The welcoming committee at the memory unit in Spring House Estates gathered recently at a table to fill brightly colored paper bags with gifts for new residents.
Chances are they didn’t know it, but they were about to participate in an activity that uses Montessori techniques, which were developed more than a century ago for teaching young children. With modifications they are now being used to help elders with dementia learn new skills — or reclaim old ones — and focus on what they can still do for themselves and their community. The goal is to make memory units like this one feel less like way stations and more like home.
On the table there were balloons, packs of tissues, bags of chips, and bottles of water — small items that the residents had said they would want to receive themselves.
Helen Adams, 89, opened the bags and passed them around as each of the others added one thing. “We’re a team,” proclaimed Marilyn Jacobs, who said she was “about 100” to much laughter.
Some had to be reminded why they were there and a staff member gently showed one resident how to put things into the bag, not take them out.
But they had fun and it felt like they were doing something to help others.
Adams, the group’s most vocal member, liked the socializing. “Everybody talks,” she said. “They’re not quiet in any way. I hate quiet people. Tell me what you think, good or bad.”
Jacobs also enjoyed the meeting. “It makes you use your brain a little bit,” she said, “and you’re with nice people I like to be with.”
Spring House Estates and another retirement community in South Carolina operated by Acts Retirement-Life Communities, a Fort Washington-based senior housing provider, in November became the first continuing-care organizations in the world to become certified in Montessori Inspired Lifestyle programming through the Center for Applied Research in Dementia (CARD).
Continuing-care facilities provide care for people with a wide range of needs including dementia, from those who can live independently to people who need skilled-nursing care. Alzheimer’s — the most common cause of dementia — is the most expensive disease in the country, according to the Alzheimer’s Association, which estimates that more than 5 million Americans are living with the disease, costing taxpayers $290 billion in 2019.
CARD is run by Cameron Camp, an Ohio psychologist who became interested in Montessori in the mid-1990s. His wife was a Montessori teacher and he was working with elders. He thought the program’s emphasis on hands-on, strengths-based, incremental learning could help the older people he worked with.
He has been consulting with senior facilities about Montessori for years and is not the only person doing so. He started the certification process three years ago and said about a dozen organizations that provide only memory care have achieved certification.
Kelly Carney, corporate director of memory care services at Acts, brought the program to Acts after seeing some aspects of it at work in her previous job with Phoebe Ministries in Allentown. Phoebe does not have certification, but has used Montessori techniques in some activities, especially in its Spirit Alive religious program for people with dementia.
Carney said the Montessori programming is part of an overhaul of memory-care programming across Acts’ 26 properties to align the organization with current best practices. All staff members at Spring House, including those in housekeeping, culinary services, and maintenance, received education about dementia and what they can do to help residents with memory problems.
“We’re all learning together to look at our residents from a different perspective,” said Allison Shope, director of rehabilitation services.
The new program includes residents in all levels of housing, from independent living, where people often first show symptoms of dementia, to assisted living and up. Acts hopes to foster stronger connections among people across the cognitive spectrum.
Acts has also been teaching residents about dementia, including those who are living independently. That group has tended to shun newly diagnosed peers in the past, partly out of fear about what the future may hold.
Elmer Heiland, who came to Spring House six months ago to be executive director, said the new attitudes are palpable. “It’s taken away the fear,” he said of the new program. “It’s shown people how to communicate, how to be engaged with them.”
Before the holidays, memory-care and independent-living residents sang carols together to staff members. They also helped organize and participate in a gift raffle for staff. As much as possible, Acts wants residents to use the skills they have to become “contributing members to their communities,” Carney said.
In recent years, “culture change” and “person-centered care” have been buzzwords at senior facilities. These trends aim to give residents more choice about how they spend their time and Acts was among the pioneers.
Camp said his group’s philosophy is similar, but Montessori helps facilities fulfill culture change goals. “The question is how do you make these trends real and viable,” he said. “That’s where we come in.”
Montessori emphasizes the use of concrete objects, like puzzle pieces and tools, to teach and, through repetition, create deep “muscle memories” that elders can access more easily than the sort of short-term memories we form after, say, listening to a lecture. Many older people with dementia, he said, can relearn to dress themselves or brush their teeth.
“People with dementia can learn very effectively if they’re taught the right way,” Camp said. The easy test to see whether people with dementia can learn new things, he said, is to “put somebody else in the chair they usually sit in at lunch.”
The more residents can do by themselves the better they’ll feel. Studies have shown the program leads to a decline in psychotropic drug use and problem behaviors.
Camp recalled asking an electrical engineer in a facility what it was like to live there. The man described a rigid schedule, with lovely amenities. “This is a beautiful prison,” he said.
Giving people more agency, more say in how they spend their time and energy, restores the sense that their lives have meaning, Camp said.
He quoted Maria Montessori, the founder of Montessori schools: “Everything you do for me you take away from me.”
The new approach means big changes for staff, who find themselves in a support role that can require more creativity. “Your job is to be in relationship with people,” Camp said. “It’s actually a better job and a less stressful job.”
At Spring House, residents now decide where they want to go on outings. One suggested eating Italian food by a lake. The staff made it happen. A man who had grown tomatoes spurred a trip to a farmer’s market, followed by a group tomato-sandwich making activity. Residents said they were tired of watching travelogues on television and wanted conversations instead. Peers and family members who had traveled were found to lead discussions.
Even bingo, always a popular event with seniors, was changed. The residents wanted to call the letters themselves, and they started helping peers with difficulties, instead of relying on the staff.