Nestled in a former orchard where apple trees spread their welcoming branches, the Margaret T. Morris Center assisted living community for people with Alzheimer's disease and dementia is home to 57 happy and active residents. The emphasis is on person-centered care at the rambling, two-story manor in Prescott, Ariz.

A DAY IN THE LIFE

MTM's residents reside by their level of care in comfortable, spacious areas called neighborhoods. In addition to semi-private accommodations, each neighborhood has communal spaces for dining, exercising, socializing and relaxing, and a secured space where medications are stored.

The sun streams through a sitting room's French pane windows as the residents of two neighborhoods gather in a slightly askew circle. One of the community's four activity personnel paces the residents through their exercises. The activity is gentle, but the conversation among the residents is animated and sparked with friendship.

Down the hall, a resident who has reported difficulty sleeping recently, excitedly tells a resident assistant that Pepper, MTM's immaculately groomed Australian Shepherd, found her way to the resident's room to lie at her bed the night before.

"Sleep came quickly," she says with a glow, as both she and Pepper heaped attention on the other.

Outside, a resident uses a wheelchair to easily navigate the winding paths through MTM's award-winning therapeutic garden for people experiencing memory loss. Residents relax among plants that attract butterflies or beside the tranquil waters of a koi pond.

In one area, residents and their families created a colorful mosaic of tiles which are mounted to a fountain. In the Zen garden, a pendulum is positioned at just the right height to encourage residents to etch their own patterns in the sand. With the guidance of a horticultural therapist, residents are welcome to till and plant in raised flower, herb and vegetable beds.

Yvonne Napolitano, director of community relations at MTM, reflects: "The garden elements work together, not only to create a haven for the senses today, but also to help reawaken beautiful thoughts of yesterday."

THE PERSON-CENTERED APPROACH

Behind the scenes, careful attention, meticulous planning and continuous ­evaluation make the leisurely lifestyle possible at MTM. In 2003, the community adopted the philosophy of person-centered care developed by the late Dr. Tom Kitwood. MTM recently received a $300,000 multi-year grant to perpetuate this philosophy across its own community and across the state of Arizona.

When a resident moves in, the staff studies the resident's life history, including past professional affiliations, favorite foods, daily rhythms, hobbies and other interests. In addition, a six-hour dementia care mapping session occurs quarterly for each resident. Also created by Kitwood, the mapping results are used to create a very specific person-centered care plan that meets the unique needs of each resident and enhances the quality of his or her life.

CULTURE AND COMMUNITY

MTM offers a full schedule of meaningful activities to enhance socialization and recreation. Popular options include:

• trips to community events

• an intergenerational program with third-grade students at a nearby school

• painting classes sponsored by the local Alzheimer's association

• an indoor rolling plant cart for residents who are unable to join the plant cultivation classes

• cooking culinary delights using ingredients grown in the garden.

MTM becomes an extension of the original family unit. Family members can visit at any time of day or night. The continuity of these relationships is demonstrated by a daughter spending the night in her father's room upon his moving in; a husband coming each night to watch television and eat popcorn with his wife, as they have for the past 20 years; and a son sharing lunch and conversation with his mother in the garden.

FLEXIBLE PERSPECTIVES

Communication and flexibility are at the core of creating the highest quality of life for each resident. On the other side of the continent, Rola O'Meally, director of adult day and dementia services for St. Ann's Community in Rochester, N.Y., observes: "With dementia care residents, it is important to look for the person behind the disease. The disease affects residents in many different ways. Some age gracefully, and others are not able to do so. With patience and caring, we focus on the human being within the body."

O'Meally continues: "What works for one resident may not work for another. Our staff must be creative in providing the personalized level of attention deserved by each of our residents."

COLLABORATION

St. Ann's Community and The Margaret T. Morris Center have both embraced CARF International's dementia care specialty program standards because accreditation recognizes each organization's strengths on improving the quality of the lives of its residents.

Kathy Cunningham, director of nursing at MTM, comments on today's changes in the health care system and the importance of providers staying ahead of best practices in the field.

"The CARF standards provide a roadmap for future quality practices," she says. "CARF provides a wealth of resources through networking with other organizations, as well as the advice of the CARF resource specialists to help us provide a higher quality of care."

O'Meally agrees. "It is very valuable to hear from an outside party about quality care standards and to be on the leading edge in implementing these practices."

CARF's dementia care specialization standards can be applied to a variety of settings, including adult day services, assisted living, nursing homes and continuing care retirement communities. These standards represent a framework incorporating person-centered approaches and current insights to promote independence and a high quality of life at all stages of dementia.

ONGOING EDUCATION

Programs and activities alone can't keep forward-thinking facilities at the top of their game-they need to constantly learn. At MTM, Linda Fuegen, BS, director of education, requires all potential caregivers to begin with an average of 66 hours of training to become a certified resident assistant. In addition, people interested in becoming managers have additional classroom requirements to enhance their knowledge for the state board exams. Annual continuing education and monthly person-centered care workshops are also required.

Jodee Johnson, resident care manager, attributes the investment in staff education as a way to retain quality personnel. MTM also offers training sessions for community family members on the various aspects of caregiving. As a positive result of this training, MTM enjoys many volunteers.

END-STAGE SUPPORT

Honoring the whole person is important at the end of life. Given the unique requirements of each resident and his or her family, MTM identifies and supports each resident's journey and individual wishes. A beautiful hospice room was donated to MTM so that families would have a dignified and peaceful place to spend their last moments together.

"We are not judgmental about family members' practices and wishes at the end of life," Cunningham notes. "Our staff is there to support the entire family at this important time."

"Compassionate care is more than a buzz phrase," Johnson concludes.

Keri Sanders is marketing manager, CARF International, Tucson, Ariz.