Environment matters for memory care patients

Margaret Calkins, an internationally recognized leader in the field of environments for elderly people, gave the keynote address last week at the Alzheimer’s Association’s 19th annual Upper Peninsula Fall Conference in the Great Lakes Rooms of the University Center at Northern Michigan University. Below, audience members listen to Calkins’ talk about “Environmental Design’s Impact on Dementia” at the conference on Thursday. (Journal photos by Mary Wardell)

MARQUETTE — Environment can make a big difference for memory care patients, whose health and quality of life is profoundly impacted by how they feel about their home and their ability to contribute to it, said Margaret Calkins, an internationally recognized leader in the field of environments for elderly people.

As the keynote speaker last week at the Alzheimer’s Association’s 19th annual Upper Peninsula Fall Conference, Calkins talked about “Environmental Design’s Impact on Dementia.”

Calkins described a needed culture change in elder care emphasizing resident autonomy and control with increased participation, greater individualization, meaningful relationships, respect for abilities and attention to built environment.

“We read our environments,” Calkins said, showing images of nursing homes that look like hospitals, versus ones that look like homes. “We can look at an environment, and we just understand it right away.”

Self-directed, relationship-based living involves spaces that support confidentiality and personalization, comfort and dignity, choice, engagement and community, she said.

While environmental changes can seem expensive at first, Calkins said research shows nursing homes that adopt person-centered care practices increase their occupancy and revenue. She added that inexpensive changes can make a big difference.

Calkins, who has a bachelor’s degree in psychology and master’s and Ph.D. in architecture, described how existing facilities can be restructured to contain a series of “households,” where four or five residents share an apartment-like space within the home, that has it’s own “front door,” kitchen space and “virtually everything that household needs to function.”

“This is what those front doors look like, I mean it looks like a front door,” Calkins said. “It creates this expectation that I am entering somebody’s house. This is not just a unit in a hospital, this is where people live and I need to respect that and honor that.”

Patients with dementia and Alzheimer’s disease often struggle with excess disabilities, stemming not from their memory loss, but their environments, Calkins said.

The right environment gets rid of those excess disabilities and improves people’s ability to cope, while creating meaning, purpose and a higher quality of life, she said.

“We think they’re disabled and not functional and can’t make any decisions, so a lot of it is our mindset of what we project on them,” Calkins said.

Access to the outdoors, for instance, is too often limited in nursing homes, she said. Even in cold regions like the U.P., many natives are accustomed to going outside to chop wood and do other activities.

“And those are the things we take away from people when they move into shared residential settings. ‘We’re here to do that for you,'” Calkins said. “Never mind the fact that it was something that gives them a lot of joy to do.”

Calkins said she applies the Montessori principal, which is to offer residents meaningful roles and an environment that supports those roles. She described a man who delivered everyone’s mail and a woman who liked to offer hand massages with scented lotion to other residents.

“These are people who are profoundly deep into their course of dementia,” Calkins said. “And yet by setting it up the right way, you can still get them to be actively engaged in a meaningful activity that contributes to where they live and to the people with whom they live. That’s what creates meaning for people who are living with dementia.”

Describing a woman who, from the confines of her wheelchair, used a mechanical sweeper to clean the floor after every meal, Calkins explained, “She is not just a recipient of care, she is taking care as well.”

After the presentation, Stacy Donati, a diversional therapy director at the Iron County Medical Care Facility in Crystal Falls, said she enjoyed the presentation and knows that studies show the person-centered approach keeps residents functioning at their highest capacity.

“It’s always our goal to take the clinical aspect out of living in long-term care and have them function like it is their home or it is somewhere that isn’t so clinical and stringent,” Donati said. “We want them to feel comfortable.”

Donati said the examples Calkins gave in the talk will be very useful and applicable.

“She made you look at things differently,” Donati said. “Person-centered and resident-centered care, not only is it the best thing to do, but it’s the way that state and federal guidelines are pushing us to do, so to be able to have all of the examples she gave us and tons of pictures of the way it used to be and the way it is now (will be helpful) to change our environment to best serve the residents.”

Calkins, who wrote the first book on this subject back in the 1980s, said most people responding to her work are philosophically in agreement, but they do see barriers.

“I think most people understand that this kind of an approach … makes sense and is the right thing to do,” she said. “They have a hard time figuring out what it means they need to change and do differently.”

Cost can be a big barrier, she said — but this is the direction care is going.

At least, “I sure hope so,” Calkins said.

Mary Wardell can be reached at 906-228-2500, ext. 248. Her email address is mwardell@miningjournal.net.