Angie McClure
I am the VP of Wellness & Programs for Touchmark Living Centers which has communities in 8 states and Canada. I found this so complementary to what we do in our design features. No dead end corridors, excellent lighting that exceeds current standards, enclosed accessible courtyards and most of all person-centered care. Residential care is the right solution for most residents dealing with a diagnosis of a dementia illness. Thank you for this article!
From LinkedIn Groups
I agree, this is an impressive design. I spoke with Steve Jaberg as well and came away impressed by the ingenuity and level of detail that went into planning this memory care community. Look forward to taking a tour when its completed.
By Brian Greene
From LinkedIn Groups:
Looks like Arden Courts, which has been around about 15 years, but on a larger and more grander scale
By Charlaine Reynolds
Five Arden Courts memory care communities were recognized for excellence in this year’s Caring Stars award program based on rave reviews from families and eldercare experts: http://www.caring.com/articles/caringstars2013 Among the reviews for one of those communities (Arden Courts of West Palm Beach), a family caregiver (Jeanne) described how the design of the community was particularly beneficial to her aunt, who she said was a flight risk: “This place was perfect for her. She would be able to roam around all day in and out of many doors that always lead to the same place and she would never realize that was exactly why it was designed that way.” Jeanne’s full review and others likewise praising the community’s design and quality care: http://www.caring.com/local/memory-care-facilities-in-west-palm-beach-florida/arden-courts-of-west-palm-beach-fl
From LinkedIn Groups
Thank you for calling people’s attention on this project. As in-house physician in a small assisted living / nursing home facility in Mexico, I am deeply impressed. I would love to see something similar some time in my country. I’ve visited IAHSA site, and I’m asking that our home for the ageing join that network.
By Fernando Prieto
From LinkedIn Groups
When memory care environment, design and programming is done with the residents’ needs and opportunities to be successful in mind – it is an amazing thing to experience. When it is designed for the adult child or for what our likes and dislikes are – it only serves to frustrate the residents.
By Andréa Catizone
From LinkedIn Groups
Love the “porches” outside their rooms!
By Gina Conte
As Director of Marketing and Communications at Cedar Community, I warmly invite all of you to visit the Cottages at Cedar Run when complete in June, 2014! The video tours show many features, but ultimately, having opened one of the nation’s first memory loss-specific facilities in 1976, we at Cedar Community are keenly aware it’s the individuals who live there who will truly bring the environment to life. Each cottage ‘porch’ will be decorated uniquely as the resident wishes to help with wayfinding. The changing seasons can be viewed in all their glory each day via expansive windows across the entire back of the building – with no fences to limit the coming and going of wildlife. Pet therapy, music therapy, art therapy … more than ‘activities’ that a resident may or may not engage in, they support an engaging ambience where the resident can experience self-discovery again each day.
Angie’s comments about each individual stage and behavior is spot on: The marketing team here at Cedar Community recently participated in the Alzheimer Association’s Virtual Dementia Tour (conducted by our own trained staff). To replicate the challenges a dementia patient may face, participants wear equipment to obstruct hearing, vision and tactile senses. They must then complete a series of timed tasks. While it of course could never duplicate the full measure of a true Alzheimer’s patient experience, it was quite revealing: I fixated on one task (folding towels), desperate to get it done correctly. Another team member wandered from task to task in hopes to find one she could master, until time ran out. Another simply sat on a bed – too overwhelmed with the noise and the fear and what she described as feeling ‘exposed.’ You of course would recognize the variety of our behaviors as comparable to your residents’. We are all using these experiences to better define care for our residents – I highly recommend it for ALL your staff – not just direct caregivers!
I agree with Tracey that more health care staff should go through the Alzheimer’s Virtual training. Our staff at Meadowview go through a similar training given by Teepa Snow, a renouned Dementia trainer, and it gives staff a true understanding of what our residents are experiencing and then provides ideas for a positive approach. Awesome training!
This summer, Caring.com featured an interview with the inventor of the Virtual Dementia Tour, geriatric specialist P.K. Beville, who shared that it is now available in seven languages and three editions, and has been experienced by more than 500,000 people in 17 countries: http://www.caring.com/articles/virtual-dementia-tour Carol Steinberg, chief executive officer of the Alzheimer’s Foundation of America, said, “This inside look can help family and professional caregivers better understand this devastating brain disorder, adjust how they provide assistance with activities of daily living, and soften their own reactions to behavioral issues — ultimately resulting in more optimal and compassionate care.” The article includes how to contact a Virtual Dementia Tour-certified trainer who can conduct a VDT event for local memory care communities.
I found the design to be very inviting and attractive to individuals and families looking for a way to foster independence while providing supervised care. I can see how there could also be potential to have different levels of care in each building. This could reduce the stress of feeling as though they are declining further or are resistant to moving if they are still within the same community which would have the same “feel”. The holistic environment with an activity director on staff would certainly help promote residence involvement in their community! Thank you for sharing.
Some great design ideas here. Keep in mind that every market has unique populations when it comes to specific designs such as single and double occupancy and the associated costs.
Very nice, indeed. I love the individual front porch entries to each resident. It’s like a town w/in a residential care facility.
From LinkedIn Groups
It is beautiful. But time will tell how the residents respond to it. I found it a bit overwhelming while watching the video. That may simply have been the impact of the camera coming into rooms and turning corners. The real thing might be very different. I’m lucky to be less than an hour drive from Cedar Run – so I will plan a visit! Thanks for sharing Steve!
By Janis Nowak
From LinkedIn Groups
very cool. I hope it is affordable. Always wonderful to build anew using all the advances we know with technology and studies.
