A 1950s-era adult day care center designed “to elicit memories and encourage conversation and engagement,” sometimes called reminiscence therapy, recently opened in Chula Vista, Calif. As an article from the Wall Street Journal describes, it’s an approach that has been used successfully in Europe — particularly the Netherlands — but is relatively new to the U.S. The owners plan to franchise the concept, and build up to 200 centers across the country in the next five years.
My favorite anecdote from the story: A former accountant who was diagnosed with Alzheimer’s at 68 frequents the center, often working in the faux City Hall. She believes that she’s the bookkeeper for the organization. This notion is supported by staff who print invoices for her, fostering a sense of purpose, according to her family.
This 9000 square-feet adult day care center can accommodate 75 patients — most in moderate stages of dementia — each day.
By Sumanthi Reddy, WSJ – Sept. 18, 2018
Chula Vista, Calif.
The two men, high school buddies, sit in a turquoise and white booth at Rosie’s Diner, ribbing each other like they are teenagers at Sweetwater High School where they played baseball together so many years ago.
A 1950s-era jukebox spits out tunes like “Peggy Sue” by Buddy Holly. Vinyl records and black-and-white pictures of celebrities like Elvis Presley and Audrey Hepburn line the walls.
Now in their 70s, James Mann and Richard Eshbach are actually in Glenner Town Square, a new adult day-care center for dementia patients that is like entering a time warp. The 11 storefronts that surround an indoor park represent the time period from 1953 to 1961, when most of the patients were in the prime of their life.
Glenner Square opened in August and is believed to be the country’s first memory-care facility built entirely around the idea of reminiscence therapy, a therapy that uses prompts from a person’s past—such as music, movies and photographs—to elicit memories and encourage conversation and engagement. It’s a behavioral approach to treating Alzheimer’s and dementia patients, often used in nursing homes in the Netherlands and other countries, that is growing in popularity as efforts to create effective drugs for the memory-robbing disease fail.
“We know dementia makes it hard for patients to remember the recent past, like the last 10 years, whereas the older memories are preserved better for a longer time, especially memories from childhood and early adulthood,” says Dorthe Berntsen, a psychology professor and head of the Center on Autobiographical Memory Research at Aarhus University in Denmark. Her studies have found that dementia patients can engage more when they are exposed to objects from the past. “You want to have an environment that fits the kind of memories that people have,” she says. “It doesn’t cure dementia, of course, but it does provide a context where these people have a better connection to their past and to their sense of identity.”
Research on reminiscence therapy is mixed. Dr. Berntsen’s most recent study tested a five-week Danish program in which about half of 43 Alzheimer’s patients were assigned to weekly sessions in an authentic, 1950s-style apartment in a local museum, while the other half got standard care.
Most participants showed no improvements in a series of cognitive tests done before and after the intervention. But they did become better at talking about autobiographical memories when triggered from older objects.
A recent Cochrane review concluded that the effects of reminiscence therapy are inconsistent and small in size. Still, it said that there is some evidence it can improve quality of life, cognition, communication and mood.
Myrra Vernooij-Dassen, a professor at Radboud University Medical Centre in Nijmegen in the Netherlands who also chairs a European network of dementia researchers, says the Cochrane conclusions were “promising.”
“It’s very hard to do research in this kind of group and to get positive effects,” says Dr. Vernooij-Dassen.
“People with dementia still are people with their capacities, with their dignity,” she adds. “We can use these capacities and reminiscence is one of the ways that we can stimulate people with dementia. If they have the right treatment then they can stay stable for really many years.”
Glenner Town Square is a partnership between the George G. Glenner Alzheimer’s Family Centers—a California-based nonprofit organization—and Senior Helpers, a national in-home senior care provider.
The partners have plans to franchise the concept and open up similar centers across the country. Peter Ross, CEO and co-founder of Senior Helpers, says they’ve already received interest in the concept and hope to have 200 Town Squares across the country in the next five years.
Glenner is 9,000-square-feet with 24-foot ceilings. It’s licensed for 75 patients a day. Currently the facility has more than 50 patients enrolled, though the number that attend the center on a given day fluctuates as patients can create their own schedule depending on their families’ needs. They are open for half-a-day or a full-day every weekday.
The program is mostly geared toward patients who are in the early to moderate stages of dementia, who are typically living with family or at home with caregivers. Their family members or caretakers drop them off at the facility.
“We really looked to bring people back to where their fondest memories are, typically between the ages of 10 and 30,” says Scott Tarde, CEO and executive director of Glenner Centers, noting that the average participant is about 82-years-old. The facility hasn’t been open long enough to assess the benefits of the program, but is participating in research on its effectiveness.
The setting—an idealized vision of the 1950s that omits explicit references to societal injustices that civil rights and later feminist movements battled against—may not resonate for all patients, who include immigrants from China, the Philippines and Latin America, as well as African-Americans. The son of one Chinese immigrant, for instance, says his mother probably doesn’t relate much to the memorabilia and items.
