It’s no secret among senior living operators that many residents are living with some form of cognitive decline, and that has created a vast need for more early-stage memory care services.
Over the past two and a half years, the Covid-19 pandemic prompted many families to hold off on moving a loved one into a memory care community. But that delay in move-ins has meant that residents are sometimes moving into memory care communities with greater needs than before, and often at a later stage of cognitive decline.
Now, operators including Brookdale Senior Living (NYSE: BKD) and the newly launched Bella Groves are extending their dementia-focused services beyond the walls of their memory care neighborhoods in an effort to reach this population before they hit a breaking point. And they are improving health outcomes for existing residents living in their communities through added services such as education for those recently diagnosed with a form of dementia or more daily support from staff.
As a former executive director with Brookdale and former vice president of training and sales with memory care operator Silverado, Bella Groves CEO James Lee is no stranger to the sector. And as he surveys the industry, he sees many who share a “healthy frustration with this with the status quo in senior living.”
Specifically, he believes that memory care needs a “sharp right turn” toward hiring workers who can create a more sustainable business model that better supports residents, whether they live in a memory care setting or not. And, he sees a real need to move to a model that addresses memory care sooner.
“We need a drastic change,” Lee said during a panel discussion at the recent Senior Housing News BRAIN event in Chicago earlier this month. “We need to reframe, restructure how we do this business.”
Both Bella Groves and Brookdale are making resources available to help reach prospective residents sooner, specifically through practices such as finding more engagement opportunities and incorporating memory care treatment into resident wellness via diet and exercise.
And that is just the beginning of those efforts. The memory care component of senior living is constantly evolving and the pace at which the field is growing is only accelerating as new technologies and treatment options begin to take hold in the sector.
“Dementia care providers really have a unique set of skills, a set of expertise that families need,” said Juliet Holt Klinger, who is the senior director of dementia care at Brookdale.
Value-based care and preventive measures
The senior living industry is shifting toward a more value-based care and payment model that rewards quality health outcomes and preventive measures.
Although this wasn’t the case just a few years ago, insurers and the federal government are beginning to understand that preventive measures are much more important in health and senior care, according to Holt Klinger. And that is doubly true in dementia care, where the earlier a resident’s cognitive decline can be managed, the sooner operators can potentially reduce or delay more costly treatments later in life
“In a value-based system we really have to look at a lot of these preventative measures earlier,” Holt Klinger said. “One of the most interesting emerging trends is the change in the way we look at the diseases of dementia.”
As Silverado CEO Loren Shook and Symphony Senior Living CEO Lisa Brush said during the conference, the memory care sector is in a new era of new treatments and diagnostic tools. Today, many senior living residents are living in a sort of “pre-clinical” dementia stage. And Holt Klinger believes it won’t be long before dementia care plays a bigger role in overall health and holistic wellness, including outside of senior living communities.
“My physician is not asking me about my dementia risk — they should be,” she said. Right. “So, I think it’s the wave of the future, but we’re not quite there yet.”
And indeed, those are efforts that some in academia are focusing on, according to Tessa Garcia McEwan, a licensed clinical social worker for the Center for Comprehensive Care and Research on Memory Disorders at University of Chicago School of Medicine.
The school has an interdisciplinary team focusing on memory care under the leadership of Dr. James Mastrianni which “really tries to meet patients where they are at” by diagnosing their conditions as soon as possible and walking their families or caregivers through their care journey, step-by-step.
“I’m like a kind of a gatekeeper: They come to me when they’re like, ‘What do we do? When is it time? And what can we do at home now?’” Garcia McEwan said. “A lot of knowledge-sharing and a lot of education happens, including education on communication strategies and dementia care.”
Beyond the initial visit and diagnosis, Garcia McEwan is also involved in the family’s decision-making process, including as their loved ones progress into later stages of dementia.
“Our medical team supports them in between visits to triage those symptoms, and we work all together for problem solving along the way,” she added.
The university is also involved with Lorenzo’s House, a nonprofit that serves as both a cost-free healthcare resource for Chicagoans living with younger-onset Alzheimer’s and other dementias.
To improve value-based care models when it comes to memory care, Lee said there was “real opportunity” in the industry to more closely collaborate among researchers, medical staff and non-medical community staff.
At Bella Grove, Lee and his team have worked to bring awareness, education and structure to the early stage memory care space with a tiered approach that includes family and the prospective residents. This nexus is something Lee called “the starting point” for those entering early stage memory care.
When it comes to value-based care, Lee emphasized that it shouldn’t be up to insurance companies to define what the term means.
“I think families are the ones who can tell us, ‘I’m willing to pay you $500 a month to manage care for my loved one’ — that’s value,” he said. “So if we can do that, we don’t have to figure out how to crack the insurance nut.”
Reaching the resident and family sooner
Locating those with early stage memory care needs is challenging, but the first step in the process is developing publicly available, recognizable education for families so that a family isn’t just Googling “assisted living near me,” Lee said.
For instance, Bella Groves makes available an online learning center so that older adults and their families can understand memory care terminology and treatment strategies.
Although memory care communities are naturally the best place to offer care, Lee estimated that as much as 80% of it can be pre-packaged and delivered to people in their homes. The company achieves this through its membership-based model, which includes a tier where older adults and their families can pay a subscription to access nursing care assessments, dementia care coaching and medication management services from their own homes.
“We can take our care plan that we do for residents and give it to families instead,” he said. “So they have a way to think through the care steps for their loved one.”
The highest tier on Bella Groves’ membership tier is residence inside of the company’s memory care community in Bulverde, Texas, which offers a one-to-four staffing ratio.
As Holt Klinger alluded, residents are moving into communities at later stages of dementia. As such, she also sees a need to expand memory care services and education into the wider community.
To reach families more quickly, Holt Klinger said providers must open up communities to be “more of a community resource” so that families can hold conversations around dementia and dementia care earlier in the progression of the disease.
“People don’t want to sit around in a circle and commiserate anymore, they can do that online,” Holt Klinger said. “What they want to do is get education.”
With education in mind, Holt Klinger said it is up to the industry, regardless of a company’s portfolio size, to educate families on memory care and dementia.
“It’s an obligation to help educate the entire community,” she said.
Holt Klinger is also heartened by the fact that she sees more residents and their families understanding that “dementia care as a product line is an important part of offering.”
“When we talk about early-stage memory care, we need to begin to think about those other product lines that are in front of that continuum,” she said. “We need to be talking about all of this in our ILs and our ALs and our home care companies and hospitals and doctors offices.”
Removing the stigma to address ‘care gap’
Older adults living with early-onset dementia can face challenges to accessing care, both within society and the senior living industry. That process is made harder by what Garcia McEwan calls a “care gap.”
Through her work with University of Chicago, Garcia McEwan said she most commonly runs into families that have “fear and lack of trust” about the early memory care process, from running out of money to trusting individuals outside of their familie with their loved one’s care.
“We need to crush the fear, build the trust and clear the stigma,” Garcia McEwan said.
She called for more public service announcement-type advertisements or campaigns raising awareness about dementia while making educational resources more visible. For example, that could be videos presented to communities to show differences between relief care and respite care.
Garcia McEwan added that providers needed to better highlight respite care stays which are “one of the most effective” things memory care providers have to engage with families in a long-term care plan for their relatives who might still not want to commit to a full-time stay at a community.
Within that lens, McEwan once again noted education as one of the best ways to inform community staff, regardless of staffing shortages, of the nuances required for memory care to be done properly.
“It’s key for going a long way with time efficiency, joy and joyfulness within the residence,” she said.
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