New York Times Feature: "Main Street as Memory Lane" by Deborah Baldwin
Posted on January 10, 2002
NEW CANAAN, Conn.— At first, the tall, wiry man was agitated, pacing back and forth. He insisted he wanted to go home, back to where he had lived for 43 years and raised three children. The Village, a new health-care facility for people with disabling memory loss, seemed to make the 75-year-old man, who arrived on Nov. 15, uneasy and unhappy.
His wife took him home but was unable to care for him, and he was persuaded to return. Weeks later, now calm, the man, a former stockbroker, follows a routine, rising for breakfast, donning a jaunty golfing cap and descending to Main Street to see what's up. When he loses interest in scheduled activities, which is often, he sets off, taking small but purposeful steps past a barbershop with an old-fashioned striped pole, a neighboring bakeshop, and a tiny general store.
Another resident, once a high-powered engineer, was so depressed by his cognitive and physical impairments that he hunkered down in his room for days at a time. A staff member finally coaxed him into the bakeshop kitchen to help decorate Christmas cookies. Carefully dividing the red sugar glaze from the green, he smiled contentedly. ''Yep,'' he said, ''just like I used to do when I helped Mom bake.''
Four million Americans have Alzheimer's, according to the Alzheimer's Association, and barring preventions or cures, the number could climb to 14 million by 2050. Many millions more have dementia resulting from strokes, Parkinson's and other illnesses, making serious memory loss one of the driving fears of the baby boom generation. Almost unspoken of 10 years ago, it is now dealt with bluntly in memoirs and movies, like ''Iris,'' and best-selling novels like ''The Corrections.''
While medical science searches for a cure, care-givers are turning to architects and environmental psychologists to alleviate the symptoms. Increasingly, designers are charged with creating settings that serve not only patients but their families. Paying an average of $50,000 for assisted care in a facility like the Village, those families are looking for more upbeat environments. Perhaps it was only a matter of time before centers like the Village, which opened Nov. 1, began springing up, their paradisiacal glow and manufactured Neverland innocence reminiscent of ''The Truman Show.''
At the Village, the reproduction Main Street is based on the way downtown New Canaan looked 40 years ago. Built by the Waveny Care Center, a not-for-profit organization that runs an adjacent senior care facility, the Village has full-scale brick and clapboard-faced storefronts and a public clock with righteous Roman numerals, just like the real thing just down the road. The replica downtown, stretching 175 feet under a swath of skylight, is buttressed by glass walls and doors that will open in the summer onto enclosed gardens and courtyards. Aside from a player grand piano parked mid-street, like a detail from a Magritte painting, the Village is a wry mirror image of reality.
For the 12 families who pay up to $73,000 a year for its sun-drenched security, the Village represents one answer to the overwhelming challenge of caring for loved ones whose short-term thoughts are eroding like castles built of sand. No one argues that design can restore mental health, but a number of experts in dementia believe that a structured setting can improve the residents' quality of life and reduce staff turnover.
Recognizing that people who can't remember what they were doing moments before nonetheless can unearth memories of life 30 years earlier, senior care centers from Australia to Manhattan are relying on settings laden with nostalgic cues, hoping to get patients talking in what are called reminiscence groups. Dr. Deborah Marin, director of geriatric psychiatry at Mount Sinai Medical Center, which is associated with an assisted care center in Manhattan that has memory programs, said that in the early stages of Alzheimer's, talking about the distant past ''allows patients to go to memories they can recover, and you can communicate with them, you can engage them.''
Just a generation ago, nursing homes used to tie down Alzheimer's patients, who have a tendency to wander. During the 1980's, however, as more research went into the care of patients with dementia, nursing homes began replacing narrow corridors and harsh lighting with landscaped housing that came to look like mock-suburban compounds -- gated communities for the aged.
Now, assisted care centers have become more ambitious, spurred by public demand for homier settings and by observations that residents respond to changes in everything from lighting to room size. Equipped with carpeted walkways, low-key color schemes and circular paths, many new residences encourage patients to walk for pleasure -- an activity environmental psychologists like Dr. Lorraine G. Hiatt, a consultant who helped design the Village, believe helps organize their thoughts.
''It's like remembering your glasses are on your head once you get up and start looking for them,'' Dr. Hiatt said.
But can environmental changes bring back memory? Gerard Plunkett, administration manager of an elaborate care center, the Corumbene Nursing Home in Tasmania, hesitated when asked to assess the therapeutic effects of the design, which features a Main Street theme. But he hastened to add that it had been warmly received by families and by the community.
