After working with people with dementia for many years as a licensed nursing home administrator, Scott Tarde was fed up with the lack of affordable care options. So as the CEO of George G. Glenner Alzheimer's Family Centers, he decided to reimagine a new kind of day care: a faux mini-town with a 1950s and 1960s look designed for people with dementia. His concept is based on reminiscence therapy. His creation is Glenner Town Square, set to open in San Diego next spring.
Reminiscence therapy, developed by psychologist Ellen Langer in 1979, involves the use of past activities, events and experiences with other people, usually with the aid of music and tangible, visual prompts from earlier years, such as photographs and familiar household items.
Glenner Town Square bathes the senses in sights and smells to reflect a person's younger days. Its 9,000 square feet of space, designed by renowned architect Douglas Pancake, sits in an industrial building and will include a pet store with shelter puppies, department store with clothes and a movie theater with real popcorn. Everyplace is staffed with trained caregivers.
Besides being fun, the retro town, outfitted with gas-lit streetlamps, also has real uses, like triggering positive past memories, say experts, and can help people with dementia feel calmer and need fewer drugs. The goal is to offer a safe location where residents have a structured day, as well as autonomy and independence — giving them a higher quality of life.
"We're taking people back to their strongest memories," says Tarde, noting it is a form of time-travel therapy. "Long-term memories are more preserved than short-term ones."
Tarde, who has 20 years of experience working in the long-term care industry, has targeted a growing demographic in America. An estimated 5.4 million people in the United States suffer from Alzheimer's disease, a number that is expected to grow as baby boomers age. Even more suffer from a form of dementia. He got the idea for the village after visiting a junior-achievement mini-city in San Diego, where young people discover how the "real world" works by learning how to generate wealth and effectively manage it.
Tarde has ambitious national plans, too. He wants to build 100 of these day care centers throughout the United States within 20 years. "Families need reliable options and meaningful experiences," he says. As the projected number of dementia patients grows, he adds, society will need new, viable solutions.
A new day care model
Glenner Town Square fits into a new type of community called dementia villages. They're attempting to bring fresh models of care, rather than just relying on drugs to take the sharp edges off the disease. The villages also provide safety and connection, which can increase well-being.
Tarde's creation may be the United States' first dementia village, though. In 2009 the first kind of residential dementia village appeared in Hogewey, Holland, outside Amsterdam. Inhabitants walk freely among the walled town's parklike grounds and live in housing units arranged by theme. There are also grocery stores, hair salons and pubs, where the staff works and keeps an eye on the 152 residents The village is about the size of 10 football fields.
Bringing more residential dementia villages to the United States may be a challenge. Hogewey is mainly funded by the Dutch government. Glenner Town Square, conversely, is privately funded by real estate developers Village Holdings, who have anted up $1 million in capital so far. The cost for day visitors, though, is affordable at $95 per day, says Tarde.
An aging demographic
Still, Tarde is optimistic about the power of day programs like Glenner Town Square to transform lives. He believes that medicine alone can't effectively treat people with Alzheimer's. "Many people can also stay home if they have the right support," he says.
There's such a tsunami of dementia care needed, agrees Donna Surges Tatum, board of directors of the National Certification Board for Alzheimer and Aging Care. In the United States an estimated 4 million to 5 million Americans currently have dementia. It remains the most expensive disease in America — a study funded by the National Institute on Aging estimated that in 2010 it cost up to $215 billion a year to care for dementia patients, surpassing heart disease ($102 billion) and cancer ($77 billion).
In addition, 5.5 million people are currently living with Alzheimer's. By 2050 that number is projected to reach 13.8 million, according to the Alzheimer's Association. "It's expensive to create a whole village," she says. "And we have such trouble getting care to anyone needs who it these days."
Reminiscence therapy, which taps into positive back memories, works well, though, she adds. These villages also emphasize personalized care and more engagement, too. "People are currently sometimes drugged more than necessary," she adds.
Jason Karlawish, a co-director at Penn Memory Center at the University of Pennsylvania, agrees. He advocates for spaces that tap into well-learned memories and comfort. "They should be safe, social and engaged," he says. Social isolation can even lead to dementia, according to studies, he says.
"People with dementia need to feel like they're part of the human race," he adds. "And so we need new approaches that aren't just biomedical."
For people used to growing up on farms, Prairie Elder Care in Kansas has a different solution. It's developing a dementia-care residence farm in Overland Park, Kansas, set to open next year. Called Prairie Farmstead, it has chicken coops and gardens. About 16 residents will always be supervised. But they can also plant tomatoes or roam in a sensory garden with butterflies. The cost is about $7,400 per month.
"People with dementia need to feel like they're part of the human race. We need new approaches that aren't just biomedical."
"Men with dementia can be difficult to engage," says Mandy Shoemaker, co-owner of Prairie Elder Care. "They end up being on lots of medications for aggressive behaviors."
The goal, she says, is giving them back control over their lives. "Control is slowly lost over the most basic decisions," she adds, explaining that with more engagement, they can be more calm and connected.
There are no one-size-fits-all dementia villages, though, says Mario Garrett, professor of gerontology at San Diego State University. "Your 1950s is completely different then my 1950s," he says. Yet every attempt is a good one, he adds, since people with dementia tend to be ignored.
Even dementia village models will evolve into something better, he says. "People need emotional support."
— By Constance Gustke, special to CNBC.com