I attended the 2013 Assisted Living Federation of America (ALFA) conference last month and sat in on a number of informative presentations. One dealt with a predicted paradigm shift for assisted living and memory support programs. Dr. Peter Rabins, MD, MPH of Johns Hopkins School of Medicine and co-author of The 36 Hour Day, led the presentation.

Dr. Rabins pointed out that many of today’s senior living organizations serve residents living with dementia through specialty dedicated environments and/or programs suited to their unique individual needs. He predicts that over the next five to 10 years, however, the demographics in senior living will undergo a remarkable series of changes. The paradigm will shift and people with mild cognitive impairment and dementia will become the majority of those living in senior living settings.

Statistics show that 20 percent of the U.S. population will be 65 and older by 2030. With advances in medicine, medical technology and social and environmental conditions, people are living longer, doubling the number of 85-year-olds and tripling the number of 100-year-olds living in the U.S. With the population growing at such a rapid pace, so too will the number of new and existing cases of Alzheimer’s disease.

How can you prepare for the operational challenges that emerge when residents living with dementia, or who have undetected early signs of dementia, outnumber residents with normal cognition? Dr. Rabins explored this shift and how to prepare physical environments, programming, marketing and admission criteria. He also outlined steps executive directors and senior living organizations can take to better manage the changes to come.

Things to remember about managing care beyond diagnosis:

  1. Focus on function NOT memory
  2. Behavioral/psychiatric symptoms of dementia increase likelihood of placement
  3. Medical co-morbidity increases complexity geometrically
  4. Family expectations are increasing
  5. Non-cognitive impaired residents are an increasing minority
  6. Pressure to NOT use medications to treat behavioral/psychiatric symptoms

Things to remember about humanizing dementia:


  1. Frame the diagnosis for the family and resident in an accepting manner
  2. Identify strengths and weaknesses in the rehab approach
  3. Avoid infantilizing
  4. Discuss the disease with the person

In order to be prepared we must take advantage of opportunities to:


  • Display great leadership
  • Imbue a culture
  • Model the expected behavior
  • Review successes and failures

— Mindy Cheek, Senior Manager, Marketing Services