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Personal Touch: New Home in Mendota Heights Offers Alternative Senior Care

By: Megan Anderson

Sun Current July 24, 2008

Outside the room of one patient at Mendota Manor, "Queen Celine," is written colorfully on a chalkboard.

Nestled in a residential neighborhood, while venturing past the Mendota Heights home, some may find that it blends in with the other houses on the block.

Inside, however, exists a unique and alternative type of residential care for seniors offered by Heart to Home.

Co-owner Josh Cesaro said the long-term care facility, which opened this past April, can accommodate six patients, offering hospice care, general care and memory care.

"We wanted to do a home that is specifically catered to this type of care," he said.

Most nursing homes house 20 or more residents, he said, but the small number of patients at Mendota Manor translates into more personal care.

Cesaro, who grew up in Eagan, received experience with elderly care as a nursing assistant in college. He said Heart to Home provides something unique. "The feeling between this and a nursing home is like night and day," he said. "You get a very high level of attention."

A doctor makes on-site visits, a registered nurse is on-call 24 hours and there is a 24-hour awake staff, in addition to home-cooked meals and activities.

Spa services are brought in and therapy dogs also visit, said Cesaro, who hopes they can bring senior yoga in for the residents.

The house was designed entirely for senior care, he said, while also bringing a more comfortable, homey feel.

Wheel-chair access is possible throughout the house, he said, and sight lines toward the front door have been removed for memory care patients.

Residents like "Queen Celine" can choose between private or shared rooms. Rooms come with in-room bathrooms and a memory board to write messages.

There is a large great room where residents can spend time when their families come to visit, he said.

With 20 years of nursing experience, co-owner Paulette Vrem of Highland Park, said that personal care is the highlight of Mendota Manor. "It's such a needed service," Vrem said. "I see a lot of elderly that should be in a safer place."

With its holistic approach, Vrem said Heart to Home takes into account what the patients need. "It's been very satisfying," she said. "We can return quality of life to a lot of people who have lost it."

Being part of the community is also an advantage of Mendota Manor, Cesaro said. Residents enjoy making trips to nearby Village of Mendota Heights for coffee and summer parks performances.

Catherine Breet of Eagan said she couldn't say enough about the care her mother, Julia, received at Mendota Manor. "They were heaven sent," she said.

After six months of declining health, Julia, who was 71, needed to go into a nursing home, Breet said. "It was horrific," she said of the experience, particularly because the patient to staff ratio was 18 to one.

She found Heart to Home through the non-profit referral agency. "For our family it was a painful, stressful, frightening time," she said. "We felt like we landed in a little oasis at Mendota Manor."

Although they hoped her mother would be at Mendota Manor for one or two years, Breet said she died after three weeks. Even though it was for a short time, Breet said she praised the care her mother received through Heart to Home.

Meals were catered to her mother's tastes and she was given handmade booties for her ankles, she said. "The way they welcomed me, my father and my children," she said. "I felt like we were becoming a part of a family."

Breet said she wasn't sure why more people haven't looked into places like Mendota Manor. "I think the public hasn't demanded it," she said.

The affordability factor becomes a very personal choice for each family, she said.

Her mother had already moved to private pay for her care, she said, and costs for the amount of care she needed was $250 to $300 a day in a nursing home.

The costs at Mendota Manor, Cesaro said, are $245 for shared suites and $300 a day for private suites, depending on the level of care needed. Heart to Home accepts long-term care insurance or private pay, he said. "It really depends on the policy," he said.

Breet said she recommended Mendota Manor to others looking for a place for their loved one. "If their loved one needs that level of care, I just think there's no other choice to be made," she said.

Cesaro said they are starting construction on another care facility, also in Mendota Heights, called Mendakota Manor.

For more information, call 651-454-5250 or visit

Aging: Small is Beautiful

The newest thing in end-of-life care: residences that look--and feel--like the house you've lived in all your life.

