Millbrook's homelike setting assists Alzheimer's patients
By Caryl Buckstein

     LONGMONT -- It's taken a long time, but Raymond Wismer, 95, seems happier now.  Until two years ago, he took care of his ailing spouse. When her condition worsened, he drove to the nursing home each day to spend three hours by her side.
     Wismer was crushed by the death of his wife. He would never talk about it, but he began to slip, his daughter Sally Steinmetz said. He was unable to remember things and started wandering off on his own, becoming disoriented. He moved to a nursing home, where his spirits and his physical capabilities began to drop off. He went from 130 pounds to 110. "He would barely eat enough to stay alive," Steinmetz said. "He was very unhappy."
     The turning point came when he moved into a new home that actually seemed like home. Wismer soon began to improve. The house sits in a residential area of carefully tended homes near Fox Hill Country Club. He joined four other people in similar straits, all with some kind of Alzheimer's disease or dementia. "He seems so happy now. I look forward to our visits," said his daughter.
     It is part of the good life that Chief Executive Officer Paul V. Miller and his associates hope to provide residents of MillBrook Homes, a Denver-based corporation focusing on long-term care for Alzheimer's and other memory impairment disorders. Whenever physically possible, he hopes MillBrook residents can avoid placement in institutions and remain in MillBrook home settings for the rest of their lives.
     People with Alzheimer's disease begin to forget recent events or familiar tasks. The rate the disease advances varies from person to person, but Miller, a psychotherapist, notes, "The results are always the same." The brain disease eventually causes confusion, impaired judgment, and personality and behavior changes. Communication becomes difficult. If a MillBrook resident's condition ever deteriorates to a state where they need total nursing care, they may need to move.
     MillBrook has built seven homes in Colorado, two of them in Boulder County. Of the others, four are located in Arapahoe County and one in Jefferson County. Miller joined with an emergency room physician, Dr. Michael Opatowski, and a certified public accountant, Harvey Milzer, in early 1997 to form the corporation.  The trio hopes to operate 50 homes within three years, and 100 homes within five years. MillBrook's first out-of-state home, in Las Vegas, is expected to open later this year. Miller and his colleagues are optimistic about the future of their business, but realize it's a two-edged sword. "It is a very sad illness," Miller said.
     The Chicago-based Alzheimer's Association estimates 4 million people have Alzheimer's. Its reach is much farther, however. A national survey in 1993 indicated 19 million Americans had a family member with Alzheimer's, and 37 million know someone with the disease. Blame an aging population or other factors, but the association projects the number of Americans with Alzheimer's will grow to 14 million in the next 50 years, unless a cure is found.
     Despite a growing need for Alzheimer's care, most health-care providers aren't interested in offering it . "It demands a higher level of care than required in a nursing home setting," Miller said. "The residents need a lot of attention." MillBrook has a trained staff member on duty around the clock.
     If a patient's prognosis seems poor, the presence of the MillBrook home stands in defiance. The house here is light and airy for a reason. Light is particularly important to Alzheimer's patients, noted Darren Delfino, a worker at MillBrook Homes. Each resident gets a private room decorated by relatives to be as homey as possible. Wooden dressers, homespun bedspreads and paintings abound.
     Residents who share the MillBrook Home with Wismer visit with loved ones in a front room that resembles the front room of many houses built 23 years ago. A hairstylist stops by once a week. Manicures are provided. The $3,500 monthly cost also includes clothes, incontinence supplies, everything but medicine. The home-cooked meals have helped her father flourish, noted Steinmetz.
     Wismer is probably unaware of the front door that bolts so securely to protect its residents from wandering alone into the daily unknown that lurks beyond the front yard. Residents are free to walk in the backyard to enjoy outdoor flowers and grass.  MillBrook provides residents with activities that include exercises and excursions appropriate to the particular patient's stage of the disease. Stimulation from movie theaters and a trip to the zoo is too much for most dementia patients, Miller said, so most outside trips involve long drives. "They're often topped off with a trip to the Dairy Queen," he added.
     When residents are still able, MillBrook has a van to take them to more stimulating fare.
As in other settings, the cost of care is largely borne privately by families. Neither Medicare nor private health insurance covers the long-term care most patients need. The cost is reasonable when contrasted with the cost of institutional care, Miller said. The average bill per patient for nursing home care is $42,000 per year, but can exceed $70,000 per year in some parts of the country, according to statistics by the Alzheimer's Association.
     In the past, Alzheimer's patients often were housed in nursing homes, with patients suffering other afflictions. Most patients with Alzheimer's disease or dementia are healthy, said Miller, a psychotherapist with a background in geriatrics. Their actions were often misjudged and result in wrongful retaliation. "Here, if someone wanders into the wrong closet and puts on someone else's clothes, it's not a big deal," Delfino said. "Someone else has done it, too."


