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Houston Chronicle
Section D
Sunday, June 6, 1999

A Facility For Caring
By Mary Sit-DuVall
Houston Chronicle


When Joan Jacobson's 79-year-old mother tried to climb over the balcony of their home, Jacobson knew it was time to find a safer place for her mother, who suffers from Alzheimer's disease.

But it was an arduous search that involved visits to at least a dozen facilities and a short stay at a place that didn't work out.

"There are so few places that have worked hard to understand the disease and are focusing on what each individual patient needs," said Jacobson, 54, a retired early childhood educator in Sugar Land.  "The sad thing is…there's no point of reference to compare what's good and what is adequate."

Eventually, Jacobson found what she was looking for - a small place devoted exclusively to residents with Alzheimer's, with a staff well-trained in the disease.

Such stand-alone Alzheimer's facilities are cropping up across the nation.  In the Houston area, five facilities designed solely for seniors with Alzheimer's disease or related dementia have opened this year or are scheduled to open by fall.

Though many assisted-living senior housing facilities have a special wing for Alzheimer's patients, these stand-alone facilities are specialized residences - a niche within a niche-that is poised to take advantage of a graying population.

Alzheimer's is a degenerative disease of the brain that weakens mental abilities changes personalities and disables an elderly person's ability to function independently.  It is not a normal part of aging.  It affects one in 10 people who are age 65 and older and one in two people age 80 and older, according to the Alzheimer's Association.

An estimated 4 million Americans suffer from Alzheimer's now.  That number is expected to triple in the next 40 years as baby boomers age.

In Texas, $13 billion a year is spent taking care of people with chronic disease-and much of that is for people with Alzheimer's, said Ellen MacDonald of The Texas Council on Alzheimer's Disease and Related Disorders.  Nationally, cost for Alzheimer's care run about $100 billion a year.

With the 85-and-older elderly the fastest growing segment of the population, it is no wonder that developers and investors are building specialized housing for this group.

Noah Levy, a principal in senior housing for Prudential Real Estate Investors in Atlanta, said Texas has been a magnet for construction in senior housing generally and ranks as the third most active state for senior housing, right behind California and Florida.

"Texas is a relatively low-cost place to build," Levy said.  "There are few union issues.  Barriers to entry are relatively low."

Starting in January, the state has required facilities that advertise services for Alzheimer's residents to be certified.  Currently, there are 4 certified homes for Alzheimer's and 13 applications pending statewide, according to the Texas Department of Human Services.

John Trevey, the 37-year old chief executive officer and co-founder of Uncommon Care in Austin, said his company mirrors the growth that has occurred in this field.  In 1996, Trevey and a college buddy, Bob Bouchard, opened the first Barton House, a specialized home for dementia patients.

Back in the summer of 1994, when Trevey was researching the field, no one wanted to work with Alzheimer's patients.

"If you had Alzheimer's, you couldn't get in a resident facility.  If you were already in one and got Alzheimer's, they threw you out.  There was a real need here," Trevey recalled.

Now, Uncommon Care has six Barton House facilities in the Austin, San Antonio, Fort Worth and Houston areas.  Each provides a house with20 private rooms, attention to detail and a staff who understands Alzheimer's.

"It's not rocket science," Trevey said.  "We try to create a 'yes' environment.  It plays to their strength.  In some Alzheimer's facilities, it's 'No, don't do that.  No that's not right.'  We assemble a fairly high-functioning group together, and then we all go down the road of Alzheimer's together.

Special design features include crushed granite on the garden paths - easy to see when the sunlight reflects on it, and easy to walk on so someone with a shuffling gait won't stumble.  Wardrobes have a separate space where one day's outfit can hang by itself, so the resident won't be overwhelmed by choice.  Doors have different numbers of panels on them, so residents can distinguish rooms.

Outside each resident's room is mounted a "memory box," in which a resident can display art objects, curios and framed photographs.