By: Claudia Kalb and Vanessa Juarez

With: Nomi Morris

Newsweek August 1, 2005

Dorothy Green had always been an independent woman. A Cadillac-driving, mink-coat-wearing, Tiparillo-smoking woman. So it was especially hard on her family members when they realized that their spitfire matriarch, now 85 and suffering from dementia, could no longer care for herself. Last year Green's family moved her into a 60-bed assisted-living facility in San Luis Obispo, Calif. Green was well cared for, but she didn't like the rigid schedule. And living with dozens of other people made her agitated. "She would cry a lot," says her granddaughter and staff nurse, Teri Weitkum. All that changed last fall, when Green moved 30 miles away into a luxury suburban home called Vista View. The stand-alone house is a long-term-care facility for people with Alzheimer's and other forms of dementia, but it feels like home. There are spacious bedrooms, wall-to-wall carpeting and a garden, where residents grow tomatoes and squash. In the mornings, Green pads around in her slippers. One recent summer day, she and her three housemates gathered for beef stew served on china plates with designer cutlery. "They treat me like I'm a somebody," says Green.

It seems so obvious: let people age the way they have lived. Today, finally, it's beginning to happen. From upscale residences in California to family-size nursing homes in Mississippi, living facilities for the elderly are undergoing an architectural and cultural makeover: big, sterile institutions are out, small, homey environments in. The need has never been greater. Today 35 million Americans are over the age of 65--by 2030, that number is expected to double. As baby boomers age into sixtysomethings, the demand for civilized living will only intensify. "We have to completely transform the system," says Rose Marie Fagan of the Pioneer Network, an umbrella group for innovative aging programs.

Nursing homes are at the top of the list. Many of the nation's 17,000 institutions are decades old and operate on an impersonal hospital model--lackluster corridors, shared bedrooms, strict sleeping hours. Enter Dr. Bill Thomas, a 45-year-old geriatrician at SUNY Upstate Medical Center, who's on a mission to revolutionize long-term care. In the 1990s, Thomas launched the "Eden Alternative," which called for humanizing big facilities by removing nurses' stations, adding plants and pets, and focusing on the staff-elder relationship. Eden was just the beginning. Today his baby is the National Green House Project, a radical shift away from large institutions to homes with no more than 10 residents each. The advantages: cozy living, privacy (individual bedrooms and baths) and time for caregivers to get to know residents--not just their medical needs, but their life stories, too.

The project's birthplace is Tupelo, Miss., where Steve McAlilly, CEO of Mississippi Methodist Senior Services (MMSS), is making Thomas's vision a reality. Several years ago MMSS was going to replace a worn-out 140-bed nursing home called Cedars Health Center with a big new facility. Then McAlilly learned about the Green House Project. "Intuitively," says McAlilly, "it made sense." In 2003, MMSS opened the first four Green Houses in the nation. Two more launched in June and four are expected to open by mid-September. The 6,000-square-foot single-story houses, which cost the same to live in as Cedars, have a driveway, a doorbell and a yard. Residents get to select, and even help cook, their own meals. In Mississippi, says Jude Rabig, the project's executive director, that means plenty of okra and fried chicken. Mildred McDonald, 85, says mealtime reminds her of her childhood, when she and her seven siblings ate around a long table. "It's like family," she says. Today dozens of other Green Houses--from New York to Hawaii--are in the planning stages or have recently broken ground.

As the home-living concept spreads, questions arise: Is the medical care adequate? Is quality of life improved? Daniel Carsel, founder of Alta Vista Living, which owns Vista View, says he was prepared to witness the rough transition that people with Alzheimer's typically experience when they move. Instead, he says, many residents were settled within a day. "We were reducing medications, people were eating more," he says. Alta Vista operates a second house in California and plans to open a third this August. Rosalie Kane, a long-term-care expert at the University of Minnesota's School of Public Health, has studied the Tupelo houses for two years. Compared with traditional nursing homes, she says, residents are more satisfied and in better physical shape. And in an industry with a massive work-force-retention problem, caregivers feel more empowered and relish the personal contact with residents. The result: they're more likely to stay on the job.

Long-term-care facilities never come cheap. The average monthly price tag in a nursing home is more than $5,000. The Tupelo Green Houses, which are licensed as nursing homes, ring in at $4,350; Medicaid covers the cost for most residents. At Alta Vista Living, shared rooms are $4,500 per month, private ones, $5,500. But because the houses operate as assisted-living facilities--residents need help with daily living, but not skilled nursing care--government insurance doesn't pick up the tab. Jill Hreben, CFO of Otterbein Homes, which manages six retirement communities in Ohio, admits that she was skeptical about the business model at first. But after visiting Tupelo, Hreben concluded that the project's simple organization--no hierarchy, no separate departments for food, laundry, maintenance--would ultimately reduce costs. Otterbein is now planning to convert its own nursing homes into Green Houses. "I think the dollars are going to work," says Hreben.

