Alvarez 1

Brenna Alvarez
Corinne Kohlen
FSN 315-02
23 November, 2014
Residential Care Facility:
Garden House Alzheimers Residence
Abstract
I volunteered at a nursing home called the Garden House Alzheimers Residence.
It is a special care unit that specializes in dementia care with trained staff that provide
high quality care and provisions of activities of daily living (ADLs), including bathing,
dressing, grooming, and cooking. I conducted short interviews with residents and
recorded answers to questions and observations made during mealtimes in my notebook.
The findings from the interviews and observations helped portray the common issues that
are associated with dementia patients living in nursing homes.
Background
Aging: the inevitable, unwanted aspect of life. Sorry Dolly Parton and Bruce
Jenner, but no surgery will help you avoid it. Our culture is in a state of denial about
aging. Lets face the reality: everyones eyebrows will sag and everyones skin will
wrinkle. Not only will our outward appearance continue to change, but also our minds.
Plastic surgery wont improve our ability to remain functional in all areas of life. One day
we may not be able to any longer dress ourselves, brush our teeth, stand up, cook, or even
remember a friends name. There is no way to avoid aging, and along with aging comes
other symptoms that will potentially affect our activities of daily living (ADLs) and
possibly our psychiatric and behavioral health. This is where nursing homes come into
play. According to the U.S. Department of Health and Human Services, the older

Alvarez 2
population aged 65 and older has increased by approximately 6 million since 2000,
making the population 41.4 million in 2011, and it is expected to continue increasing to
about 80 million in 20143. Because of this, the demand for nursing homes and quality of
care will continue to increase.
When a person is no longer able to live by themselves due to functional
limitations, a nursing home will ensure the fulfillment of their needs and ADLs. More
than half of the elderly who live in assisted living and nursing homes have a form of
dementia or cognitive impairment6. Nursing homes for people with dementia and
Alzheimers provide special services in order to meet their specific needs. There have
been markers of better quality of end-of-life care in special care units (nursing homes that
provide dementia care) compared to traditional nursing homes among nursing home
residents with advanced dementia2. Special care units tend to display more positive
effects on behavior, cognition, functional status and quality of life compared to traditional
nursing homes4.
Those who have dementia have experienced a decline in memory and one or more
of the following cognitive functions: execute motor activities, make sound judgments,
generate coherent speech, understand spoken or written language, or identify objects. The
decline of these cognitive abilities will greatly interfere with the lives of individuals with
dementia. Alzheimers disease is the most common cause of dementia among people aged
65 years and older. It is an irreversible, progressive brain disease that slowly destroys
memory and thinking skills. Almost all elderly who have Alzheimers disease move on to
residential care facilities. Most nursing homes that provide dementia care will help with
an individuals ADLs, including dressing, eating, cooking, grooming, getting up, and

Alvarez 3
using the restroom. Not only do they experience a decline in memory and cognitive
functions, but they also experience food and nutritional issues.
Certain nutritional issues associated with dementia and Alzheimers that need
specific attention are reduced body weight, side effects of medications,
increased/decreased energy expenditures, pocketing foods, and dehydration. Although
most nursing homes that specialize in dementia care provide a better quality of life for
residents, studies show that there is no difference in nutritional status between nursing
home residents with dementia or other forms of cognitive impairment in open units
versus in special care units1. According to the Alzheimers Association, a holistic
assessment of residents will provide information of a residents cognitive health, physical
health, behavioral status, sensory capabilities, decision-making capacity, communication
abilities, personal background, cultural preferences, and spiritual needs and preferences6.
This sort of assessment will help the caregivers in the nursing home know which actions
and measures to take when dealing with issues caused by dementia. Dementia causes
issues with adequate food and fluid consumption, paint management, social engagement,
wandering, and mobility6. Residents with dementia are vulnerable to negative health and
quality of life outcomes, but assuring high quality care is necessary to prohibit this. At the
Garden House Alzheimers Residence in Morro Bay, they do just that.
The Garden House Alzheimers Residence is a nursing home in Morro Bay that
provides dementia care. It cares for elderly who have Alzheimers or another dementia by
making them feel at home, providing all ADLs, cooking for them, feeding them when
necessary, and helping them maintain as much independence as they can. Most of the
residents at the Garden House are mostly independent. The main issues I encountered