At Barton House in Sugar Land, antiques and black-and-white photos of Roy Rogers remind residents of earlier days.  An 8-foot-high metal gate surrounds the back yard, which overlooks a lake.  A refrigerator with a glass door is stocked with fruit, gelatin and yogurt, inviting residents to snack anytime.

No one wears uniforms or name tags.  Two doors, opened by keypad only, keep residents from wandering out into the street.

Syd Gerber, executive director of Garden Terrace, said its parent company, LifeCare Centers of America in Cleveland, Tenn., tries to create secure, self-contained facilities with a home-like setting.

Gerber said family members are encouraged to bring in a s much personal furniture, paintings and pictures as can fit safely in a room.  "As long as (residents) are safe and secure in their unit, we allow them to do just about anything."

At Garden Terrace, there's no paging over loudspeakers.  Hallways are twice the normal width of six to seven feet, to keep residents from feeling claustrophobic.

LifeCare Centers, which has five Alzheimer's facilities, plans to build 20 more nationwide in the next five years.

"Our strategy is to develop relationships with hospitals, neurologist and all doctors who specialize in Alzheimer's," said Gerber, adding that the company also sponsors research fellowships at Baylor College of Medicine.

While operators in the Northeast are building smaller, specialized facilities in the city, here in the South, developers are building in the suburbs, where Adult children of Alzheimer's residents live.

"We strategically want to locate ourselves close to those caregivers, and in most cases the caregivers are the adult children," said Ed Shoemake, vice president of Pine Haven Health Care II.  "The residents are mot making the decision.  They really don't know where they are in most cases.  So it's really located close to the adult children."

Pine Haven has constructed facilities in northwest Houston and Sugar Land and is building one near the Woodlands and Kingwood.

Specialized housing doesn't come cheaply.  In the Houston area monthly fees range from $2,400to $4,275 a month.  Only one facility accepts Medicare; the rest accept private payment only.

Most facilities provide everything-room, board, linens, personal care items, laundry - except medications.  Some facilities include one-site nurse's aides around the clock.

While operators acknowledge their specializes assisted living houses are pricey, they point out these facilities are less expensive than nursing homes.

Since most Alzheimer's facilities are relatively small, the equity needed to build one is not tremendous, pointed out Skip Comsia, co-owner of Pine Tree Cottage in Pasadena and a board member of the Assisted Living Federation of America, a trade group for owners of assisted living facilities.

Comsia said he received funding through a small business loan from a Kentucky bank that specializes in small assisted living facilities in the South.

In fact, investors are becoming more interested in financing free standing Alzheimer's facilities.

In 1994, only 26 percent of senior housing investors funded such facilities.  By 1997, that had more than doubled to 54 percent.  In addition, 64 percent said they would be funding more in the future, according to the Assisted Living Federation of America.

But two major challenges are surfacing as more and more free-standing Alzheimer's facilities are built: finding and training the staff to properly care for people with Alzheimer's and keeping regional differences alive despite consolidations.

"The pool from which we can find employees is diminishing, and that makes it really hard for nursing facilities," said MacDonald of the Texas Alzheimer's council and president elect of the Houston chapter of the Alzheimer's Association.  "Nurse aides are paid minimum wage.  There are few benefits, and they do the hardest work of anyone.  Every where we go, staffing is a problem."

The real challenge is to build facilities over the next decade that recognize both regional differences and seniors' individuality, said Richard Gollis, principal of the Concord Group, a real estate advisory group in Newport Beach, Calif.

"One of the concerns I have is that we will lose the specificity of the local community…in terms of food served, the ways people are treated, what's a positive living environment.  It will get blurred," Gollis warned.


