A New Approach to Dementia Care at MCH’s Friendship Place

Lydia Cordero had lived at Crimson Ridge Meadows, an assisted living facility, for three years before the 82-year-old began needing more support than the facility could provide.

But with nursing shortages worsened by the COVID pandemic, skilled nursing beds — including memory-care beds — have become harder to find across the region and nationwide. According to her daughter-in-law, Nancy Cordero, the family’s top local options for memory care had waitlists stretching as long as 2 1/2 years.

Crimson Ridge then suggested that the family look into Friendship Place at Monroe Community Hospital.

“When we walked in there, we fell in love with the place,” Nancy said after touring the recently renovated unit with her husband, Miguel A. Cordero Jr.

She said the courtyard stood out immediately. “And that's why we picked the room that we did for Mom. Mom is a people watcher, and her room looks right into the courtyard.”

Friendship Place is a 25-bed secure unit for residents who may wander, including people with dementia and Alzheimer’s disease. Work on the redesign began in 2019, paused during the pandemic, and resumed with help from dementia-care consultants from around the world. Construction started last year, and the first residents moved in earlier this fall.

The unit had not been updated in decades, and Alyssa Tallo, executive health director at the hospital, said it was time for a change.

“We wanted to ... bring it up to a more home-like environment,” she said. “I think someone referred to the (previous) color scheme as ‘Pepto pink.’ It really was outdated. It was not dementia-friendly (based on) what we know now.”

New York state contributed a $500,000 grant to the project, and the Mother Cabrini Health Foundation added another $400,000. Monroe County covered the rest of the $2.86 million budget.

The design centers on balancing resident safety with as much independence as possible.

Although residents cannot leave on their own, they can go outdoors through a fenced-in courtyard.

To encourage independence and what Tallo calls “safe wandering,” the layout guides movement in secure ways. The flooring pattern nearly points residents in certain directions, using lighter colors where they are meant to walk and darker tones where they should not go, such as supply areas or other staff-only spaces. Matte flooring was selected because shiny surfaces can be mistaken for wet or slippery by people with dementia.

Soft blue and green walls help distinguish different areas of Friendship Place. Doors reserved for staff are nearly concealed within the color scheme and wainscoting.

Trash and soiled-laundry bins are also hidden, with walls built around them, in an effort to reduce clutter and create a more home-like setting.

One of Tallo’s favorite features is biodynamic lighting, which changes color temperature and brightness to reflect the light outside.

“That was probably one of the more meaningful cost investments on the unit. ... The lights have been shown to help regulate circadian rhythms, sleep cycle, improve mood, and improve behaviors,” she said.

Shadow boxes outside each room hold items tied to residents’ personal interests and help them recognize their rooms. The bathrooms include walk-in showers, motion-activated faucets and sinks without stoppers to reduce flooding risks, among other features.

Arlene Wilson, senior director of programs for the Alzheimer’s Association of Rochester and the Finger Lakes, said the physical setting is especially important for people living with dementia or Alzheimer’s disease.

“You want a person to feel safe, for the environment to feel familiar, and, as memory loss progresses, to feel comfortable. If you think about your home ... there are certain things that make you feel comfortable,” Wilson said. “Those are things that impact people, and you want to make sure that a person with dementia has a setting that is as close to the quality of life as they're familiar with and they're comfortable with.”

Lydia Cordero and the seven other current residents of Friendship Place — with enrollment kept low so staff can meet the unit’s goals — are settling into their new home.

Nancy Cordero said she expected an adjustment period, but her mother-in-law felt at home quickly. Staff gave Lydia a vintage stroller so she could keep her cherished dolls, or “babies,” with her as she walked around the unit.

Even though the renovation is finished, Tallo said the work is not done and the learning continues.

“I think what's important to remember for all of us is that we serve people,” she said. “The people that are on that unit are our customers. The ribbon cutting has come and gone ... (but) it's going to be an evolving process that we can look at and improve upon.”