This article is sponsored by Dementia By Day. This article is based on a Senior Housing News discussion with Rachael Wonderlin, CEO and Founder of Dementia By Day, Jessica McCollum, Vice President of Operations at ThriveMore, and Reed VanderSlik, President and CEO of ThriveMore. This discussion took place on May 16th, 2024 at the SHN BRAIN Conference. The article below has been edited for length and clarity.
Senior Housing News: I think ThriveMore is pursuing a really interesting model to keep couples together in memory care. To start us off, can you just describe the origin story of that model and what some of its key elements are?
Reed VanderSlik: About eight years ago, I was the Chief Operating Officer at a community in Grand Rapids, Michigan. My boss had run into one of our residents who lived in an independent living cottage, and his wife was in our Green House Home, which was brand new, a couple of years old. He said, “We have a support group that gets together every week. There’s about 20 of us if we’re all there. We’ve been talking the last few weeks. We don’t think your industry has what we’re looking for.”
Of course, my boss said, “What are you looking for?” He said, “Well, it’s too complicated to tell you in a parking lot.” He said, “How about coming to one of our next sessions?” My boss said, “Sure, I’ll send Reed.” I trek off to it, and we go through introductions, and I mention the comment, right? I said, “I understand you’ve been talking, and you don’t think our industry has what you’re looking for.” I said, “What is it?” They said, “Well, we’ve been talking, and what we really want is we want the ability to stay together as a couple. We want a home that looks like a home on the outside, feels like a home on the inside, but when we as caregivers need to run errands or do things, we’ve got a spot,” they called it a studio apartment at the back of the home, where they could escort their spouse into. That studio apartment would then open up, and would have another door that opened up into what I would describe as an adult daycare area.
I said, “I’m not aware of anything like that.” I asked the question, I said, “What are you doing today?” There are two stories I’ll never forget. The first one said, “Well, let me tell you about my morning.” He said, “I was supposed to go golfing 9 holes with my buddies, and I can’t be gone 18 anymore, I just can’t be gone that long. I had a caregiver lined up, it was the same caregiver that I had last week for a doctor’s appointment. Last week, everything went fine. This week, when the caregiver showed up, my wife wanted nothing to do with her. Started screaming at me, I started screaming back at her, we both started crying. We sent the caregiver away, we had to pay the caregiver for showing up, and I didn’t go golfing. That was my morning.” It starts to really feel real.
The second one was the gentleman who lived on our campus, his wife was in our Green House Home. He knew me. He said, “Reed, for us, it’s a little different. We’ve been married 67 years, and we had two habits our whole married life. The first is, “We always dined together.” When our kids were little, we’d sit at the table, we’d cut up the food, we’d clean up, and then the two of us would have dinner together. The second habit we always had is, “We held hands before we fell asleep.” I can remember a tear running down his cheek. He said, “As beautiful as the Green House Home is where my wife is, we can’t do either one.”
At this time, I’m sliding into my chair feeling awful, like we failed these people that want to stay together. I met with him a few more times. I’ll fast forward to when I moved down to North Carolina, those communities have land, so the idea started to percolate. I moved three months before COVID hit. So, we were just trying to survive and do the right thing every day.
Fast forward, we have a “strategic planning retreat” coming out of COVID. One of the themes that ends up on the board is this idea of being known in every market as the best in memory care. Then the next one that comes up is being innovative and the idea comes back into my head. I shared this with our board and they loved it.
SHN: Rachael, you’ve used the phrase “community within a community” in relation to this model, can you elaborate a little bit on what that means and what that vision is?
Rachael Wonderlin: “Community within a community” is a sense that we can cater to the spouse who is living with dementia and the caregiver spouse. The caregiver spouse gets the benefit of being able to engage with the other caregiver spouses. It’s really this community, and then within that community, you have these smaller ecosystems.
SHN: Can you maybe just describe a little bit about Mindful Impressions, that approach, and how that’s integrated into this model as well from an operational standpoint?
Wonderlin: We built a program called Mindful Impressions, which is the dementia care program that the other ThriveMore buildings use, really focused on small group activities, a lot of hands-on programming, some art focus, and Embracing Their Reality™ and focusing on how do we do what’s true for them, and teaching families that same concept, who are really struggling. We’re going to be implementing that in this community as well. There’s going to be hands-on small programming for the spouse living with a cognitive impairment, and having that, and then having the ability for them to continue living their lives, essentially as normally as they would if the person with dementia didn’t have dementia, it’s awesome.
SHN: Reed, could you talk a little bit about the feasibility of the model, and how you’re thinking about it penciling out?
VanderSlik: It’s the very early stages when they’re giving you a budgetary number. They gave that to us, gave it to our CFO to run the numbers, and he came back to me. I think he was a little surprised. He goes, “Reed, the model actually works if you can have a 95% occupancy.” I felt like that’s probably possible, it’s unique, and there’s not a lot of this, but I also made a commitment when I came on to the organization that every new project that we do should stand on its own.
We are actually in a capital campaign to raise at least $1.5 million which will allow us to service the debt at 80% occupancy.
SHN: Jessica, can you talk to us about this campaign and where you’re at in the timeline?
