Montessori Comes to Dementia Care - at - Menorah Park Center for Senior Living

Nursing Homes, August, 2001 by Laura Bruck

Most people associate the name Maria Montessori with innovative education methods for preschoolers. At Menorah Park Center for Senior Living in Beachwood, Ohio, the Montessori philosophy is becoming a way of life for residents with dementia, their caregivers and family members. The Menorah Park community includes 352 skilled nursing beds, 206 independent living apartments and 115 assisted living units, in addition to an adult daycare center, a home healthcare agency and other community service programs.

"The mission statements of a good Montessori school and a good dementia care facility match almost perfectly," says Cameron Camp, PhD, senior research scientist and director of Menorah Park's on-site Myers Research Institute. "Both stress goals related to developing high self-esteem and promoting the highest level of function possible."

In the Montessori school setting, children are engaged in series of activities that correspond to their individual functional capabilities, helping to foster independence and guiding them to make meaningful choices. From the standpoint of the elderly, "Montessori programming is grounded in rehabilitation," explains Dr. Camp. "We've adopted a rehabilitation approach to dementia care, by breaking down tasks into their simplest steps and guiding residents through each component, one step at a time." [*]

Dr. Camp explains that the idea of his facility's program is to "uncover residents' strengths and interests by exposing them to as many interesting and stimulating activities as possible and, thus, enabling them to demonstrate their remaining capabilities and knowledge." (In referring to "activities," Dr. Camp stresses that, while activities professionals are instrumental in implementing Montessori programming at Menorah Park, activities are, in this context, viewed in a broader context, as anything the resident does during the course of the day.)

From Concept to Practice

It was Dr. Camp who, in 1995, first broached the idea of adapting Montessori methods for use in dementia care at Menorah Park. After initial pilot work, Myers received funding for a feasibility study and, subsequently, a three-year study conducted in Menorah Park's special care and advanced dementia units, and the Mandel Adult Day Center. The program was originally developed by research staff but is being incorporated into the Menorah Park culture as researchers document outcomes and learn to optimally engage residents.

A Montessori consultant helps the staff develop meaningful activities for residents. Some examples include individualized activities to match the capabilities of each resident, from those as concrete as sensory activities, in which residents match degrees of roughness or smoothness, to more abstract activities, e.g., in which more historically minded residents sort Spanish Civil War leaders into "fascist" or "communist" categories. In a reading and discussion activity for residents with memory impairment, all the information needed to participate is placed at the residents' fingertips, enabling them to demonstrate their knowledge about topics of interest without relying upon long-term memory. In keeping with the "children-teaching-children" practice in Montessori classrooms, a grant proposal has been submitted to train mildly impaired residents to be group leaders for activities involving residents with mild dementia.

Now that the infrastructure is in place, research is focusing on ways to generalize the Montessori approach to all activities of daily living (ADLs). The idea is to enable residents to do as much for themselves, and for those in their community, as possible. For example, the Montessori approach applied to dressing would focus on giving residents choices about what to wear or, for those who can dress on their own, structuring the environment to allow them to do so. At mealtime the focus might be on a resident's ability to feed herself or play a role in helping others. Dr. Camp cites the example of one resident who used to hold all three utensils in one hand while eating. "By giving her a placemat with outlines of a knife, fork and spoon, we were able to provide her with some guidance as to where to put the utensils she wasn't using; this allows her to feed herself and maintain her independence."

Staff Training

The initial model for training staff to use Montessori methods operated with five half-hour in-services for activities professionals. More intensive training (i.e., four half-day inservices plus hands-on experience) is being developed for the home health agency staff, and online training also is being planned to supplement the videos and written materials that have been developed. Pilot studies have been conducted to train Menorah Park's nurse assistants in Montessori programming, as the research staff looks at ways to incorporate the approach into regular work routines. Training also is being developed for volunteers and family members, as well as for staff of other long-term care facilities.