They Can Dance to It

In the living room at Arbor Place one recent afternoon, a gentleman in a plaid shirt dipped into a romantic embrace with a regal woman wearing a full skirt, her hair tucked into a ballerina's bun. Others held their partners' hands and bobbed to the beat of Latin jazz. Some of those in wheelchairs hand-danced. When the song ended, everyone laughed and hugged.

What may be most remarkable is that the 15 residents of Arbor Place Assisted Living in Rockville have Alzheimer's disease.

"When I first came, I had so much fun here," says Stephanie Waldron, daughter of the stately woman on the dance floor. Visits to other facilities offering dementia care had left Waldron "desperate," she says.

But when she visited Arbor Place, she says, "the residents had me in stitches playing a gambling game. When I left here, I felt happy."

Arbor Place offers an alternative model of care – a small-scale, intimate facility that employs music, art and personal relationships, plus the medical expertise of its founder – to make the residents' days pleasurable and active. (It's also a very expensive model of care, of which more later.)

Arbor Place is among dozens of facilities in the Washington area, including group homes and special units of retirement communities and nursing homes, for dementia patients who can no longer live safely in their own homes. While most facilities provide safe, acceptable living arrangements, often the residents spend much time walking the halls, watching television or going to bingo games.

Geriatric psychiatrist Walter Fanburg conceived of Arbor Place as an alternative. After years of consulting at some 20 Washington area nursing homes and assisted-living facilities, he knew the norm very well.

"It was the result of seeing how shabby the care was and how isolated and discarded these people seemed to be" that led him to set up Arbor Place, he says.

He set out to create an environment where people would feel secure and engaged in a community of warmth, respect and fun, he says. As residents' anxiety levels were reduced, he reasoned, the unpleasant behavior often associated with dementia – wandering, confusion, hostility – would also decline.

Though he had no background in business, Fanburg drew up a plan for a for-profit enterprise and applied for loans. He hired an architect and a builder. The facility opened in 1998. Today he and his wife and co-director, Eileen Fanburg, remain fully engaged with Arbor Place.

Geriatric care consultant Susan Johnson, who helps families choose facilities for their loved ones, says Arbor Place is among the best of its type in the country.

"If you read the brochures of other places, they all are saying the same thing: good activities, customized care," she says. "But they may not deliver on that promise. The Fanburgs deliver. They provide stimulating activities that are for adults, not childlike activities just to keep people busy."

The home's floor plan is easy to negotiate. The living room blends into the dining room, which in turn opens to a large country kitchen. Glass doors open to a small putting green, walking paths and flower gardens out back.

The bedrooms – all private, with a half-bath – are along two hallways off the living areas. Adding to the homeyness and cheer are large bowls of fresh fruit in the kitchen, fresh roses and live orchids on end tables and family photos and residents' art on the walls.

The facility's one obvious concession to institutionalization is the closed-circuit television system, with a camera in each resident's bedroom. The night staff watches a central TV monitor to see if anyone needs help getting to the bathroom. The system is necessary, explains Fanburg, because people with Alzheimer's may not remember to ring a call bell for assistance.

For Art's Sake

Arbor Place serves people in the early to middle stages of Alzheimer's.

"Our criteria are stringent," says Fanburg. "We take people who will benefit from living here. They must be self-feeding, ambulatory, and their language skills must be intact."

The average length of stay is three years, according to Fanburg; typically a resident leaves because her condition has deteriorated and she must move to a nursing home for more skilled medical care.

"We are able to keep people here comfortably until pretty close to the point when their disease has really gotten them," says Fanburg. "The people who have left have usually died within weeks or a few months."

While Fanburg's method of care has not undergone scientific scrutiny to determine its effectiveness, certain observations clearly suggest a benefit.

He points to a small woman sitting in the dining area. Three years ago, she was admitted to a nursing home in Virginia after becoming increasingly agitated and erratic in her behavior – a condition that grew worse after the nursing home put her in its locked ward for dementia patients. Today, she appears calmly engrossed in painting, an activity that often keeps her working into the night. After completing a work, she may not recognize it and will wonder aloud why someone wrote her name on such a lovely painting. But that does not diminish the pleasure she had in creating it, Fanburg notes.

Art and music are integral parts of life at Arbor Place. After the daily dance session, residents drift over to the dining room, where the tables have been shoved together and covered with paper. On this day Margot DeMessieres, an artist who volunteers there, shows the group a nude by Amedeo Modigliani, an early 20th century Italian painter, and talks briefly about the artist and his work. The residents appear to listen attentively and regard the painting with pleasure.

DeMessieres suggests they choose from among the prints scattered across the table. As each resident selects a picture to copy, DeMessieres circulates among them, asking if they would prefer to use pencil or watercolor. An aide puts on some Mozart.

But not everyone is aboard.

Harriet Sterman, a petite redheaded woman in a coral-colored sweater, gets up and says she's no good at art and would rather not participate. "I may look stupid, but I'm not," she says.

Walter Fanburg assures her she doesn't look stupid, and Eileen Fanburg engages her in banter. "It's not your cup of tea, eh?" she asks.

"No, it's not."

"Well, would you like a cup of tea?"

Sterman smiles. "No, I'm fine."

"How about a gin and tonic?"

"Now you're talking!" And both women laugh.

The Money Question

Mona Pollack, assisted living ombudsman for Montgomery County, agrees that Arbor Place is impressive, especially in terms of its activities and staffing. But she says it is not alone in providing excellent care.

And at a cost of $251 a day (or about $7,500 per month), the home is out of reach for most families, though there is a waiting list. The cost range for assisted living is vast, according to Pollack – from $1,800 to $7,500 a month. And while many other facilities accept residents subsidized through various government programs, Arbor Place is strictly private pay.

In addition, some other facilities provide the "aging in place" option, which allows residents to remain until they die, rather than having to move to a nursing home when their condition deteriorates.

Other high-quality assisted living facilities for people with dementia, says Johnson, include Brook Grove Foundation in Olney and five homes in the county that are run by Cedar Creek Associates.

Walter Fanburg acknowledges that the high cost of care at Arbor Place is an obstacle to replicating his model widely. One answer might be to replace some paid staff with volunteers or family members, he says.

Waldron says her mother's quality of life is far better than if she had remained at home. Her transition to Arbor Place was "incredibly stress-free and seamless," says Waldron.

"The wonderful thing about this place is that her life is continuing," says the son of an Arbor Place resident who declined to be identified in order to protect his mother's privacy. "It provides wonderful memories for us, even if it doesn't for her."