Jessica McCollum: This capital campaign is a part of a larger capital campaign called Immeasurably More, which is a $3 million, three-year campaign. As Reed mentioned, we’re hoping to raise $1.5 million for this project to improve the lives of our memory care residents and their caregivers. We are still in the silent phase of that campaign, and, obviously, we’re so excited we’re not completely silent. We are currently just shy of $200,000.
SHN: Can you talk a little bit about measuring the impact of the model and explain that element?
McCollum: Because there’s nothing like this quite yet, we’re going to use working with groups like LeadingAge to look at industry trends. We currently have two methods of measuring impact as an internal organization, resident patient satisfaction surveys, as well as an internal scorecard that measures evidence-based industry standards. As this model, hopefully, is replicated throughout the country, we would look at how that impacts the residents and the dementia residents as well.
SHN: Reed, a question for you. What happens when one spouse dies? Is there a transition plan?
VanderSlik: We could change our minds yet before it opens but our thinking right now is we’re building this on the campus of a continuing care retirement community, so we have other products to provide service. If one of them passes away, we will transition the other one to our traditional model.
SHN: Rachael, can you talk about how to communicate this model to the overall market, something that’s untested?
Wonderlin: I think this model will speak for itself in a lot of ways, because this is such a huge need. The problem that we all run into frequently is if a couple wants to stay together, they’re sort of met with a challenging decision about where they will live. There’s not really been a good answer. I think even speaking to that initial problem and saying, “We have a solution for that,” I feel like people are going to immediately see the value in keeping this couple together if that’s what they wanted to do.
SHN: How about operationally? Anything you can talk about in terms of challenges that you anticipate or must-haves for this to work?
VanderSlik: I would say the one thing we’ve run into is the regulations. We need to know if we license this, and, if yes, that changes for each state. It’s been challenging to get regulators to really understand that.
SHN: Can you speak a little bit to the staffing model here?
VanderSlik: The plan is to have two universal workers on day, two on second, and one on third. They will be dementia trained. They’ll also be food ServSafe trained. They will be paid at a higher rate, and we built that into our model. That’s the plan right now.
SHN: Can you talk a little bit about the dining component of this and how that’s going to work?
VanderSlik: We are building that clubhouse with the capability of providing dining. Being on a campus, we can use our main kitchen for a prep kitchen. We’re going to provide a “Green House like” kitchen, a light, commercial/heavy residential.
SHN: Rachael, can you describe a little bit about your relationship with ThriveMore?
Wonderlin: Dementia By Day is the name of my company. We work all over the country. We work primarily with senior living companies who have dementia care units or wings, but not necessarily a plan in place for what the residents do all day, how they educate staff, how we educate families, or a brand.
I started talking to Reed around COVID times, and, over the next six months or so, we decided to partner up and work on the existing ThriveMore buildings. In the last year or so, the Couple’s Memory Care program was brought up, and I wanted to be a part of it.
SHN: Is this model prepared to help couples age in place as they progress through the stages of dementia?
VanderSlik: Our goal is that, yes, they can live there to the end of life, and we’ll support them in every way we can..
SHN: Will there be nursing oversight services or overnight services?
VanderSlik: Being on the campus, we do have nurses there, and this is going to be actually very close to our clinical, in terms of on the site. We feel we can support it that way.
SHN: Can you elaborate a little bit on choosing the site for this? Was it just a function of having the land availability, or were there other market conditions that you weighed?
VanderSlik: It’s a little bit of both. We do have space on the site, and we also have some of our best staff, clinically, to support something new like this, and this particular market where our life planning community has the most competition, so it gives us something to just differentiate in the market.
SHN: Will the Adult Day portion be open to the general community?
VanderSlik: Our plan is not at the initial opening, because we do want to develop a pace and a rhythm to this new model. I think we are open to doing that. Again, if it’s licensed as Adult Day, we’ll have that ability in that interior space.
SHN: I’ve heard it put forward that Adult Day as a model can be a more affordable alternative than middle market. Do you think, even this model aside, that that has potential to meet that part of the market?
VanderSlik: One of the things we try to do to address the middle market is a sliding scale. We’ll do a sliding scale for those people who don’t qualify for Medicaid but can’t afford private pay. We fundraise for that delta. Of course, we have to limit it, but at least we can do something.
SHN: What’s the timeline for construction and opening?
VanderSlik: We’re in the fundraising portion. We don’t have a final timeline, but the construction cycle would be 12 to 18 months. We are moving forward all the way to CD drawing, and then we’ll reprice it all.
SHN: Rachael, is there something that could change in Adult Day that would make it more successful?
Wonderlin: I’d love to see more Adult Day options because it really does seem to make sense. We just don’t see a whole lot of it. One thing that’s very helpful is having the person living with dementia “go back to work”. They go to the Adult Day. The person feels like they’re not there because they’re living with a cognitive impairment, they’re there to help others.
SHN: Anything else in the works to ThriveMore that’s exciting or innovative that you want to shine a light on?
VanderSlik: We’re very excited because we’re all dealing with the workforce issues. On campus, we’re planning to add child daycare. That will give our employees’ children priority access. Then we’re going to do a sliding scale to supplement based on their income so that we can really try to make it affordable.
Dementia By Day offers a new approach to dementia care for senior living companies who want to offer better solutions for their residents, staff and families. Have a dementia care program but need someone to run the day-to-day operations? Dementia By Day does that, too. To learn more visit https://rachaelwonderlin.com/.