By KERRY HANNON

March 11, 2009
There’s a sense of calm when you enter Copper Ridge, a residential assisted living and nursing home facility that specializes in caring for Alzheimer’s patients in Sykesville, Md., near Baltimore. Natural light streams through the windows, and the aroma of baking bread and strains of piano music float through the air. For nearly 15 years, Copper Ridge has focused on developing a model of care for dementia patients in partnership with Copper Ridge Institute, an Alzheimer’s research and education outfit affiliated with the Johns Hopkins University School of Medicine’s Neuropsychiatry and Memory Group. Johns Hopkins neuropsychiatrists work in tandem with Copper Ridge clinicians, nurses, social workers, and nurse aides to develop individualized care plans and remain involved in resident treatment on a daily basis.

And academic research on dementia directly meets resident care. “Copper Ridge is nationally recognized for its extraordinary commitment to a multidisciplinary integration of biomedical, clinical, and social approaches to dementia care,” says gerontologist Kevin Eckert, dean of the Erickson School of Aging Studies at the University of Maryland, Baltimore County. Every resident has an attending physician, who takes care of whatever medical conditions exist, plus an attending neuropsychiatrist. “That level of attention allows them to take on individuals with more challenging behaviors who need a higher level of dementia care,” Eckert says. Unlike many assisted living facilities for those with dementia, Copper Ridge features a nursing home and cares for people until death.

About 75 percent of the 126 residents who live at Copper Ridge were unsuccessfully managed in at least one other assisted living or nursing facility and were asked to leave because of behavior complications, according to executive director Marcie Koenig. “You have to look at the whole picture,” Koenig explains. “Often, what you see on a prospective resident’s record from another nursing home is completely different than what we get. There might be some challenges that we need to work through, but with a more supportive environment and a staff trained in how to manage it, we can make it work.”

When a new resident arrives at Copper Ridge, he or she undergoes an exhaustive assessment. The evaluation looks at all aspects of how someone lived his life: what activities he enjoyed, what his occupation was, what religion he may have practiced. In addition, his strengths are evaluated. The aim is for each resident to receive individualized care. For instance, someone who is barely verbal because of the advanced nature of her disease might still play the piano, so the staff incorporates that into a daily life plan. “They are truly person-centered, and that’s essential,” Eckert says. “It ultimately provides a higher quality of life.”

The assisted living portion of the facility, divided into “houses” of roughly 20 patients apiece, offers mostly private rooms with window seats overlooking garden courtyards and Dutch doors opening to inviting hallways painted in soothing colors. There are small, intimate living-room areas and family-style dining rooms. The skilled-nursing unit, or comprehensive care, houses 66 residents in two houses. The design there is a far cry from how you might imagine a nursing home to look. In fact, it’s hard to tell that you have left assisted living: The nursing home houses are equally bright and spacious with courtyards. (There are, however, no Dutch doors, for safety reasons.) In recent years, this pioneering layout has become the design of choice for the latest generation of nursing homes, as nursing home reform activists have argued that seniors with dementia do best in homey settings with as much one-on-one attention and social interaction as possible.

Copper Ridge prides itself on offering “evidence based” care for individuals, making sure that what caregivers do is based on research. Once a month, the Copper Ridge staffers hold an interdisciplinary team review with their Johns Hopkins associates to focus on a particular topic, review the published studies on the subject, and compare those findings with their own procedures.

Sometimes the findings reach a dead end. For instance, aromatherapy was considered by many in the field to help calm agitation in people with dementia. The staff at Copper Ridge worked with the Johns Hopkins team to develop a study to determine the effects of aromatherapy on residents with problem behaviors. Then they used aromatherapy with a select group of residents over a period of several weeks. End result: zilch. It didn’t help at all.

Another key to the Copper Ridge approach is steady staffing. The facility claims an overall nursing staff turnover of around 25 percent annually, compared with more than 100 percent for nurse aides at many nursing homes and 50 percent for nurses. Remarkably, many staffers, including Koenig, have been at Copper Ridge from its inception in 1994. That’s a good sign, says Katharine Bau Hsiao, coauthor of The Baby Boomer’s Guide to Nursing Home Care. “If the staff wants to be there, they tend to pay more attention to patient care.”

The Hopkins collaboration ensures that staff training is continuous and well above par. Maryland state law calls for 12 hours of ongoing education each year for certified nursing assistants, for example, and Copper Ridge more than doubles that quota. Nurse specialists, neuropsychologists, and neuropsychiatrists from Johns Hopkins teach and brainstorm with staff to assess the right solution for every challenge. “For this population, you need to have a training program that is ongoing and very topic specific to what they are dealing with,” Koenig says. “Our staff tells us what most of our training topics should be based on what they are dealing with on a daily basis.”

While there are other facilities around the country aiming to provide top-level dementia care similar to Copper Ridge’s, they are far from the norm. The most obvious similarity, though, is found in the living quarters and resident-centered care. A growing number of assisted living and nursing homes are offering a homelike environment and are stressing activities and physical stimulation. Few, however, have the extra benefit of working in tandem with a world-class medical team each day.

Not surprisingly, the educated care doesn’t come cheap. Copper Ridge costs as much as $113,515 a year for assisted living (from $205 to $311 per day, depending on the level of care) and up to $140,525 a year for nursing home care ($385 a day). Although the facility’s nursing home unit accepts people on Medicaid, the assisted living component is strictly private pay. (Some residents have long-term care policies that help foot the bill.) Even at this price, at times there’s a waiting period of a few weeks for a bed. In the nation’s 100 largest metropolitan areas, dementia care in assisted living averages $56,316 a year for a private bedroom, or about $154 a day, according to the Annapolis-based National Investment Center for the Seniors Housing and Care Industry.

Originally published in U.S. News & World Report on March 11, 2009