The River Residences nursery in the Bronx is a sunny and inviting space equipped with a ass, a nativity scene with a musical mobile phone, some toys, bottles, illustrated books for a reading of bedtime and a small clothing grid.
The other morning, Wilma Rosa was there to try to soothe one of her small irritable accusations. “What’s the problem, small?” Croniò, giving a pat on the back of the Lament. “Yes ok? I want you to go to sleep for a while.”
Mrs. Rosa, 76 years old, residing in memory in the assisted life, visits the nursery daily. He had a lot of experience with children.
She was the oldest girl of eight children, so she managed many family responsibilities, she told Catherine Dolan, director of the enrichment of the life of the structure, who was asking questions to help memories flow. Later in life, Mrs. Rosa worked in a bank and a shop; The stories emerged as the doll cuddled.
No real child lives in this engaging environment, in which the mixture of fragrances includes a perfume of talc. Just as real sales were not taking place at the shop at the bottom of the corridor, another new Fiverspring company.
Among its wooden clothing shelves, accessories and Tchotchkes, sales employees were, such as Mrs. Dolan, the members of the staff trained to interact effectively with residents with dementia.
“Excellent choice,” said Lo Alleg for Cassiere-Andre Ally, the coordinator of the commitment-a a 91-year-old who had selected a checked marmotter. “Perfect for this time.”
The shopper delivered a plastic card that the residents had been emitted, which had no monetary value, and came out with its walking area, happy with its new scarf. “It’s very hot,” he said. “And a good size, so you can wear it with any coat.”
David V. Pomeranz, President and CEO of River Living Living – his campus includes independent and assisted life, memory care, rehabilitation and a nursing home – sees these efforts as the ways “to restore normality to people who they were stripped so much. “
Bringing a group of residents with dementia in a real shop could prove excessive, he said, and people could not simply leave when they had enough. But a shop or a nursery of only runs of reality “gives them those life experiences that are familiar, which are comfortable, who are enhanced and deny the feeling of not having control over their life”.
It is a strategy with supporters and some critics.
A few decades ago, those who took care of people with dementia, at home or in the structures, have adopted a very different approach.
They tried “orientation to reality”, reminding patients who today is Tuesday, not Thursday. Who could not “go home” because their house had been sold. That their spouses were not visiting because they had died years ago (causing new shocks and pain at any repetition).
“He didn’t work,” said Steven Zarit, an emeritus professor at Penn State and a long -standing researcher for care and dementia. “He did not help people’s memories, he did not help their adaptation, it was not useful.”
Instead, the caregiver have widely adopted a strategy, sometimes called “therapeutic lie”, which gently deflects painful questions. Where is a loved one (deceased)? “I’m sure it will soon be here. You know how traffic is. Let’s go for a walk while we wait. “
The introduction of robotic pets that merged and detained and the children’s dolls to take care of, extended this approach. Especially when the pandemic limited other types of interactions, some people with dementia seemed to enjoy such inanimate companions.
Creating entire environments, which can evoke the past or simply allow people to feel to participate in the present, seems to be the next step.
In 2018, the family centers of Glenner Alzheimer’s non -profit have developed the Adult Day Adult Day adult program, replicating a main street of a small city in the 1950s within a Vista chain warehouse, California .
It presents a hot table for meals, a library showing the portrait of Ike, a space that imitates a vintage cinema and atmospheric touches like a thunderbird from 1959 and an old -fashioned telephone stand. The franchisees have opened nine squares similar cities in seven states, with others in development.
The day programs have shown benefits for cognitive participants and their caregiver, but “this environment allows us to deepen the reminiscence therapy”, said Lisa Tyburski, Chief Marketing Officer of Glenner, referring to the use of suggestions and objects to encourage i memories and communication.
For the participants, “he brings so much peace to have a conversation on something they remember,” said Mrs. Tyburski. “We see them laughing and smiling, forming friendships.”
There are scarce tests that these environments, including dementia villages in Europe that create entire residential neighborhoods (but do not imitate the past), provide clinical benefits or reliably improve the quality of life.
Yet “the environment is really important and can be enabling or disabled”, said Andrew Clark, co-publisher of the book “Dementia and Place” and professor at the University of Greenwich in England.
“We have to find ways to connect, to keep routine and daily activities,” he said. These environments can encourage those with dementia “to commit themselves to people, go out and around, not to be closed”.
Some experts express ambivalence and ethical concerns. Dr. Clark supports the transition from orientation to reality. “In dementia, there are all types of situations where not telling the truth could be better for people’s well -being,” he said.
But ethics becomes “dark”, he added, if the caregivers well intentioned deal with people with dementia like children. For Dr. Zarit, for example, distributing children’s dolls “feel childish”.
The main roads returning to the past “Test the limits of how much this creativity against deception is,” said dr. Jason Karlawish, geriatrician and co-director of the Penn Memory Center. “He begins to become problematic if” the others “,” he said, creating a distance between those with cognitive impairment and all the others.
“I think we could find more creative ways to engage in significant activities,” he added.
In fact, dementia programs across the country have more and more offers as interactive theatrical experiences, opportunities to make art and explore music, efforts to connect through ecclesial congregations, intergenerational gatherings with real children and pet therapy with live animals. Hundreds of memory coffee meet regularly.
Nancy Berlinger, ethics and researcher of the Hastings Center, indicates another concern for the environments focused on dementia: “Most of this is reduced to what you can afford”.
In the squares of the city in franchising, participants pay $ 150 per day on average. (Medicaid, veterans’ affairs and state and local agencies sometimes subsidize daytime costs.) In River, which already offers a complete program of interactive programs, the memory care costs $ 15,000 per month.
(In New York City, by comparison, assisted life had an average of $ 6,500 per month and the care of the nursing home about twice the one in 2023, according to the annual survey of Genworth).
With villages and dementia environments, “the concern is that they become enclavs for the rich,” said dr. Clark.
Or that become substitutes for adequate staff. The creation of kindergarten and River’s shop was cheap, said Pomeranz. But the staff is not and to work as expected, the environments require employees who commit themselves to extensive conversations.
Many nursing homes and housing structures assisted, perpetually short of staff, struggle to respond to basic needs such as the escort of residents in the bathroom, not to mention facilitating shopping in a two -week shop. Instead of taking and training enough people, administrators can be tempted to simply pass dolls and robots.
However, the continuous search for ways to make life more stimulating and supported for the elderly with dementia, a growing part of the population, wins applause everywhere.
“The choice of restoring the brain into an unsafe state does not exist,” said dr. Berlinger.
But the caregiver can “try to meet people where they find themselves and say:” What does comfort give? What reduces stress? What do you bring pleasure? ‘”He said.” We should think about it all the time. “