Innovative Alzheimer’s Residence Tries New Models of Care

It is a raw March day in Oakmont, a small town located in the Allegheny Mountains of western Pennsylvania. Yet nestled on the outskirts of Oakmont is an inviting-looking residence—three high-roofed, gray-shingled houses, all linked to a large main building and patterned after a traditional Pennsylvania Shaker village.

Inside, the residence is even more enticing. Seniors lounge around in comfy chairs and soak up the soft lighting and cheerful décor. A couple sits on a sofa in front of a gas-lit fireplace and chats. A beige tabby weaves his way among the residents. Music from another era—is it Lawrence Welk?—fills the air.

Welcome to Presbyterian SeniorCare’s Woodside Place, America’s first personal care home designed expressly for Alzheimer’s patients.

The idea for Woodside goes back two decades. Charles Pruitt was CEO of Presbyterian SeniorCare, a nonprofit network of living and care options for seniors in the Allegheny County area. Jules Rosen, M.D., a professor of psychiatry at the University of Pittsburgh’s Western Psychiatric Institute and Clinic, knows Pruitt, who is no longer CEO but is still a consultant to Presbyterian SeniorCare.

“Charles is an administrator who understands the role of both government and families in senior care,” Rosen explained in an interview. “He is a Renaissance man, a visionary, a dynamo, a gem.”

Even with these talents, though, Pruitt and his colleagues at Presbyterian SeniorCare faced a big challenge: Allegheny County had (and still has) a large number of seniors in proportion to the total population. Some 25 percent are over age 60. This fact meant that the county had to deal with a large number of elderly who were succumbing to Alzheimer’s disease. So the challenge facing Pruitt and his coworkers was how to provide living quarters for so many seniors with Alzheimer’s, and especially quarters that would benefit them as much as possible. Or as Pruitt recalled in an interview, “We were looking for new models of care, and we were looking for ways to do it that would be humane and that would also be more comfortable for the families of seniors.”

In 1981 Pruitt visited a facility in England that gave him an idea in this regard. It was an assisted-living facility for Alzheimer’s patients instead of the usual nursing home. In 1988 Pruitt again visited this facility, which was named Woodside, and by that time several others had been fashioned after it in England. At this point, he said, “we really got the idea that we were going to do this”—that is, build a home-type assisted-living facility for Alzheimer’s patients in Allegheny County.

Now enter J. David Hoglund, an architect with the Pittsburgh architectural firm of Perkins Eastman. Pruitt and his colleagues at Presbyterian SeniorCare had had a longstanding relationship with Hoglund and his team on other architectural projects, so they hired Hoglund and his coworkers to help them design and build a residence for Alzheimer’s patients.

But even with Woodside in England as a model, it was a challenge, Hoglund admitted in an interview with Psychiatric News. “There was nothing architecturally special about the building. It had been used for other things in the past,” he said. What’s more, he explained, “if you go back 12 or 13 years ago during the planning, there was very little written about environmental design and alternative housing settings for people with dementia, and there were certainly no facilities [here in the United States] to look at. So we really started at the ground level in doing research on how older people with dementia behave, what their issues are, what kind of housing they would require, and what kind of environmental needs they have.”

They then set about designing a residence for persons in the early or middle stages of Alzheimer’s that would be less restrictive and that would provide a higher quality of living than a traditional nursing home would. What’s more, the residence would cost less to build than a traditional nursing home. That was one of the goals, Hoglund said. The residence that they designed was then constructed in 1991 and licensed as a “personal care home/assisted living facility.” Costs indeed remained less than those of building a traditional nursing home. The residence was named Woodside Place after Woodside in Birmingham, England.

Woodside Place is located on Presbyterian SeniorCare’s Oakmont campus. It is surrounded by a fence so that residents can go outdoors whenever they want, yet not wander away. The lawn around the residence contains meandering paths that intersect and never end. This way residents can wander to their hearts’ content, yet never find themselves in a cul de sac, frustrated and confused about where they are.

The main building contains a great room where residents can gather whenever they want. It contains comfortable chairs, sofas, a gas-lit fireplace, and other amenities of home. The main building also contains a television room, where residents can watch and listen to videos of “oldies-but-goodies” like the “Lawrence Welk Show”; a music room; an art therapy room; and a beauty parlor, where residents can have their hair washed and styled on a regular basis.

Since the main building is connected to the three individual houses, residents can come and go between the main building and the houses whenever they want. The floors contain carpeting in some places, yet tile in others to give residents as much sensory stimulation as possible.

Each of the three houses has its own visual theme—a star, a tree, or a house—to help orient residents to where they are and to find their way home.

Each of the three houses also contains a kitchen, where food is prepared for its residents. The idea is to provide residents not only with home-cooked food, but also to get them involved in food preparation if they wish and to expose them to the pleasurable aroma of food cooking.

Each of the three houses also contains bedrooms for its particular residents. Photos of residents are placed outside their rooms to help them find their way into the right one. The bedrooms have Dutch doors. The reason, Woodside Place’s soft-spoken and personable administrator, Amy Ernst, explained, is to allow residents to look out of their rooms when they desire, yet to discourage other residents from barging in.

And last but not least, the residence is designed to keep residents safe. For instance, there are keyed shutoffs for major appliances, cabinets containing harmful products are kept locked, pictures are framed in plastic instead of glass, and lamps are too heavy to be picked up.