The lifestyle does, says McDonald's granddaughter Sherry Wood. McDonald, who has dementia and congestive heart failure, feels right at home in the Green House she moved into this spring. "She has a smile on her face," says Wood. "She's happy." The ultimate vision for the future.

Copyright (c) 2005 Newsweek, Inc.

Environment critical for Alzheimer’s care

By: Dennis Boggio

The Denver Business Journal

Health-care Design

May 10, 1997

Winston Churchill once remarked, “We shape our buildings and our buildings shape our lives.”  As the nation’s elderly population continues its dramatic rise, how we “shape” environments for the increasing number of frail seniors will greatly influence the quality of life we provide for these older Americans.

The U.S. Census Bureau anticipates a doubling of the 85-plus year old population between 1990 and 2010. In numbers, this represents an increase from 3 million individuals in 1990 to more than 6 million in 2010.  This population again will double during the next 30 years to more than 12 million people. It is estimated that more than half of this population group suffers from Alzheimer’s disease or some form of cognitive impairment.

Until a cure for Alzheimer's is found, one of the most effective interventions to improve the quality or life for those with the disease begins with a well-designed environment that utilizes architecture as a tool to compensate for cognitive losses that accompany this disease. Studies have shown responsive design of the physical environment can help Alzheimer's residents function more normally, which fosters independence and a higher quality of life.

The architecture, however, is just one component in the total response system.  No amount of architectural talent or knowledge can compensate for a poor service plan. an inappropriate or hostile neighborhood or an inept use of the building.  Designing special-care environments for Alzheimer’s residents is both a physical and social undertaking that has to begin with an understanding of the social and psychological needs of the resident.  Only through this understanding can we provide design solutions and support systems that enhance the quality of life for residents.

The dementia resident:

Those with Alzheimer’s have a reduced ability to reason and make judgements, which puts these individuals at risk.  They can become confused and disoriented very easily.  Design solutions should therefore incorporate simple and direct circulation patterns that are easily understood and comprehended.  Distinctive, memorable, architectural features that provide cues and clues of location, along with the use of familiar building elements that allow for the incorporation of personal furnishings and objects, help promote orientation in time and space.

A residential environment:

Those with dementia are constantly dealing with changes in themselves and their world, and it is important to help them maintain links to the past and to “things” that are familiar.  Creating a home-like environment with rooms and furnishings modeled after the single-family home is an important design objective for a therapeutic environment.  The design should reflect the premise that the special-care living environment is a home, not an institution.  All aspects of the development should be residential in orientation.

Some basic ideas for planning and design are:

Brick, wood siding, sloped roofs, covered porches, shutters, fireplaces, staircases, lamp posts, and circle driveways are home-like materials and details.  Choose materials and design standards from the single-family home industry for the impression of the building.

Establish the size and volume of interior spaces based on single-family homes and other residential building types.  Avoid atriums and large open spaces that are more commercial than home-like.

Incorporate residential building systems and elements that are likely to be familiar to residents.  For example, doors and windows should look and operate much like those most commonly used in homes.

Use residential interior furnishings, materials and color schemes that are familiar and consistent with the vocabulary of single-family homes.

Provide electrical, mechanical and hardware items used in the housing industry for all interior devices, including light fixtures, sprinkler systems, thermostats, door hardware, bath accessories and kitchen appliances.

Safety and security:

Safety and security are primary objectives in the environment.  Those with Alzheimer’s and the cognitive impairments that accompany this demeaning illness are physically vulnerable.  Providing safe and secure walking areas, eliminating  places where residents are likely to fall are important goals.  The physical environment should allow observation of residents.  The use of hardware such as visual monitors and lock-outs prevent residents from entering unsafe places.

Family participation:

Family involvement and intervention in the daily lives of the Alzheimer’s resident is a major objective in creating a normal lifestyle.  Regular visits and participation can be encouraged by a physical environment that makes family and friends feel welcome.  This gives the setting a residential, non-institutional persona and enables family members to feel more comfortable.  Private dwelling units and small private niches in the public areas, for example, can provide opportunities for visitation and create feelings of home.

There is no one specific design that works for all residents or for all projects.  The challenge for meeting the needs of the burgeoning senior population afflicted with this disease will be to carefully understand the needs of the individuals and provide innovative new approaches to how we “shape” their environments.

Dennis Boggio is the president of Lantz-Boggio Architects in Englewood.