Mr. Tarde says the center tries to incorporate activities that relate to other cultures, such as playing games like Loteria, a Mexican game similar to bingo. He says they “are very sensitive and aware of history and absolutely will recognize history, Civil Rights and cultural days, weeks and months” with different activities that acknowledge the diversity of their patients.
Reminiscence therapy is not expected to fully restore patients’ capabilities—there is still no cure for Alzheimer’s—but participants may show glimpses of their former selves, says Mindy Baker, director of education at Glenner Centers. Participants are placed in groups as they rotate through storefronts led by staff in different activities. Patients who require more assistance pay $65 for half-a-day or $95 for full day care. Those in the earlier stages of dementia who don’t require medications pay $60 or $85.
The center of the village is a small, indoor park, with natural skylights, and artificial grass for a small putting green and bocce court. Parakeets from the adjacent pet store add to the ambience.
Mr. Tarde points to a real 1950s San Diego police call box, a pay phone that calls the front desk and a restored 1959 black Ford Thunderbird car, which patients can get in and even open the hood to tinker with it.
A clinic where the center’s registered nurse works has cribs with lifelike baby dolls that patients cradle. There is a library with a card catalog, a 1950s National Geographic set and Monopoly and Scrabble games circa-1930. A re-created home space called the “Little Blue House” has an original Philco Fridge and a record player.
At the movie theater, “The Greatest Show on Earth” plays in 15-minute clips. At Joy’s department store, patients can shop and even bring home a fur coat and bowling shoes. And at the Gone Fishin’ Pub there’s a pool table, a mini-basketball court and darts. The storefronts use graphics and pictures that can be changed to re-create different eras for different generations of patients.
Staff work in a “City Hall” office space. Among them: Susie Heavilin, a 69-year-old former accountant who was diagnosed with Alzheimer’s last year and believes she’s their bookkeeper.
“They print out invoices for her,” says Sheri Berg, her daughter. “It’s really given her a sense of purpose. It’s really changed everything for us.”
On a recent day, activities buzzed in different corners. There was a painting class in the diner while in the library Marilyn McPhie, a storyteller, talked about trains and railroads. At one point she passed around a penny flattened by a train.
Mike Casey, a 78-year-old retired orthopedic surgeon who was diagnosed with Parkinson’s disease and dementia two years ago, cradled it affectionately.
Later, Dr. Casey, who was at Town Square for the first time, called the session “remarkable.” (He is one of the few Glenner patients who is sufficiently aware of his condition to be able to reflect on the treatment.) He recalls living two blocks from a train station in St. Louis, where he grew up.
“I can remember vividly sneaking down there and putting my ear on the rail and you hear a train coming, look down and see a train that’s a mile down but looks like it’s 8 feet away,” says Dr. Casey.
At a music and theater class later in the day, Trevor Gibson, a local piano player, leads the multilingual group in songs ranging from La Bamba to Cielito Lindo. Two women get up and spontaneously start ballroom dancing together.
Meanwhile, at the local pub an employee leads a group of patients in a game of penny poker. And in the Little Blue House a woman, alone, watches an iPad with black-and-white episodes of “I Love Lucy.”
Mr. Mann and Mr. Eshbach hadn’t been in touch for decades until they bumped into each other at a local Alzheimer’s disease support group a couple of years ago, says Marsha Mann, Mr. Mann’s wife.
Her husband is diagnosed with mild cognitive impairment, a type of memory loss. Mr. Eshbach was diagnosed with Alzheimer’s in 2016. The two now go to Town Square together once a week.
Ms. Mann she noticed an “elevated cognition” in her husband after he went to Town Square. He belted out a Leonard Cohen song. “I just felt like he was more conversant,” she says. “The singing, it just warmed my heart.”
TRYING REMINISCENCE THERAPY AT HOME
Experts say reminiscence therapy can be done at home with dementia patients, using old photos, music and other props.
Mindy Baker, director of education at George G. Glenner Alzheimer’s Family Centers, says looking at old pictures is a great way for family members to connect. “Think about what stories your loved ones like to retell, special events, or accomplishments that happened in their life,” says Dr. Baker, suggesting photos of the house they grew up in, family members, weddings and trips.
She suggests enlarging photos and making a memory book together. Keep it simple with one or two photos per page and large print to label photos.
Dr. Baker says doing a favorite activity or hobby together is also helpful. She suggests making an old favorite recipe together and using old mixing bowls or measuring cups, if you have them. “As you are doing the activity, the smells, tastes, visuals and context will likely trigger some memories,” she says.
Music is also a great way to trigger memories, expert say, both playing old songs or taking out an instrument they played in the past.
Keith Anderson, director of the Montana Geriatric Education Center at the University of Montana, says the exercises should facilitate memory rather than challenge it.
He warns against correcting dementia patients. “Use suggestions when their memory does not align with the facts,” says Dr. Anderson. “In some cases, you can simply go along with the older adults’ recollection and support their perspectives on the past.”
Pamela Givens, a reminiscence therapy guide at Glenner Town Square, says they always refrain from asking patients, “Do you remember?”
“We try to stay away from that word: ‘remember,’” she says.