Copyright (c) 1998 Boulder County Business Report.
All Rights Reserved.
July 1998

Peace of Mind
MillBrook Home caters to Alzheimer's patients' special needs
By Ted Nelson

     LONGMONT -- The 85-year-old woman loves the friendly, blond cocker spaniel that shares her stylish ranch-style home in the Fox Hill neighborhood, but she can't remember its name. If someone reminds her that the dog's name is Buck, she'll likely forget it again within 10 minutes.
     Most of the residents of the six MillBrook Homes for people with Alzheimer's disease and dementia need help getting dressed, bathing and preparing food because they often forget what they're doing in the middle of a task.
MillBrook co-founder and chief executive officer Paul Miller has seen men try to shave with their toothbrushes and a woman complain that a man's black wingtips didn't fit her much smaller feet.
     Each MillBrook home houses up to five residents who need a lot of special attention. A caregiver remains in each home 24 hours per day and accompanies residents whenever they leave. Groceries are delivered to their door. Hairstylists and pedicurists make regular visits.
      All stairways in the homes are closed and locked. Stoops and sunken floors are leveled off. Bathroom lights are controlled by motion detectors so residents will not become lost or have accidents.
Kitchen utensils are kept in locked drawers to prevent accidental injuries. Each room is equipped with extra lighting to prevent confusion associated with darkness.
     MillBrook 's first home in Longmont opened in January, but will have just two residents until it is licensed by the state for five residents. Miller said the company is looking for a second Longmont house and hopes to open one or two more within the next two years. It plans to open up to eight additional homes in Fort Collins, Loveland and Greeley during the same period. The chief executive officer said Longmont had only 58 beds in facilities providing specialized care to Alzheimer's patients before MillBrook arrived. Some Longmont families drive as far as south Denver to find care for their relatives, he said. Such distances make it difficult for families and friends to visit as regularly as they wish.
``Our house is a home,'' Miller said. ``There are no regulated visiting hours.''  He said the concept of small group homes for people withAlzheimer's disease was pioneered more than 12 years ago, but really got off the ground during the past five. It is part of a general shift from nursing homes to assisted-living centers.
     Miller said 85 percent of MillBrook 's residents are women -- mainly because they often outlive their husbands. Many of the residents moved to the homes after their caregiving spouses died or after they were required to leave assisted living centers because they wandered away or mistakenly picked up another person's things. Miller said his 14 years of work in hospital psychiatric wards and outpatient clinics helped him understand the needs of people with Alzheimer's.
He has found they respond more favorably in a home environment than in an institution.
     ``Security is the main factor,'' Miller said of the Longmont home. Because confused wandering is common among Alzheimer's victims, the front door of the home is secured with a magnetic lock operated with a numerical code on a keypad. Fire alarms would open the door automatically. Residents are free to walk out the back door and into the roomy back yard. They may even start a garden there, but a waist-high hedge and a 6-foot, wood fence prevents them from leaving. All other doors are locked. ``We've never had anyone wander off,'' Miller said. Controlling noise and stimulation is critical to preventing people with Alzheimer's from becoming overly confused or frustrated, he said.
     ``They lose the ability to filter out noise they don't need to pay attention to, and it just bombards them,'' he explained. Classical or Big Band music plays constantly but softly on the home's stereo. Alzheimer's sufferers can become boisterous, aggressive or loud if they become bewildered to the point of frustration. ``We have none of that,'' Miller said. When an 84-year-old woman asks when her parents are coming to pick her up, he said, it would do no good to explain that her
parents have been dead for years. To avoid anxiety or agitation, caregivers might gently tell the woman her parents are at work.
     Christine Lucero, who rotates on 24-or 48-hour shifts supervising the Longmont home, said residents can have difficulty understanding directions unless she speaksslowly and clearly. The University of Colorado kinesiology graduate volunteered in nursing homes throughout high school and has been working in MillBrook homes for six months. MillBrook homes are not staffed with nurses, because residents do not have serious medical problems other than Alzheimer's. ``The residents don't so much need constant attention as a little direction and help with their activities. And they enjoy the help,'' Lucero said.
     Caring for five people with Alzheimer's usually is easier than caring for five children, she said, because they are ``nice, calm and generally have retained their social skills so that they act appropriately.'' On a bulletin board Lucero keeps an hourly schedule of activities she will organize for residents. The list includes exercise sessions, ball tossing, board games, painting, crafts, baking, ice cream socials, tea time, clothes folding, reminiscing, occasional trips, sing-alongs and instrumental music.
     To provide mental stimulation, caregivers occasionally open up the ``sensory box'' for residents to explore. It contains items that may trigger pleasant memories or activities, such as a toy tractor, dolls, knitting needles and yarn.  ``It would never occur to me to be in any other place,'' said a well-dressed resident, Ada Mary. Ada Mary's daughter, Barbara Lavender of Boulder, moved her mother to the home when dementia made it impossible for her to remain in her own house or in a large assisted-living center. At the time, she said, her mother was forgetting to eat, wandering outside in her housecoat and slippers and not allowing anyone to clean her house.
     Lavender sees the home as a wonderful, comfortable, safe and personable alternative to the busy, institutional atmosphere of a nursing home, which she finds ``really depressing.'' She said her mother's mood noticeably improves when she is taken on outdoor walks. Terry Zamell, who administers personal care home inspections for the state Health Facilities Division, said MillBrook 's five other homes are safe and well-run and obtained licenses without significant problems. The Health Facilities Division has not yet inspected the Longmont home.
     Julie Medearis, who lives on the same block with the home, said she knows of no problems caused by the facility in her neighborhood. She said she will be interested to see what happens when the warmer weather draws residents outside.
The cost for a room, board, basic supplies and all care in one of MillBrook's homes is $3,500 per month. The company does not accept Medicaid clients.