It is estimated that 2.5 million American adults have the disease, which is the most common form of dementing illness. More than 100,000 die each year, making it the 4th leading cause of death. Alzheimer's disease is characterized by progressive memory loss, a decline in the ability to perform routine tasks, and the loss of language skills. Most victims are over 65 years of age, but it may strike persons in their 40s and 50s. Persons with this disease may be taken care of at home, but due to the encompassing nature and constant vigilance needed in the care, many are now living in long-term care facilities.

Salem Village is a multi-level long-term care facility in Joliet, Ill.., and is a program of Lutheran Social Services of Illinois. The 314 bed facility includes three levels of care, sheltered, intermediate, and skilled. Within the intermediate level is a special unit for those residents who have been diagnosed with Alzheimer's disease or related disorders. This unit recently had a change in focus of care. Before the change, the unit was a typical nursing home unit, where the residents were provided activities at designated times during the day. Need has produced an ever increasing demand for a unit that could effectively care, treat, and program for the resident with dementia.

Administration and staff worked together to develop a unit utilizing activity-based treatment. Since this program was to be activity-based but utilizing all staff, an interdepartmental task force was formed. Along with the activity director, the social worker, the unit nursing coordinator, the chaplain, and the volunteer coordinator compromised the task force, each with an area of expertise and an area of responsibility.

Program Development

Extensive research into current literature and visitation to other special units in long-term care and adult day care was undertaken. Workshops and conferences that dealt with the disease and the treatment of the person were attended. After compiling this information, the task force determined that treatment for the resident with Alzheimer's needed to be comprehensive. Two or three optional activities a day would not provide the necessary stimulation to keep the resident at their optimum. A schedule was set to provide the residents with a continuous program of activities beginning after breakfast and lasting until supper time. This schedule would include all aspects of recreation, combining physical movement and intellectual stimuli to provide a well rounded program to maintain their physical status and to utilize their mental capacity to their highest potential.

Staffing for an intensive program was an obstacle that needed to be addressed. To compliment the activity department staff at the initiation of the program, department heads were utilized. While an active volunteer recruitment and selection process began, three volunteer training sessions were held. The first session dealt with the medical and psychological aspects of the disease. The second dealt with the programming aspects of this population, and the third session dealt with actual program offerings for the residents and the volunteer leader. Volunteers were selected for programs based on their desire to lead, their skills, and areas of knowledge.

Information about Alzheimer's and the resident with Alzheimer's is constantly being updated and new discoveries are being made.

The residents were divided into four groups depending on their cognitive level, ambulalion skill, and their ability to socialize with other group members. This selection was done so the group members would compliment the other members of the group to the best of their abilities. Since Alzheimer's is an ongoing disease and the rate the disease progresses varies with each individual, group membership was reviewed monthly unless some medical or mental emergency dictated sooner review.

Prior to the actual initiation of this program, the residents' families were informed of the new program and how it would affect their family members who were residents. The residents who would not benefit from this program due to overriding medical needs were moved to other units within the facility. The residents who remained on the unit were given private rooms. This entailed moving residents to new rooms. Families were encouraged to assist in decorating the rooms with home-style furniture.

Program implementation

The day room was set with tables sufficiently spaced to minimize distraction. Two rooms that were vacated went into use as small group rooms. Each group had a designated area for programming. Staff came to that area to lead their programs. This left the resident with a very minimal amount of movement between programs. This proved successful. The residents started to recognize their group members and the leaders who did the program. Residents were not being missed in transit to other program sites.

Many benefits became apparent during the first months of the program. The noise level on the floor decreased because the resident was involved and was not interfering with the actions of other residents. Accidents decreased because the wandering of most residents decreased. The leaders were asked to document any significant action or verbal response that the resident made during his/her program. A resident who was not thought to be able to read, read a magazine title to the leader. One resident had the opportunity to sit at a piano and let all know that she could play. She was now able to function and perform at a higher level and have feelings of accomplishments. Throughout the program, revisions have been made, staff has been replaced with volunteers, new volunteers have been added, and some of the volunteers have left.

Special events such as a picnic, a small band performance, an ice cream social, and monthly birthday parties have been added to the calendar of events. Families, once resistant to their family member being moved to the floor, are now encouraged with the program. Staff are more aware of each resident and their individual needs.

Review and updates

A monthly meeting is held to review resident groups and leader assignments. Input from the leaders is actively solicited to find out which programs are working and which ones are not. Some programs that were tried did not work. Crafts were difficult to program since residents have a very short attention span. They cannot encompass the project from pieces into a finished object. Research into lifestyles of the residents were found to be important. Residents are uncomfortable doing something now which they never did or never wanted to do. With a changing resident population, constant updates are needed to keep the program relevant to the current population. The benefits to the residents can be seen when comparing the atmosphere and milieu of today with the unit one year ago. Positive resident interaction has increased. Staff morale has increased. The anxiety level of the residents has decreased. A quieter unit that benefits all now exists.

Information about Alzheimer's and the resident with Alzheimer's is constantly being updated and new discoveries are being made. The program moves forward in step with these changes. A safe and secure environment is provided where the resident can live in dignity and utilize his/her capabilities to the fullest.

About the Author
Laurence D. Lindholm is Director of Resident Programming for Salem Village. He is a Certified Therapeutic Recreation Specialist, a graduate of Illinois State University and the Therapeutic Recreation Management School and Leisure and Aging Management School of the University of Maryland.