More than five million Americans have Alzheimer’s or similar illnesses, and that number is growing as the population ages. Without any immediate prospect of a cure, advocacy groups have begun promoting ways to offer people with dementia a comfortable decline instead of imposing on them a medical model of care, which seeks to defer death through escalating interventions. The Green House Project, based in Arlington, Virginia, pushes for the creation of small group homes in which medical care is less intrusive; the Pioneer Network, based in Chicago, urges reforms such as less reliance on psychotropic medications.
Many of these approaches overlap with the methods of the Beatitudes Campus, which, over the past decade, has become an incubator for a holistic model of care. “When you have dementia, we can’t change the way you think, but we can change the way you feel,” Alonzo said. Ann Wyatt, the consultant on residential care at the New York City chapter of the Alzheimer’s Association, calls Beatitudes a “magical place”—a phrase rarely used to describe a nursing home. She is currently coördinating an effort to implement the Beatitudes approach in several New York City facilities, including Jewish Home. “Beatitudes has sort of put the pieces together,” she told me. “It all—embarrassingly and intuitively—makes sense.”
In the advanced-dementia unit at Beatitudes, the elevator is blocked by a velvet rope attached to silver stanchions. Visitors must unhook the rope to proceed. The rope is meant to dissuade a resident from wandering onto an elevator and out of the building; a black square of carpet in front of the elevator performs the same function, since people with dementia have been shown to be unwilling to step onto such a black space, taking it to be a hole. At other nursing homes, exits are often marked with “Stop” signs, or blocked with the kind of fluorescent banners that police use to cordon off crime scenes. The velvet rope at Beatitudes makes a subtle, more positive suggestion: that residents are ensconced in an exclusive club.
The unit is on the fourth, uppermost floor of a nineteen-sixties-era medical building. Its residents are men and women who can no longer live alone safely: they may not remember the location of the bathroom in the house where they have lived for fifty years, and they may have virtually lost the power of speech. (Residents on the lower floors have less advanced dementia, or are undergoing rehab for, say, a stroke.) Across from the elevator is a large, sunny sitting room, where the nurses’ station used to be. “We took that out because they deserved the real estate, and we didn’t need it,” Alonzo told me as she showed me around what is always referred to as the “neighborhood”—a semantic adjustment meant to signal that Beatitudes is a place where residents live, rather than an institution where they are confined.
by Rebecca Mead, New Yorker | Read more:
Image: Phillip Toledano
