The Boston Globe
Wednesday, February 9, 1994

New facility fills gap in Alzheimer's care

By Jody Foreman
Globe Staff

Hopkinton - Earlier this week, as sun poured through the windows of a wicker-filled solarium. Esther Cohen sat quietly on a bench under a trellis, where faux flowers twined into a graceful arch. Gazing out to the trees beyond, she seemed every inch a lady, a figure of peace, a far cry from the stereotypical patient with dementia.

Down the hall, Mitzi Krueck was busily vacuuming the carpet, not because it needed it - it looked new- but because vacuuming comforts her.

Nearby in a cozy, sofa-filled TV room, Joan Thompson and her friends sat glued to "The Price is Right." Their conversation, guided gently by an aide, flowed merrily, punctuated by Thompson's laughter. Farther down the corridor by the kitchenette, two other residents sat on stools, watching aides get snacks ready, almost as if they were in a friend's kitchen.

Welcome to Hearthstone, the state's first assisted living facility specifically designed for people with Alzheimer's disease and other forms of dementia. It is, elder advocates say, an idea whose time has long since come.

Hearthstone is an attempt by owners Joan Hyde and John Zeisel, who are aging specialists, to bridge a chasm that for years has plagued families caring for a person with Alzheimer's disease: What to do when the person is too well for a nursing home and too needy to be cared for at home.

Only 30,000 of Massachusetts 100,000 Alzheimer's patients are cared for in nursing homes, where they occupy more than half of the beds. But only 700 to 800 of these nursing beds are in units specially designed for Alzheimer's patients. The incurable degenerative disease of the brain begins by destroying short-term memory and ultimately leads to disorientation and loss of most mental faculties.

Mixing patients who have Alzheimer's disease with other nursing home patients sometimes works fine, but often, elder advocates say, it is too stimulating for the demented patients and disruptive for those with other ailments.

Until now, however, the only real alternative has been home care, preferred by many of 70,000 Alzheimer's patients living in the community. But the burden of caring for someone who must be watched constantly and helped with the basics of life sooner or later becomes too much for many caretakers.

Elsewhere in the nation - and belatedly in Massachusetts - creative housing options for older people have blossomed in the last three to five years, with growth particularly strong in so-called assisted living facilities and

continuing care retirement communities. Unlike nursing homes, which provide nursing care and must be licensed by the state, these facilities are less clearly defined; they generally provide few medical services but lots of other services, such as meals, help with personal care, transportation to appointments and housekeeping.

The idea of extending these new housing options to Alzheimer's patients is just now coming into its own.

Today the Hearthstone facility, which constitutes one floor of the larger Golden Pond assisted-living facility, will be ceremonially opened by Lt. Gov. Paul Cellucci and Secretary of Elder Affairs Frank Ollivierre.

The need for something between skilled nursing homes and home care has been acute, says Daniel O'Leary, executive director of the Alzheimer's Association of Eastern Massachusetts.

Specially designed facilities like Hearthstone, he said, "will fulfill a huge gap in the continuum of care, whereas now, it's either you are at home or in a nursing home. That is the choice families have had such a horrific time dealing with."

More than a dozen patients already live at Hearthstone, said Hyde and Zeisel, who say the unit can hold 30 patients.

Hearthstone is not cheap. Room and board come to $1,520 a month, and the services - such as help with dressing, bathing and medication reminders - come to $1,976, bringing the monthly cost to about $3,500, about $115 a day.

If residents - they are not called "patients" - want nursing care, they can do just what they would have done at home: contract with visiting nurses, for an additional fee, which is often covered by Medicare.

Hyde and Zeisel acknowledge these costs are high, but, they say, so are the alternatives. Nurses home run $150 to $200 a day. Contracting with personal care helpers to care for a person with dementia at home can cost about $125 a day, or roughly $3,750 a month, says O'Leary of the Alzheimer's Assn.

The real benefit of a specially designed place like Hearthstone, add Hyde and Zeisel, is that it is so Alzheimer's friendly.

Bathrooms, for instance, are everywhere, to minimize incontinence problems. The sunporch looks markedly different from the TV rooms, and from the kitchen/dining area, to keep residents from getting confused about where they are.

Best if all, say Hyde and Zeisel, the staff is prepared to spend as much individual time with each resident as possible - including a cup of tea and help with a jigsaw puzzle. Even at 3 a.m.