Alvarez 4
while volunteering were having to assist three of the residents with meals, some of the
residents lacked an appetite, they were all dehydrated, one of the residents would pocket
their food, and another resident wandered around most of the day and had a hard time
staying focused while eating a meal. All of these issues are common with most dementia
patients. Over half of all nursing home residents have severe cognitive impairment,
including dementia, and there is continual research on which interventions can minimize
limitations in ADLs and improve psychiatric and behavioral health3.
Garden House Alzheimers Residence
The Garden House Alzheimers Residence is a licensed Residential Care Facility
that provides 24 hour care for elderly who have Alzheimers and other dementias. It is a
Non-Profit corporation that provides care and service to its targeted population. Along
with providing subsidies for families who need a safe and loving permanent home for
their loved-one, they also provide respite care that is free of charge. The Garden House
provides temporary relief to family members who are in need of a break from caregiving.
There are fifteen residents who cared for at the Garden House. The specialty trained staff
provide high quality care, assistance with bathing, dressing, grooming, cutting their food
and feeding, are pampered, and are encouraged to be as independent as possible. The
home also ensures safety by having an enclosed courtyard, doors with keypads, and
locked exit doors. According to the Centers for Disease Control and Prevention, at least 7
out of 10 residential care communities with dementia special care provide such features5.
For the course FSN 315 Nutrition in Aging, my Community Service project gave
me the opportunity to get involved with a Community Service in San Luis Obispo and
apply my knowledge of elderly nutrition associated with dementia and Alzheimers. I

Alvarez 5
decided to fulfill my 12 hours of community service at the Garden House which was a
great decision. The four times I visited the Garden House I was there from 4-7pm during
dinnertime. Volunteering at the Garden House consisted of engaging in conversation and
getting to know the fifteen residents, participating in activities planned for the evening,
calming down residents who felt confused, helping set the tables for dinner, and assisting
residents with their meals when necessary (cutting their food and feeding them). After
dinner, some of the residents would get agitated while waiting for their turn to get ready
for bed, so my partner and I would talk to them and help distract them. This opportunity
taught me more about the issues dementia patients face when living in a Residential Care
Facility and the measures that caregivers take to ensure quality care and help minimize
these issues.
Learning Component and Findings
All of the residents at the Garden House had dementia, but they were all at
different stages. By talking to the residents individually, my partner and I could judge
how far along the residents were with their dementia. Our first method of learning was
having short individual interviews with residents who were willing to talk and answer
questions to the best of their ability. We came up with specific questions to ask before we
interviewed residents. We wanted to first figure out how much each resident could
remember and whether they could give us valuable answers to our questions. The first
questions we would ask were, Where are you from? Do you have siblings? What job did
you have? Do you enjoy cooking? Did your mom cook a lot? What was your favorite
food to eat growing up?. While asking these questions, there came a point with some of
the residents when they couldnt remember whether their mom cooked or what their

Alvarez 6
favorite food was. Those that could answer all the questions gave us more valuable
information to record in our notebooks. During dinner, we asked residents questions like
What are you eating? Do you enjoy it? What does it taste like? Is it too hot or too
cold?. We then would ask the caregivers who worked their more of the health related
questions, like Do any of the residents have modified diets? Do any of them eat pureed
food? Do any of them have health issues other than dementia that affect their food
intake?. All of the answers to these questions were organized in our notebooks.
My partner and I observed the residents during mealtimes and recorded our
observations in our notebooks. We would watch to see how long it took residents to eat,
how small they cut their food, and how often they took sips of water while eating. Every
mealtime there would be residents that needed us to help feed them, and I would pay
attention to pocketing of food and how thoroughly chewed their bites were. Only one
activity was done out of the four times we visited. We did puzzles with two of the
residents and asked them questions about how healthy they think they ate when they were
younger and how healthy they think they are now. The activity also showed us their
cognitive ability to complete the puzzle and whether or not they were able recognize
specific objects.
After interviewing and asking the residents and caregivers questions, we recorded
the information in our notebooks. We learned a lot about health issues that are associated
with dementia, how the staff care for these issues, the nutritional health of most residents,
and eating habits. After asking the staff questions, we learned that all of the residents are
dehydrated and dont drink enough water. This is a common issue associated with
dementia. Dehydration potentially causes people to become constipated and confused.

