Over the past 15 days, one resident at Heritage Homes, a Memory care facility in Watertown, Wisconsin, has been out of bed a lot at night. He’s opening his door at night more than he usually does, activating his emergency call pendant more, and spending more time during the day in bed.
The staff knows this because the sensors know this.
These are not simply motion sensors that send one-time alerts. They are a system of up to 11 sensors per room that collect behavioral data for both immediate staff alerts and long-term trend analysis. Staff can use the data to tailor routine care – by seeing how much time someone spends in bed, for instance – but also for predictive and preventative care, like using the bathroom data to anticipate urinary tract infections.
Today’s preferred layout
Picture a campus, split in two parts, connected in the middle. One part is a multi-story assisted living facility. The other is a single-story memory care facility. They are attached by common areas, including the entrance, reception desk, lounges, bathrooms and a kitchen.
“This is a very common plan that we’re using across the South, from Florida to Albuquerque,” says David Dillard, founder and principal of D2 Architecture and one this year’s judges for the SHN Architecture & Design Awards.
About five years ago, the Dallas-based D2 didn’t build any of these. Today, half of D2’s projects, about 12-15, use this layout. Dillard sees three reasons for its increased popularity.
The first is that some states allow single-story buildings to be built out of wood, which saves $10 to $20 per square foot in construction, which ultimately lowers the cost for the residents, Dillard says. The second reason is that the courtyard for the memory care residents receives more sunlight due to the lower walls.
The third reason speaks to an uncomfortable reality about facilities serving people with different conditions.
“Assisted living people aren’t keen on looking into the courtyard of what could be their personal future,” Dillard says. “Whether it’s for independent living to assisted living, assisted living to memory care, assisted living to skilled care — you just don’t want to see where you’re heading. So we physically design buildings so that the younger side — say, 80 — can’t see what’s going on with the older side — say, 90 to 95.”
In January of 2016, Titan Development opened one of these D2 designs in New Braunfels,Texas. This is Élan Westpointe (pictured above). The memory care wing has 36 units, all private suites. That’s lower than many standalone memory care facilities, which are closer to 50 units, says Titan’s Director of Senior Living Julie Ferguson.
For Élan Westpointe residents, the space is “free of distractions and noise,” Ferguson says. The smaller environment creates a feeling of safety, and the courtyard is secure, allowing residents to move around.
For staff, there are operational efficiencies because of shared common spaces between the memory care and assisted living. The design allows for that convenience for staff while still giving memory care residents their own space.
“We wanted to do something a little different in the space,” Ferguson says.
A studio apartment with a view
For John Cronin, principal at AG Architecture just outside Milwaukee, the most important memory care design trend is a connection to the outdoors.
“There are designs where all the rooms are in-facing into an interior space in the building,” Cronin says. “I describe it the way prisons are laid out. The common rooms are right there in the middle, and there’s really no daylight in there.”
The availability of daylight in the rooms speaks to another trend Cronin wants to see more of: prioritizing the resident rooms over the common areas. He wants to see more facilities built with rooms that feel “like a studio apartment, rather than a nursing home-type bed.”
Some of these opportunities are missed, Cronin says, because of what he views as uneven priorities.
“I hear this in every project, everywhere,” he says. “They spend more money on the common spaces and not enough money on the interior, personal space where a person is actually living.”
Cronin’s preferred budgetary priorities in memory care are for a comfortable room, with space for one’s own furniture, and thoughtfully designed outdoor physical spaces, with landscape architects creating healing gardens.
“I think the trends are going to be more toward well-designed exterior spaces, specifically geared toward memory support,” he says, adding: “We’re born in nature, we live in nature, and we’ll die in nature. We should always be part of the natural world.”
Sensors catch on
Just because Cronin wants to re-emphasize nature doesn’t mean he opposes technology. He visited Heritage Homes recently and was blown away by the sensor system. He hasn’t designed any facilities with these sensors but he sees this as an expanding trend.
Kelly Hildebrand does too. A registered nurse who is Heritage’s RN clinical care coordinator, Hildebrand came to Heritage Homes in June of 2016 after four years in what she calls a “traditional” skilled nursing facility. That facility was built in the 1970s; Heritage Homes was built in 2010.
The difference was huge. The data system — designed by HealthSense — includes sensors in a resident’s room on the front door, bathroom wall, toilet, bed, chair, and around the bedroom to capture motion. For residents with dementia who live outside of the memory care, sensors are in the kitchen, in the refrigerator, and in the cupboard.
“We can monitor if there is more kitchen activity than normal, which can be very helpful with our residents with dementia who are also diabetic,” Hildebrand says.
All of this data is stored in an interactive database, giving Hildebrand a dashboard that she and the staff can use to search for behavioral patterns to improve care.
“It gives you a lot less unknowns,” she says. Instead of just an anecdotal sense of changes, “these reports can actually give me a physical number.”
The use of technology in memory care will increase not just with the improvement of technology, but with the increased comfort level of family members, she and Cronin note.
“I think they’re very comfortable with it,” she says. “Safety is the number one goal. … To be able to have another eye, if you will, watching and tracking and another tool to help provide safety is the biggest factor.”
Written by Jack Silverstein
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