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Jackson County facility provides 'Light' for those with dementia

Good Samaritan medication assistant Sean Lutterman (from left) reads with resident Bob Howard as R.N. Katie Stai listens at the facility in Jackson. (BRIAN KORTHALS/DAILY GLOBE)1 / 3
A fish tank serves to stimulate memories in the residents of the Lighthouse, a dementia facility in Jackson. (Brian Korthals/Daily Globe)2 / 3
Tibbles the cat is a popular visitor at the Lighthouse, reminding many residents of the cats they once owned. (Brian Korthals/Daily Globe)3 / 3

JACKSON -- A lighthouse serves as a beacon of hope and guidance to ships afloat. The Lighthouse, a special facility in the Jackson Good Samaritan Center, serves as a beacon of hope and guidance to those suffering from dementia, as well as their families and friends.

"A lot of people think a person with Alzheimer's is miserable," said Nancy Garvin, a community relations manager at the center. "And they're not. They can be the happiest people you'll encounter."

The Good Samaritan Center was built in 1955, when nursing homes were more like retirement communities than the care facilities they have since become.

"We do what hospitals did. We get folks that are sick and we send people home," said Gordy Hormann, Good Samaritan's administrator. "Folks are living longer and they're staying here longer. So they're coming to us sicker, or in a more advanced dementia."

It wasn't until the mid-'90s that the suggestion of setting up a separate facility for people with Alzheimer's and other forms of dementia, and the conversion of the existing wing and the addition was completed in 1998. The Lighthouse's capacity is 17 people, though it generally houses slightly fewer.

The Lighthouse is similar to the other parts of Good Samaritan, but has some important differences. It features lounges, a kitchenette, softer lighting and carpet instead of tile. It's a quieter environment designed to be more relaxing and have less stimuli for the residents. Medications aren't given at a set time to all patients. Importantly, the Lighthouse also has secured doors so residents don't wander where they aren't safe.

Some things have already changed since the Lighthouse opened in 1998.

"They wanted everything muted, for color. They didn't want TV," said Toni Bandow, a registered nurse and the director of nursing at the Good Samaritan. "These things have changed."

Adding the television helped one of the residents, whose routine had included watching particular television shows. "The Lawrence Welk Show" is a favorite and polka music is popular, but the recent Winter Olympics were also a big hit.

Many of the residents enjoy doing the same things they used to do when they lived at home. They wash dishes and set tables, fold clothes or hold baby dolls. Most of the residents are taken out to activities, but a few of them find noisy environments upsetting and stay at the Lighthouse.

One of the objectives at the Lighthouse is giving residents as home-like an environment as possible, to help maintain their connections with reality and their pasts. Patients are allowed to have their own routines.

Sometimes staff will help residents bake. A visit from a cat is a popular event, because many of the residents had cats of their own. A few people garden, and though they usually can't maintain their own plants in the waist-high planters of the Lighthouse's enclosed courtyard, sometimes they enjoy watching staff members do it, too. The residents exercise in order to maintain their physical abilities.

"We're learning," Hormann said. "Even 10 or 11 years ago, there weren't a lot of special care units."

The Lighthouse can be difficult to staff, partly because the residents need additional care, though the government reimbursement rates for dementia patients do not reflect that. They may need extra care because of negative behavior, but they may simply need extra help getting dressed because they can't remember how to do it, or they may need help eating because they don't recognize a fork.

In order to become a Lighthouse resident, a patient's family needs to fill out a fourpage assessment form to determine whether the patient would benefit from living there rather than in the ordinary care facilities Good Samaritan provides. The patient needs to be mobile on his or her own, whether this means walking, or using a walker or wheelchair.

Sometimes families don't want loved ones in the Lighthouse because of the stigma attached to dementia, but often those same families will fight tooth and nail to keep them there as their health fades, Hormann said, because they've become more aware of what dementia is.

Though many people at the Lighthouse do have Alzheimer's, others have other types of dementia, such as Huntington's disease or Lewy body dementia. Dementia is a broad spectrum of diagnoses and patients in the unit may have any of them.

"(With Alzheimer's) the brain atrophies," Bandow explained. "It's like starting a car. The thing is, with Alzheimer's, sometimes that spark is going to get through, but sometimes, it doesn't.... It is a very sad and debilitating thing."

Dementia affects a wide variety of ages. The youngest resident of the Lighthouse was 52, and the oldest so far has been 96 years old.

"What's difficult is that a lot of our residents don't act the same way they used to," said Katie Stai, registered nurse and case manager. "You might see them swearing, or doing things they would never have done."

The smallest tasks can take dementia patients and their caregivers a lot of time. They don't always understand cues like "put your hand into the sleeve," and sometimes instructions need to be broken down further to make sense. Simple choices can be frustrating, Stai said, even minor issues like which shirt to wear.

And you don't correct someone with dementia, Stai said.

"If they're looking for mom, you ask 'When was the last time you saw her?'" Hormann said, giving an example. Many dementia patients worry about paying and ask how much things cost.

"But many of them are in a pleasant state," Garvin said. "You hear them sing. They talk to baby dolls."

Sometimes assisting a dementia patient can be as simple as giving them something to eat while they're wandering, especially if it's something that doesn't require silverware. People may not recognize a spoon, but they'll usually figure out what to do with a sandwich, for example.

"Bathing is a fear. A lot of times, they have a fear of water or don't know what's going on," Stai said. If a patient believes she is 12 years old and waiting at a bus stop, for example, a total stranger wanting to take off her clothes and bathe her would be very upsetting.

Before working in the Lighthouse, staff go through 40 hours of training to enable them to help the residents there. If a patient does get upset, staff members make sure the patient is safe and back away for a while, or switch caregivers.

Dementia patients also commonly suffer from sundowning, meaning their behavior becomes more erratic or difficult later in the day. Sometimes turning down the lights or putting patients to bed earlier can help, and not every patient goes through the sundowning effect.

Residents can become attached to their caregivers, too, and though they may not remember names, they do sometimes remember faces. Family members recognize staff members and can form very close bonds of trust with them.

"They're living in their teens and 20s and they're in their 80s and 90s," Hormann explained.

The Good Samaritan and the Lighthouse are always looking for volunteers, and at the Lighthouse one-to-one visits with patients are especially helpful. A volunteer might spend time getting a dementia patient set up with a simple task, like folding clothing or sorting jewelry. Piano players are also in great demand.

It's best, for volunteers to be able to commit to a regular, consistent schedule, Hormann said, but he added that some residents were more adaptable than others.

"A totally nonsensical conversation can be the best part of their day," Garvin said.

"They need visitors," Hormann agreed.