Rehabilitation For People Living With Dementia

About Juliet Holt Klinger

Senior Director of Dementia Care

Juliet is a passionate advocate for people living with dementia and their families. She is deeply committed to improving the cultural acceptance of those with cognitive differences. As our gerontologist and Senior Director of Dementia Care, Juliet develops person-centered care and programming for Brookdale’s dementia care communities. But if you ask her, Juliet says she continues to learn every day from the true experts, those living with dementia and their care partners. Juliet believes we need to move beyond the concept of caregiving, which implies a one-sided relationship, and embrace the idea of care partnering. Care partnering is about relationships built on cooperation—a two-way street promoting person-centered care and mutual feelings of purpose, where the person living with dementia also plays a strong role in shaping their care and daily routine. We are here to partner, learn and grow with our residents and families to make aging a better experience. After volunteering in nursing homes in high school, Juliet knew she wanted to work with older adults. While working on her bachelor’s degree in social work at the University of Iowa, she completed an Aging Studies Certificate program, before there were formal gerontology programs available. At Iowa, Juliet also had the chance to study with pioneers in the field of dementia care, an opportunity that shaped her passion for caring for those living with dementia. Trained as a gerontologist, with a master’s degree from the University of Northern Colorado, Juliet joined Brookdale in 2004. She is a seasoned senior living executive with more than 30 years of experience designing and executing innovative Alzheimer's and dementia care programs and living environments in both assisted living and skilled settings.

Providing skilled nursing and rehabilitation therapies for people living with Alzheimer’s and other dementias presents unique challenges. Rehabilitation therapies often rely on the repetition of specific movements and exercise. Dementia patients struggle with progressive memory loss, making it difficult for the person to remember the steps or how the sequence of exercises can lead to progress. There is often also an issue with potentially negative attitudes of the therapists themselves about the dim potential of working with a patient with dementia. This is identified as “therapeutic nihilism” in an article in the American Physical Therapists Association magazine (March 2018).

In 2018, I decided to take on this challenge and design a potential solution at Brookdale. I wanted to create a fresh approach and use new technologies that might be difference-makers for people living with dementia who were recovering from an injury or surgery. In 2019, a new dementia-friendly skilled nursing and rehabilitation unit at Brookdale Overland Park near Kansas City opened its doors. The first of its kind, this skilled nursing center incorporates specific technology devices and specialized training for clinicians to deliver person-centered, skilled nursing care and rehabilitation to patients with dementia.

Our team at Brookdale was intentional about how we approached this project. We wanted this unit at Overland Park to be much more than just a secured, skilled care environment. Our goal was to design a new space staffed with specially trained clinicians and equipped with state-of-the-art, evidence-based engagement technology to focus on improving function, increasing length of engagement in therapy exercises and treatments, and above all to promoting well-being for the patients.

One year later, we believe our approach is working. “Our rehab residents are getting better, stronger and they’re making measurable gains,” said Beth Hunter, the director of resident programs at Brookdale Overland Park. “The technology makes it easier for our residents to engage and we’re seeing more purposeful involvement in our programs which is driving consistently better outcomes.” Hunter pointed to several key new technologies that are making the biggest difference for these residents as they navigate their journey through rehabilitation:

The 60-inch touchscreen system that helps enhance speech, physical and occupational therapy experiences. Hunter says the technology is geared specifically for use with dementia and physical frailties. The platform is filled with thousands of optional content areas that are easy and intuitive for both residents and the staff and it is used in numerous ways to promote personalized resident health and well-being. “We use the system several times a day to engage residents in a variety of dimensions of wellness including emotional, physical and spiritual,” Hunter says. “We use it to stimulate muscle-memory in physical therapy sessions, and to improve speech, attention, and processing functions in cognitive exercises, but we also use it for virtual pet therapy sessions and karaoke. It’s a game-changer for our residents.” The most important feature of the system is that the content used to engage can be individualized for each resident. For instance, if a resident is having an issue with motivation for her standing exercises and we can better engage her in standing next to the and putting together a puzzle featuring her granddaughter’s face. That’s person centered rehab.
The specialized rehabilitation community features a specially designed therapy space and updated resident suites. Each suite features an Artificial Intelligence -enabled technology proven to assist in the reduction of falls. Hunter says they have seen a significant reduction in falls because the technology provides the clinical team with actionable information to devise intervention strategies that keep residents safer.
Another valuable technology is a sound system that uses headsets to remove communication barriers. “It’s been so effective to improve engagement in therapy. Our residents can hear and understand so much better with this system, so everyone benefits more from our programming,” Hunter added.
A special relaxation chair has allowed residents who are anxious, agitated, or in need of sensory stimulation to slow down and gain a sense of calm while lying in this chair. The integrated soothing music designed specifically for use with dementia, is played while the resident is gently rocked, and a weighted blanket adds to this multi-sensory experience.

The high tech dementia-friendly Skilled Nursing and Rehabilitation neighborhood at Overland Park is was a very new concept, but it remains rooted in Brookdale’s decades-old, low-tech foundation of providing person-centered care for people living with Alzheimer's and other dementias. While the results from Overland Park demonstrate that these technologies can be important tools to help boost engagement, they also show that technology alone is not the answer. It takes the right people and a person-centered care model to deliver improved outcomes. “Everyone on the Overland Park team is united by one goal: we’re committed to the success of every resident who is in our care,” Hunter concluded.