Monday, February 29, 2016

Synchronizing Assisted Living and Memory Care

22 Feb 2016                           -6-

We have now lived at Provision Living at Columbia (MO) for six weeks. The original plan was for my wife to go to memory care each morning. It is the next door beyond our two-bedroom apartment. This has not happened as the adjacent 12 apartment unit will not be opened until after about another five months.

This creates a problem shared with Mill Creek and Mill Creak Arbors where one of two spouses living in assisted living must be transported to a second building for memory care each day. Both sites raise the option of a Home Instead caregiver being added from 8 to 11 each morning at our house to get my wife up for the day and cook dinner and supper ($2,000 am + $900 pm + $2,000 food, car, and house = $4,900/mo). Level of Care II a Provision Living at Columbia (MO), in March, is an additional $600/mo or $7,100/mo total or (85,000/yr and $59,000/yr, a difference of $26,000/yr)

Chart 1. Assisted Living by the Clock

Life in assisted living and memory care is quite different. The passage of time is totally different. In assisted living, time is filled with a scheduled set of activities that are, in part, designed and sponsored by residents (Chart 1). In memory care, time is filled by a list of topics that are orchestrated in every way by the mood and response of one or more groups (Chart 2). This is a collective effort to achieve what is called “redirecting” when working with an individual.

Chart 2. Memory Care by the Mood

Assisted living follows the clock. The program success hinges on schedules that are publicized and generally kept. In operation, room checks before an event are often used to bring in a crowd. There is little downside to missing an event.

Memory care follows a pattern of redirections. Timing is critical to prevent a resident from falling out of the current activity and in transitioning between activities. It is like watching an orchestra conductor directing each player.

My wife gets great enjoyment from the bouncing ball eye and hand coordination exercise. She appears to be playing basketball with all of the faking, eye movements, and diverted tossing to other players. This stalling entertains most of the group but drives one resident to distraction. However, if I bounce the ball to this lady, repeatedly, two or three times, she is back with the group with a smile.

The downside for my wife is to be lost in time and to some extent in place. I must depend on assisted living activities to be on time and in place when I am lucky enough to make a good redirect, or the rest of the day is lost to the “worries”.

One scheme for the “worries” is to visit our old house (10 minute trip).  She no longer calls it “home” but seems to enjoy both the trip (we just drive by) and being there 10 minutes to two hours cleaning, painting, and etc. Each stay ends when it is, “time to go home, where ever that is”.

Our apartment is too far away for a memory care resident assistant (RA) to easily come and get my wife. An assisted living RA is more available and much more successful in redirecting my wife to an activity than I am. (A common experience I am told.) Level of Care II may solve part of this problem in March.

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