Pennsylvania Alzheimer’s Center Sets New Trend in Humane Caregiving

Alzheimer’s patients cannot bear to sit quietly. They snoop behind closed doors, snatch objects --even if they belong to somebody else--and get lost in their wanderings.

Nursing homes typically use drugs or restraints to confine them. But a home in suburban Pittsburgh has set a new standard: Woodside Place is built for safety, so lost souls can amble at will without escaping or hitting a frustrating dead end.

Woodside’s network of interconnecting halls and garden paths, unlocked doors, homey bedrooms and sunny common areas is changing the way Alzheimer’s patients are cared for.

“You can look at the people who are there, and for the most part, they’re happy. These are not people who are tied up, drugged or are screaming to be released,” said Betsy Brawley, author of the book “Designing for Alzheimer’s Disease: Strategies for Creating a Better Care Environment.”

About 4 million Americans have Alzheimer’s, and half of all nursing home residents suffer from Alzheimer’s or another form of dementia, according to the Alzheimer’s Assn.

Woodside was developed after Charles Pruitt, president of Pittsburgh’s Presbyterian SeniorCare, asked Perkins Eastman Architects to design a home devoted to Alzheimer’s patients that would break the nursing home mold. They formed a steering committee of doctors, counselors and designers.

What they came up with in 1991 has served as a model for hundreds of architects and Alzheimer’s specialists.

A joint study by the University of Pittsburgh and Carnegie Mellon University over an 18-month period showed that two-thirds of Woodside residents declined more slowly than Alzheimer’s patients in a traditional nursing home. Woodside residents “maintained high levels of independence,” particularly in their ability to move, eat, bathe and dress, the study’s summary said.

Woodside’s success also has inspired Plumwood, a federally subsidized housing development designed by Presbyterian SeniorCare for low-income families who want to keep living with relatives who have Alzheimer’s. Like Woodside, the homes are designed to keep Alzheimer’s sufferers stimulated but secure. Plumwood opened last year just up the road from Woodside.

Woodside was meant to feel like a home, not a hospital. Since most Alzheimer’s sufferers need little medical care until the disease’s late stages, nursing homes serve mainly for security. For already-muddled patients, the fluorescent-lighted hallways, crowded rooms and lack of mobility found in most nursing homes are a disorienting nightmare.

When Woodside residents become sicker, they transfer to the Presbyterian SeniorCare’s nearby nursing home for more intensive medical care.

Like other homes that do not provide much nursing care, Woodside is not covered by Medicare. Still, residents pay less than they would for a nursing home because Woodside does not require extensive medical supplies or staff. Woodside costs $124 a day for a private room, while most nursing homes cost roughly $150. About one-third of Woodside residents pay $65 a day or less, depending on their income.

At Woodside, the resident is always right. Staff members never correct the 36 patients when they repeat themselves or behave as if they were living in another era. They may eat, work or walk around anytime. All doors remain unlocked except the front entrance.

“At Woodside, you can have five or six breakfasts before lunch,” said Beth Deely, director of Alzheimer’s programs.

“If my mom wants to wander into the kitchen in the middle of the night, she is free to do that, and the door won’t be locked behind her,” John Caliari said.

He munched hot dogs with his mother, Annetta Caliari, 80, at Woodside’s first spring cookout. He smiled and nodded patiently, Woodside-style, affirming her incomprehensible sentences.

Since Alzheimer’s sufferers lose short-term memory first, Woodside encourages them to live in the past. Big band music plays in the common room, old photographs of Pittsburgh line the walls, and a black-and-white picture of each resident in younger years--many in Army caps or bridal veils--is posted next to each bedroom door to help guide them.

Former executives may use a portable writing desk. Former homemakers may help clean or bake in the open country kitchen.

While they’re walking around or “working,” residents stand little chance of getting lost. The bedrooms are located in three hallways, opening into the common area at one end and an outdoor courtyard at the other.

The concrete walk snakes around the back of the ranch-style home, connecting the courtyards with the common area. At each bend in the path, a visual cue--a vegetable garden, for example--helps keep residents oriented.

A forest-green, chain-link fence is hidden discreetly in the trees, separating Woodside from a neighboring subdivision.

Unlike most traditional nursing homes, natural light fills the interior through high ceilings and plenty of windows, giving residents a sense of time of day.

In fact, Deely said, she would prefer some of the ceilings were lower because the open space sometimes disorients residents. She also regrets that the front entrance--the only locked doors--was placed in view of the residents in the common room. They become frustrated when they cannot get out.

One of Deely’s favorite touches is a Shaker-style plate shelf with pegs, so residents can display knickknacks. But the shelves are placed just high enough that neighbors are unlikely to reach up and take things.

And each room has a Dutch door, so the bottom half may be closed to keep neighbors from rummaging through somebody else’s belongings, while satisfying their visual curiosity.

Perkins Eastman of Pittsburgh, the original designer, has replicated Woodside 20 times, with three nearly exact duplications: Copper Ridge in Sykesville, Md., the Marjorie Doyle Alzheimer Center in Cohoes, N.Y., and Ashbury Place in Mount Lebanon, Pa.

With about 10% of adults showing some dementia symptoms by age 65 and about half suffering from them by age 85, homes such as Woodside are critical resources while researchers work toward finding ways to alleviate the disease, Brawley said.

“We’ve got the baby boom generation that’s going right into that age frame right now,” she said. “And if we don’t come up with a way to stop this disease, it could easily bankrupt Medicare, and it could bankrupt the country as well.”