Alvarez 7
Some of the residents are given a certain powdered medicine that is mixed in their water
to help with bowel movements. Residents arent allowed to leave the table until they have
finished their glass of water. The staff also told us that most residents maintain a healthy
and constant weight. One resident has edema and lost 5 pounds in 2 weeks. Reduced
body weight is a nutritional issue in dementia. Six of the residents take blood pressure
medicine and nine residents take supplements (Ca, K, Ag). No residents are on a specific
diet. Theyre all generally healthy besides having dementia. We were also informed that
some residents dont pee everyday. This is common among dementia patients.
The interviews and questions we asked the residents gave us some insight on their
nutritional status. A few of the residents said they dont have a big appetite, but they like
to eat because it keeps them alive. Some residents said that their food is usually bland and
they are really picky. They like knowing what theyre eating and make sure that the
doctor has approved of it. One resident told us that when she was in college, most girls
had pretty bad diets. They would wake up early, drink 3-4 cups of coffee, and they never
ate any nutritious things. They snacked mostly on sweets. Most residents said they were
raised to eat well and didnt get sick very often. One resident even informed us that
breakfast is the most important meal of the day.
From our mealtime observations, we noticed that a few of the residents cut their
food into small pieces because of their dentures or missing teeth. A few residents refused
to swallow their food and the one that I helped feed pocketed her food in her right cheek.
These are both nutritional issues in dementia. There was a resident who wandered around
all day and she had a hard time staying focused during mealtimes. Another resident gets
really confused and anxious when the sun goes down, but when she starts eating thats all

Alvarez 8
she focuses on. We also noticed that the environment was well lit with yellow lighting,
there was jazz music in the background, the temperature was stable, and there wasnt a lot
of talking. Its important to maintain a calm environment for the dementia patients,
especially during mealtimes.
Experience
The most helpful way to apply your knowledge of issues associated with dementia
is to go to a nursing home that specializes in care for dementia patients and experience it
on your own. M experience volunteering at an Alzheimers Residential Care Facility Give
evaluation of your experience helped me to fully grasp the struggles and emotions that
residents and their families go through everyday. I was able to apply what I learned in
FSN 315 about dementia and Alzheimers disease to the issues that residents experienced
at the Garden House. I learned that every dementia patient has different struggles. Staff
must fulfill specific measures and interventions for each resident individually according
to their own issues and needs. It is vital that all staff is successfully trained and are
knowledgeable of how to deal with all types of issues associated with dementia in order
to provide the best quality care. This experience has improved my understanding of
common nutritional issues associated with dementia that will in turn benefit my future
career in the field of nutrition. I believed that this agency provided high quality care to its
residents. The staff was cautious, loving, caring, knowledgeable, understanding, and
ensured provision of ADLs to all residents.

123456

1 Aukner, Carine, Helene Dahl Eide, and Per Ole Iversen. "Nutritional Status among Older Residents
with Dementia in Open versus Special Care Units in Municipal Nursing Homes: An Observational
Study." BMC Geriatrics 13.1 (2013): 26. doi: 10.1186/1471-2318-13-26.
2 Cadigan, Rebecca Orfaly, David C. Grabowski, Jane L. Givens, and Susan L. Mitchell. "The Quality
of Advanced Dementia Care in the Nursing Home." Medical Care 50.10 (2012): 856-62. doi:
10.1097/MLR.0b013e31825dd713.
3 Davis, KJ, PD Sloane, CM Mitchell, et al. "Specialized Dementia Programs in Residential Care
Settings." The Gerontologist 40.1 (2000): 32-42.
4 Kok, Jeroen S., Ina J. Berg, and Erik J.a. Scherder. "Special Care Units and Traditional Care in
Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A
Review." Dementia and Geriatric Cognitive Disorders Extra 3.1 (2013): 360-75. doi:
10.1159/000353441
5 Park-Lee E, Sengupta M, Harris-Kojetin LD. Dementia special care units in residential care
communities: United States, 2010. NCHS data brief, no 134. Hyattsville, MD: National Center for
Health Statistics. http://www.cdc.gov/nchs/data/databriefs/db134.pdf
6 Tilly, Jane, Dr.P.H, and Peter Reed, Ph.D. "Dementia Care Practice Recommendations for Assisted
Living Residences and Nursing Homes Phases 1 and 2." (n.d.): n. pag. Alzheimer's Association. The
Gerontologist, Sept. 2006. <http://www.alz.org/national/documents/brochure_DCPRphases1n2.pdf