Places to go

Assisted living facilities exclusively for Alzheimer's residents:




 Date opened

State certified

Maximum residents

Barton House

2229 Williams Trace Blvdive, Sugar Land

$3,400 a   month

January 1999



Arden Courts

7800 N. Stadium

$2,850 to $4,000 a month**

March 1999




11555 Richmond Ave.


Opens August 1999



Garden Terrace

7887 Cambridge ST.

$3,960 a month*

March 1997



Pine Haven

10225 Cypresswood Drive

$2,850 a month*
$4,275 a month

December 1996




1221 Seventh St. Sugar Land


February 1997




7950 Bay Branch, The Woodlands


Opens June 1999




22995 Eastex Freeway, Kingwood


Opens November 1999



Pine Tree Cottage

2514 Pansy, Pasadena

$2,400 a month

May 1996




Cypresswood, Champions Forest


Opens first-quarter 2000


*Semi-private room ** Price varies by level of care

Source: The facilities


Tips on finding assisted living facilities for an Alzheimer's patient

When you're looking for an assisted living facility to care for a parent with Alzheimer's, it can be a confusing task.

In addition to free-standing facilities, there are assisted living facilities with separate, secured wings.

If one spouse has Alzheimer's and the other doesn't, this could be an ideal place for the couple to live.  The one with Alzheimer's can live in the secured wing while the spouse can go in and out of the entire facility and socialize with others.

Facilities also offer different levels of care.  Some accept those with early and midstage phases of the disease.  If some one needs round-the-clock nursing care, the person usually needs to go to a nursing home.

What do you look for when choosing a facility?

Since operators realize adult children will be making the selection, most facilities feature open, airy spaces. But experts say you need to look beyond that.  Here are some tips from the Alzheimer's Association:

  • Ask for a copy of the facility's mission and philosophy.  It should discuss the unique needs of people with dementia.  Are residents transferred as the disease progressed?  How is late stage dementia treated?
  • Are families involved in solving problems?  Is there a family support group?
  • Look for brochures, posters and books about Alzheimer's disease, a copy of the most recent survey and a list of resident's rights.
  • Observe residents to see if they are allowed to make simple decisions.  Is the staff talking to residents about subjects that interest residents?  Are families talking to staff?
  • Look for residents who are well groomed, smiling and comfortable.
  • How are the physical conditions of residents monitored?  For example, how does the staff track changes in medications, falls, injuries, illness?
  • Look for staff talking kindly to residents, not talking over them as if they weren't there.  See if the staff encourages residents to do things on their own.
  • Check out monthly or weekly menus.  Eat the food.  Is it appetizing?
  • Make sure residents are enjoying activities that seem meaningful to them.  Are residents clustered in small groups or isolated?
    "Just doing busy work for the sake of being busy is not useful," says Ellen MacDonald of the Alzheimer's Association in Houston.
  • Where do activities occur?  They should be both inside and outside the facility, and off site when appropriate, such as at restaurants, concerts, shopping malls and museums.
  • How often are organized activities offered?  What about evenings and weekends?
  • Does the staff receive special training in Alzheimer's and dementia care?  How often?  How many care staff members are on days, evenings and weekends?  How many residents is each staffer responsible for?
  • Look for staff members who are friendly to each other, residents and you.  Do they appear content or stressed?  Do they call residents by name?
    "Get to know the personal caregivers who really are the individuals who have the most minute-to-minute contact with your loved one.  Spend as much time as possible getting to know them," advises Joan Jacobson, whose 79-year-old mother is an Alzheimer's resident.
  • Pick a place that resembles the person's home and lifestyle.  Was it cozy or formal?  A safe place should include secure doors and safety features in the bathrooms and hallways.  Is there an outdoor space safe for wandering?
  • The environment should be supportive of people with dementia.  Look for a dining room with ambiance, personal belongings in residents' rooms, pleasant smells, clutter-free halls and appropriate noise levels that won't agitate residents.  Is the television on when no one is watching?
  • Make unannounced visits at different hours.  Take your time, observe details and see if the atmosphere is the same as when you toured the place with a staff member.

-Mary Sit-Duvall

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About this page: Article from the Houston Chronicle courtesy of Barton House, an Alzheimer's care facility located in Sugar Land, Texas.
 2229 Williams Trace Blvd.   |   Sugar Land, TX 77478   |   (281) 313-2500

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