The home, in New Norfolk, has bedrooms along narrow streetscapes within restored farm buildings. An old-fashioned store stocks candy; in the bedrooms are photographs and armoires stuffed with heirlooms.
In the United States, Alterra, a publicly traded senior care company with more than 460 facilities, erected a mini-''town square'' in Bucks County, Pa., in 1996. Anthony R. Geonnotti Jr., a senior vice president at Alterra, conceded that ''it's very hard to bring back something that is lost. But if you are able to soothe the anxiety and the rambunctiousness, which causes great pain, and you are able to handle them for an hour, a half hour, you are succeeding in care.''
The Village has benefited from both medical research and trial and error at other facilities. People with memory loss are now known to have less anxiety, for example, in relatively small common areas, analogous to rooms in a house, said John Zeisel, who is president of Hearthstone, a chain of Alzheimer's care facilities based in Lexington, Mass., and teaches a seminar at Harvard on designing for dementia.
At the Village, each cluster of suites has private rooms with beds purposefully angled to have full views of the bathrooms, an important visual cue for patients. The clusters are tied together by a living room, its fireplace ''warmed'' by a hologram of a fire. The upstairs kitchens look into the athletic field of the public high school; football players often wave.
Sensory cues are woven into the landscape -- from the sight of a barbershop pole to the feel of fresh linen, which residents can help fold at night if they have trouble sleeping.
Dr. Hiatt and others believe that rooms and objects, like a stage set, can elicit an audience response before the first line of dialogue.
The first wave of patients -- the Village can accommodate 62 live-in residents and 40 in day-care -- are beginning to respond, and the University of Connecticut will evaluate the impact. After a stroke six years ago, one resident, Shirley Williams, began withdrawing from life as if stepping back from the edge of a stormy sea. Now 81, Mrs. Williams started improving during two months with others and one-on-one attention at the Village, including physical therapy, her daughter, Laura Williams, said. Main Street, softly paved with carpet cobblestones, encourages Mrs. Williams to take a chance and stretch her legs. ''When I saw her yesterday she was really sharp, well rested and physically much better,'' Ms. Williams said, adding, ''I feel very fortunate because she's safe, and she's happy.''
Happiness is relative, of course, and during a crossword puzzle session on Main Street on Friday, Mrs. Williams stared blankly as a staff member coaxed answers out of the group. She seemed to revive as the piano cranked out the Andrews Sisters and a staff member grabbed her hands for an impromptu sit-down dance.
To create the Village's sanitized Main Street -- New Canaan before Starbucks and Range Rovers -- a team that included Waveny's director of outpatient programs, Carole A. Edelman, and Gregory J. Scott, an architect with Reese Lower Patrick & Scott, worked from photographs of contemporary and 50's-era downtown, along with images of reproduction streets in shopping malls, Disney World and even a casino in upstate Connecticut. When the team couldn't agree about carpeting and colors, Ms. Edelman asked several patients to weigh in. ''They had real feelings,'' she said. The result is a palette of clear bright shades like lemon yellow and blue, and a carpet with a cobblestone pattern.
Mr. Scott said he had observed the power of décor at another senior care facility where he saw an Alzheimer's patient being led to a rocking chair on a wooden porch. ''He started to rock and then he started to whistle'' a familiar tune, Mr. Scott recalled. ''His family just broke down.''
At the Village, one woman who loves getting dolled up brought in a dressing table with a mirror and skirt, following a routine long established in her life. Another resident with Alzheimer's, who is no longer able to speak, seems comforted by music her husband arranged to have playing at all times in her room.
Whether or not the scene rings bells among patients, it has clearly resonated in the community, a wealthy suburb of about 19,000. Jeremy Vickers, Waveny's executive director, said that students from the junior and senior high schools next door volunteer, taking residents for walks and helping out in the bakeshop. Private donors contributed $10.6 million toward the $13.5 million construction cost.
This living link to the outside world is what sets the Village apart, Dr. Hiatt said. ''Other places will accept people with dementia, or they will focus on an aspect of life, like walking or baking or music,'' she said. ''But in New Canaan people get into the actual substance of sharing memories'' about their hometown.
Poorly trained staffs and constant turnover are ''the hidden disaster'' in senior care, said Dr. Trey Sunderland, chief of geriatric psychiatry at the National Institute of Mental Health. But when a health facility is visually engaging, maybe even a little bit corny, he said, it is more likely to both retain qualified employees and draw visitors. ''When visitors come back the patients do better, they are less depressed, and they don't die as soon,'' he said.
The structure of activities also appears to help patients bring the day to a close. ''They're sleeping well,'' said Angela P. Cartwright, Waveny's energetic program director. ''I think we're tiring them out.''