Rethinking the Senior Living Approach To Memory Care

In efforts to better detect and treat the early stages of Alzheimer’s and dementia, one Dallas-based continuing care retirement community (CCRC) is partnering with a local memory care specialist on a campus-wide brain health research initiative.

Senior living providers approach memory care in a number of different ways, but the main focus is all the same: to slow the natural progression of dementia through lifestyle and health care programming.

Whereas many providers target dementia care only after diseases like Alzheimer’s have already progressed, Presbyterian Village North (PVN) is addressing cognitive decline in its earliest signs by offering programming that spans the entire resident-base of its Dallas campus, and not just those living in its memory care segment.

Earlier this month, the CCRC appointed Dallas-based physician Dr. Diana Kerwin, an internal medicine, geriatrics and cognitive specialist, as the medical director of the community’s memory care program. In this role, Kerwin is tasked with overseeing all clinical practices and cognitive therapy at PVN, including a widespread research program on brain health.

“It’s an expansion of my practice on to a senior campus,” Kerwin tells SHN. “It’s taking everything I do on brain health, research and patient care, and being able to do it on a campus to make it more convenient for the residents.”

Kerwin, who is board-certified in internal medicine and geriatrics, completed her residency and fellowship training in geriatrics at Northwestern University Feinberg School of Medicine in Chicago. She is also the founder of Texas Alzheimer’s and Memory Disorders, a practice that offers patients access to advanced, innovative treatments and procedures for a range of cognitive disorders in adults.

“With her knowledge base and expertise in the field, Dr. Kerwin is a vital part of research in the community,” said Leigh-Ann Loveland, memory care specialist at PVN. “We wanted to seek out people who could support Presbyterian Village North becoming exceptional leaders in the industry with regard to dementia care.”

Research goals

The PVN-Kerwin partnership is focused on three goals: developing a community-wide brain health program to maintain well-being; implementing therapy programs to prevent and reduce the impact of memory loss; and conducting research to detect and treat early memory loss and preserve memory.

This year, PVN and Dr. Kerwin will begin offering a brain health program and memory assessments to all residents of the community. The program will offer opportunities for residents to participate in classes focused on ways to keep their brains healthy, such as memory training activities, physical activities and nutritional guidance to maintain brain health.

So far, the research is already making great strides.

One study involves a computerized test that detects early memory loss. The program incorporates several key tests used in diagnosing memory issues, such as impairments in language or verbal memory to see how long someone can memorize a list of words they see and then repeat them. It also tracks how long it takes a user to answer a question.

“One of the main changes of aging is the brain slows down,” Kerwin says. “The computer can track that and see how a person performs on the memory tests.”

The test, which can be done by residents and their families via an iPad, is already Institutional Review Board-approved, Kerwin says, and will be available for all PVN residents to participate in during the second quarter of this year.

But not all the memory care programming is strictly resident-oriented. Dr. Kerwin is currently awaiting approval for a “geriatric workforce enhancement grant,” in which PVN and Kerwin will be doing intensive education programming for all personnel at the community on early detection of memory changes.

The purpose is to equip staff with the expertise to do more intensive memory diagnoses and develop comprehensive treatment plans for all residents who wish to participate in the community’s research initiatives, Kerwin says.

A daunting disease

The projections of Alzheimer’s disease, and the costs of caring for someone living with the disease, are daunting to say the least.

As many as 5 million people were living with Alzheimer’s disease in 2013, according to the Centers for Disease Control and Prevention (CDC). Symptoms of the disease first appear after age 60 and the risk increases with age, according to the CDC, which notes that the number of people with Alzheimer’s disease doubles every five years beyond age 65.

As the number of seniors living with Alzheimer’s Disease is increasing, PVN saw a need to expand its existing memory care program.

In preparation for the new programs the campus will offer this year, PVN is adding 44 additional memory care apartments as part of a $96 million expansion project that includes a wellness center, along with new independent, assisted living and transitional care apartments.

“Once the expansion project is complete, we can offer these services to even more seniors in the Dallas area,” said Ron Kelly, executive director of PVN.

An ideal place

Total annual payments for health care, long-term care and hospice for people with Alzheimer’s disease and other dementias are projected to increase to $226 billion this year alone, estimates the Alzheimer’s Association in a 2015 Facts and Figures report.

By 2050, when the CDC projects the number of people living with Alzheimer’s to rise to 14 million, the Association estimates the costs of caring for this massive population will eclipse more than $1 trillion—representing a five-fold increase in government spending under Medicare and Medicaid as well as out-of-pocket spending.

However, memory care models that use an interdisciplinary approach with not only geriatricians but also nurses and other personnel have been able to significantly reduce the costs of providing Alzheimer’s care.

One memory care clinic using such an interprofessional approach was shown to reduce per-person health care costs by $3,474 over the course of one year for individuals with memory problems, compared with others whose care was overseen by a primary care provider only, according to the 2015 Alzheimer’s Association report.

A campus like PVN, which as a CCRC offers a full-continuum of care, is an ideal place to embark on this type of research, Kerwin says, since the community houses seniors with varying physical and cognitive capabilities.

“Memory loss is something people are concerned about when they get older,” Kerwin says. “Providing information in a well-developed curriculum on brain health will make an impact, and will make PVN’s campus very desirable to many people.”

Written by Jason Oliva