By Sherry Picker MSW
From LinkedIn Groups
Thanks Steve for this informative video. I presently work with clients in the greenhouse model, and though I love the intimacy of a 12 resident cottage, this expands the scope of serving more people with dementia.
By Muire Flynn
From LinkedIn Groups
Very nice. I hope the message gets out.
By Patricia Faust
From LinkedIn Groups
Tour, developed by B.K. Beville for the past eight months in Assisted Living and Nursing Homes for all the staff. It has been an eye opener for everyone.
By Judy Yaffe
From LinkedIn Groups
In the video, Cedar Community does an excellent job of showcasing the benefits of the memory care design. I have to believe it creates a wonderfully powerful impression among viewers – if Cedar Community put that much thought into the design, I have to believe they will do the same with the staff they hire and the services that are delivered when the memory care opens.
Many of the design features highlighted in the video are part of the affordable memory care assisted living community that BMA opened last fall in South Elgin, Illinois, a suburb of Chicago. White Oaks at Heritage Woods of South Elgin is one of five memory care pilot projects that operates through the Illinois Supportive Living program, which enables us to serve seniors of all incomes, including those on Medicaid. The front porch facades, the recessed padded window sill, and the amount of outdoor area at Cedar Community certainly are interesting features.
Thank you for bringing this to our attention.
By Rick Banas
I’m afraid to ask what a poor pensioner would pay for accommodation such as this.
Obviously it isn’t for the poor.
James,
I agree that the cost is large and understand your assumption that the poor would not be able to benefit. I can’t speak for this particular community but just so you know many memory care communities like this are able to accept Long-term care insurances and VA benefits in addition to private pay. Therefore, if someone has a limited income they can pull from these resources. Also, once an individual exhausts their assets, a community that is authorized to accept the Elderly Waiver (form of Medicaid) is able to walk the resident through getting approved which will contribute up to $1380.00 per month towards the cost. Example: Monthly facility cost is $5900, residents monthly pension or social security is $1300, Elderly waiver contributes $1380,VA contributes $500, the balance remaining is $2720= the community writes this off.
My community, Meadowview Memory Care Village, chose to begin accepting Elderly Waiver in 2012 for existing residents who have lived with us for 2+ years. This decision was made due to individuals moving in at a younger age and living longer. Previously, in our community, individuals would have to move to a nursing home before they needed to simply because they could no longer afford to pay for AL and the nursing homes were the only ones accepting Medicaid. This has opened up opportunities for seniors in our community. Be sure to remember this in the future if you or someone you know
needs AL care but can’t private pay all of it.
I’m wondering–where’s the telecare and unobtrusive behavioral monitoring here? Everything from gait (predictive of falls) to activity levels to socialization is missing in this picture. It also still ‘feels’ very institutional to me–where can that person and the family personalize?
Cedar Run looks like a wonderful community. It is a pleasure to see that emphasis has been placed upon the connection to the outdoor environment. As a Landscape Architect specializing in the design and development of outdoor environments for individuals with Dementia, I understand why we need to maintain the connection with nature. Access to gardens and the outdoor environment are essential in maintaining good sleep habits and appetite. Balancing of our circadian rhythms is can help achieve this goal. There is also the benefits of better heath and over-all well-being. As well as an increase in caregiver retention. I would be interested to see the pictures of the gardens, now that the community has been completed and to hear how the elders of the community are enjoying the garden areas..
Thanks for sharing this very interesting community. I am always looking for thought provoking ideas to share with my clients. I was glad to see the in room medication cabinet. I have recommended in room medication cabinets to some of clients and they didn’t think it was feasible. Now I can give them a real life example.
Steve, have you been to or heard of The Liberty at Heather Hill, developed in Chardon, Ohio by the the late Mr. Bob Harr? The community opened in 1997 after the world famous Dolan center at Heather Hill. Mr. Harr utilized all of his research and developed this with front porches, etc in which many people from all over came to tour and witness all the research that was incorporated into it. Mr. Harr was truly a pioneer of our industry.
Heather,
I am interested in learning more about Luberty at Heather Hill. However have been unable to find anything on the internet regarding their specialty in memory care. I found the rehab center, long term care facility, independent and AL and an acute care hospital. Can you share the direct website so I can read more about the research incorporated in the memory care and see photos? Thank you!
There is no question that The Cottages at Cedar Run is a carefully conceived and thoughtfully designed community to house and care for those with early to mid-stage Alzheimer’s disease and related dementias. Its creators clearly did their homework, as is evidenced by the fact that they have incorporated many outstanding concepts, features, and design elements found in previous memory care projects dating back as far as Perkins Eastman’s groundbreaking Woodside Place of 1991. Other references that are clearly apparent include the Meadows Mennonite (1997) and Oakwood Village (1999) dementia care facilities by OWP&P (now Cannon Design) as well as many others. The fact is that “there is nothing new under the sun” (Ecclesiastes 1:9). Every good idea is rooted in those of others who went before. This is not to detract from the skillful synthesis of such sources represented by The Cottages, but to hail it as “The Best Memory Care Design in the Whole World” is certainly over the top. Moreover, the claim that many of its conceptual underpinnings may be traced to the truly pioneering Hogeweyk project in The Netherlands is downright specious. Most of the core principles embodied there, such as culturally and ethnically specific lifestyle neighborhoods, discrete households of six to seven residents each, and actual outdoor streets (yes, it snows in Holland too!) with real shops that residents can patronize, are clearly absent here. So let’s respect, admire, and learn from examples of good design such as The Cottages at Cedar Run, as well as those that preceded it and that will no doubt follow, but meanwhile please temper the hyperbole.