But with all these enrichment and safety features, is Woodside Place truly benefiting residents? If you observe and listen to some of the residents, you get the impression that it is.

On this particular March day, for instance, one lady is watching a “Lawrence Welk” video on television. Women recline in chairs in the great room, while another contentedly pushes a chair around in it. One resident is enjoying a visit from her husband. And then there is “Bill,” a tall, rangy resident in his 70s who obviously enjoys helping Ernst give tours to visitors. When a Psychiatric News reporter introduces herself to him, he bends over, reaches for her hand and kisses it, then looks up and grins.

Rosen also has good words to say about Woodside Place’s impact on residents: “The architecture is beautiful! There is the feeling of a home environment, people can walk anywhere without getting lost—all of that is wonderful. But it wasn’t until I spent days there that I realized how special it is. Let me give you an example of what I mean. Come afternoon, come dinner time, if they are going to have potatoes, any of the people who want to sit around the table and peel potatoes can do it. They not only feel useful, there is a lot of talking. I know because I sat there and peeled potatoes with them.”

N.J. Jacob, M.D., a consulting psychiatrist to Woodside Place three years ago and now with the Western Psychiatric Institute and Clinic, also has praise for Woodside Place’s influence on residents. Walking is an outlet for Alzheimer’s patients whenever they become agitated or irritated, he explained in an interview. Since residents of Woodside Place can wander throughout the facility and its garden as much as they desire, it helps calm them, and “they are able to be managed without much medication to control their behavior.”

An evaluation conducted of Woodside Place between 1991 and 1994 by Myrna Silverman, Ph.D., of the University of Pittsburgh Graduate School of Public Health, and her colleagues, and published in 1995 by Presbyterian SeniorCare, likewise underscores some of the good influences of Woodside Place on residents.

Silverman and her colleagues compared the physical and psychological status of 59 Woodside Place residents with that of 34 persons at a comparable stage of Alzheimer’s living in a traditional nursing home on the Presbyterian SeniorCare Oakmont campus. One of their findings was that Woodside residents declined more slowly in functional capacity than had the nursing home residents. Functions that were especially well preserved in Woodside Place residents were ability to walk, feed oneself, bathe oneself, and dress oneself. Woodside Place residents also spent three times as much time socializing as did residents of the traditional nursing home, they found.

“The physical design of Woodside Place explicitly fostered social interaction,” they wrote. “The division of the facility into three houses automatically created smaller social groups within the total population.”

The evaluation by Silverman and her colleagues, however, suggests that not all of Woodside Place’s influence on residents is positive. For instance, the team came to the conclusion that because Woodside Place is so cheerful, it may not allow residents enough opportunity to deal with their negative emotions. Or as they wrote, “One thing that has concerned us is a tendency at Woodside Place to try so hard to make residents feel happy and satisfied that there is an avoidance of dealing with more somber or painful emotions, such as grief, loss, anger, and fear.”

What’s more, even the best architecture can do only so much to help Alzheimer’s patients. For instance, Hoglund has noted, “Residents seem to respond better to people as orienting cues than to the built environment. They often look for their care attendants rather than colors or objects.”

And as Rosen pointed out: “If you build a beautiful piece of architecture and don’t have a philosophy of care that Woodside Place has, it is not going to help. But when you do have the architecture matched with the philosophy, then good things can happen.”

And what is Woodside Place’s philosophy? “It is one of respect—respecting residents’ rights, optimizing their function,” Rosen replied. “The doors are locked, yet [the residents] feel free. They are participating in choices, in planning. Even though because of their disease their world has shrunk, within that shrunken world each person feels whole, as whole as possible.”

Ernst summed it up nicely: “Everyone has value here.”

Yet, even when the best architecture is combined with the best philosophy, it still cannot hold at bay indefinitely Alzheimer’s patients’ downward spiral into dementia and physical deterioration. Residents remain at Woodside Place on average only one and a half years before they decline so much that they have to be placed in a more traditional nursing home that offers closer supervision and a higher level of medical care.

Then there is the question of costs to residents. Although the daily rate for a private room at Woodside Place is somewhat less than for a private room in a traditional nursing home in the same area—$137 versus $158—that comes to a whopping $50,005 a year, not exactly small change for most people.

Even with its limitations, though, Woodside Place seems to be sparking a revolution in housing for persons in the early and middle stages of Alzheimer’s. Since it was completed a decade ago, some 60 residences have been modeled after it in various areas of the United States and Canada, including Judson Village in Cincinnati, Ohio; the Marjorie Doyle Rockwell Regional Alzheimer Center in Cohoes, N.Y.; and McConnell Place North in Edmonton, Alberta, Canada. Hoglund and his team have designed some 20 of the 60 facilities.

On February 6, “ABC World News Tonight” featured Woodside Place as part of its commemoration of President Ronald Reagan’s 90th birthday and America’s growing Alzheimer’s challenge. Anchor Peter Jennings described Woodside Place as the “first personal care home in America” designed specifically for Alzheimer’s patients. ABC’s physician commentator, Tim Johnson, M.D., declared: When it comes to care for Alzheimer’s patients, Woodside Place “is about as good as it gets.”

More information about Woodside Place is available by contacting Amy Ernst by phone at (412) 826-6501 or by e-mail at [email protected]. ▪