At Juniper Communities we have long subscribed to the belief that the keys to healthy aging include staying physically active and socially connected. For some of us, doing one or both can be more difficult over time. This is particularly true of some individuals who are living with memory loss. Our job as caregivers and partners in caring is to facilitate new ways of helping residents to be connected to the community - their home - while at the same time fostering a sense of independence.
Environmental features are key in both keeping people physically active and connected with others. A 2011 study by Dr. Margaret Calkins, Ph.D., an internationally recognized leader in the field of environments for the elderly, especially those with Alzheimer’s or dementia, found that people who lived in small group or cottage settings had less disruptive behaviors and greater socialization. They (and their families and the staff who cared for them) were also more satisfied—happy.
Another study done in 2011 in the Netherlands by Hilde Verbeek titled Redesigning Dementia Care concurred. Her research indicated that residents in small-scale living communities were significantly more socially engaged and displayed fewer physically non-aggressive behaviors, such as wandering, than residents in larger, traditional settings. They experienced greater wellbeing and less stress—they were happier. The study also found that residents in this “person-environment model” developed an individually meaningful experience of choice, mastery and relationship. They developed a feeling of “at-homeness” or happiness!
Understanding the Small House Model
Caroline Cantley in her 2002 book Put Yourself in My Place stated that there is broad agreement that desirable dementia care homes be small scale, which she defined as 6-14 residents. Getting much larger, she and her colleagues said, is a distinct move away from a “family feel” towards something more institutional. Different research provides other specific numbers, Dr. Calkins suggests between 9 and 24 residents, but they all are within this general range. Larger communities may mitigate their size with their layout, such as linking several smaller houses together to achieve economies of scale.
Juniper has been well ahead of the trend as we have owned and operated two types of small house models for more than a decade. Two of our small house models, Aurora and Louisville, both in Colorado, were purpose built by Juniper in 1999 and 2000 respectively, as part of our initiative to provide leading-edge care to residents living with memory impairments. These two communities include four small houses, each with 12 or 13 rooms, virtually all private, surrounding a town hall area. Each town hall provides destination locations consisting of multiple familiar spaces such as an office suite, game room, library, country store, and gymnasium, where residents from all houses can go for additional services or programs. In this model, where the houses are linked, all staff are readily available to assist if needed.
Juniper’s other three memory communities although not purpose built by Juniper, were acquired between 2006 and 2014, in part based on their similar design. All three are based on a small house or cottage model. For instance our community in Naples, Florida is a campus with six small cottages, each home to 15 residents in a combination of private and semi-private rooms, spread across lovely grounds connected by walking paths and gardens. Another, acquired around the same time, has three neighborhoods of 12 residents each in a combination of private and semi-private rooms, which open onto a central common area.
In both models, residents at Juniper’s communities live within a short walk to the living room, kitchen and dining areas. The environment is homelike; there are no nurses’ stations and no medication carts that block the hallways. Staff wear polo shirts, not scrubs, and are trained to engage residents in activities of daily living, as well as social and recreational activities. In both models, there are large, accessible and safe outdoor spaces surrounding the community.
