How two local women made a breakthrough in dementia care
*Photography by Jeremey Theron Kirby
On a crisp, sunny morning at the Prairie Elder Care Farmstead in south Overland Park, Vic and Sue are enjoying the company of a pot-bellied pig named Mo and a goat named Leo.
“Boy, he can really go,” Vic exclaims as Mo darts around.
“Isn’t he cute?” Sue says with a radiant smile.
The ever-vigilant Mo, who has been known to face down and scare off a wolf, shoots a quizzical look at the pair before foraging for more breakfast.
Vic, Sue and the other residents of Prairie Elder Care have dementia, but they’re not viewed as patients who need to be locked up.
“We want to meet every need that a person has here, whether it’s physical, mental, social or emotional,” says staffer Lisa Elliott. “We look at treating the whole person. We do it in a whole host of ways, and certainly our animals play a big part in that. They all just love the animals.”
The troop of animals — a guinea pig named Coco Chanel and Silkie chickens with fluffy plumage among them — give residents an experience they can share, says Mandy Shoemaker, co-owner of Prairie Elder Care.
“When you bring together people who don’t have a common background, who are losing the ability to communicate effectively, it’s hard to have a conversation,” Shoemaker says. “But if the goats are playing and head-butting each other and jumping around on their toys, it gives them something to talk about — a shared experience.”
This unique approach has already gotten the facility national media attention. In mid-2020, Mandy Shoemaker and her sister-in-law and fellow co-owner Michala Gibson will publish a book called Now Is Found, outlining the philosophy driving their care model.
Decisions about dementia care are always very personal, says Dr. David Clark, neurologist at HCA Midwest Health/Johnson County Neurology. He says that there is no single approach that works for everyone.
“Some families choose to keep their loved one at home as long as they possibly can, either learning to do the nursing care or hiring outside help,” he says. “When a facility is considered, I always recommend working with a case worker and visiting multiple facilities before choosing the one that best fits their needs. This really can’t be generalized for everyone.”
Shoemaker and Gibson opened the first Prairie Elder Care house in 2014. Shoemaker had been an elementary school principal; Gibson, a registered nurse, had served as the director of nursing at a large nursing home.
“When people think about a place for their parents or loved ones as they get older, most of them still think of big facilities,” Gibson says. “For somebody living with dementia, that smaller, more home-like environment is key.”
Shoemaker, a certified nursing assistant, says people with dementia “kind of fade away in larger facilities. A place where they can come and be doted on offers them the best chance of having a life worth living.” This is why Prairie Elder Care only has thirty-two residents.
Gibson says the guiding principle at Prairie Elder Care is giving the residents control. “That means giving them options, giving them choices,” she says. “We allow people to wake naturally. We allow them to have breakfast when they want to, made to order.”
“People living with dementia lose the ability to express their own needs,” Shoemaker says. “A lot of times, they can’t tell you if they’re in pain. They can’t tell you when they’re hungry. They may have a restless feeling that they can’t pinpoint. If we can know the kinds of things they did in their pre-dementia lives, we can set them up for success.
Elliott says each Prairie Elder Care resident has an individual care plan to address physical needs, as well as a community plan that addresses “how this person is going to feel needed and wanted and valued in the house where they’re living.”
The late Sylvia Vena lived at the Farmstead from the summer of 2018 until June 2019.
“She loved it,” says her daughter, Ann Marie Baron of Overland Park. “It felt like family. It felt like home. It was bright, it was beautiful, there was energy.
Care at Prairie Elder Care is paid for via private pay arrangements or long-term care insurance. Residents of the two houses located off the Farmstead have regular opportunities to visit the Farmstead, especially in the summer.
In 2018, Prairie Elder Care ramped up its mission by hiring Elliott to serve as community coordinator.
Elliott set up a monthly program that brings the MidAmerica Nazarene University men’s basketball team to the Farmstead, where players share a meal and engage in other activities with residents.
“They really yuk it up and talk about what’s happening,” Elliott says. “After dinner I lead a team-building exercise. The last time they were here, we did basketball history.”
Prairie Elder Care also recently began offering dementia training to employees at nearby restaurants covering scenarios such as what wait staff should say to a person with dementia who orders chicken-fried steak when it’s not on the menu. Elliott says a waiter or waitress who has received the training would say something like, “Wow, wouldn’t that be great if that was on the menu? I love chicken-fried steak. If you like chicken-fried steak, you should try the three-egg-white omelet.”
One of the most successful of all the new offerings Elliott started is the grandparents’ program.
“We go to a nursery school in our neighborhood,” Elliott says. “We walk in and the kids stop what they’re doing and say ‘Oh, Vic’s here today!’ or ‘George is here today!’ or ‘Velma is here today!’ They run over and hug the elder and we’ll do whatever they want us to do. We’ll pretend to drink tea or work the day with the teacher.”
The nursery school outings resonate with the residents.
“They may not remember what they had for breakfast, but the next day they’ll remember that they made a connection with a little person, and they talk about it,” Elliott says.
“Don’t Make it a Quiz”
Tips on Interacting with Dementia Patients
Dementia is a syndrome that causes deterioration in memory, thinking, behavior and the ability to perform everyday activities. About fifty million people around the globe have dementia and nearly ten million new cases surface every year, according to the World Health Organization. Alzheimer’s disease is the most common form.
Behind the numbers are mothers, fathers, grandparents and friends. Trying to break through to them can be hard. There are things you should say and things you shouldn’t say to those with dementia.
Mandy Shoemaker, co-owner of Prairie Elder Care in Overland Park, recommends that you never say “don’t you remember?”
“Say ‘I remember when we…’ and then tell them the memory,” Shoemaker says. “That’s going to bring them into the story rather than put them on the spot and make them feel frustrated. Don’t make it a quiz.”
Shoemaker says you should greet a dementia patient by saying “Hi, (their name), it’s me, (your name)! I’m so happy to see you today. I remember when we used to …”
“We utilize the positive approach to care,” says Michala Gibson, Prairie Elder Care co-owner. “That is setting yourself up to have a positive interaction each time you interact with a person who has dementia. It’s things like knowing to approach them from the front because they have a decrease in their peripheral field of vision. You want to make sure that before you touch them that you get their visual and verbal acknowledgement that they recognize that you’re there.”
Flash a smile when you greet a dementia patient, Gibson says. Keep conversations simple and be patient. “A lot of times when someone doesn’t answer you, just keep talking,” she says. “Ask a question with a simple phrase and then wait and give them time to process an answer.”
Shoemaker recommends visitors bring something that strikes a chord. “We have a lady at one of our homes who loves cats. If she were my grandma or my mom, I would bring her a little stuffed cat toy. Bring a picture or a musical instrument or a song. Bring something you can share and have a lovely time over. Do things that will break up the monotony of their day.”
People living with dementia “may not know your name, but they know how you make them feel,” Shoemaker says. “If you leave them feeling good, that feeling is going to stay with them.”