SHN BRAIN: The Blueprint for Building a Best in Class Memory Care Program

SHN BRAIN: The Blueprint for Building a Best in Class Memory Care Program

This article is sponsored by The Joint Commission. This article is based on a Senior Housing News discussion with Rhonda Sanders-Simmons, Chief Customer Experience Officer at Trilogy Health Services, and Loren Shook, President, Chief Executive Officer, and Chairman at Silverado. This discussion took place on May 17th, 2024 during the SHN Brain Program Conference. The article below has been edited for length and clarity.

Senior Housing News: According to the U.S. Census Bureau in 2011, the largest ever demographic generation of Americans, the baby boomers, started reaching 65 years of age.

By 2030, the segment of the US population aged 65 plus will have grown substantially with a staggering 71 million older Americans making up over 20% of our total population. As the size of the US population age 65 and older continues to grow, so too will the number and proportion of Americans with Alzheimer’s and other dementias. In 2021, the Joint Commission launched its voluntary Assisted Living Community Accreditation Program to help assisted living communities with best-in-class quality and safety systems and processes.

In 2023, they launched Memory Care Certification for Assisted Living Communities to support assisted living communities providing memory care services.

Let’s start digging in, talking with our panelists. Rhonda, if we could start with you and talk about your role at Trilogy Health Services, and your philosophy of memory care programming at Trilogy.

Rhonda Sanders-Simmons: I’ve been with the company since we started. We’re now at 130 locations throughout the Midwest. My primary role is to support anything to do with customer engagement. I drive our customer satisfaction survey process, and the departments of culinary and life enrichment, as well as memory care.

I think my number one job is finding out how we get people to adopt the standards that we want them to do. I would say that’s my greatest opportunity and greatest privilege to do that.

SHN: Loren, tell us about your role in Silverado and your philosophy there.

Loren Shook: I founded Silverado 28 years ago as an all-memory care company. We have 27 communities in 10 states across the US. We also have hospice and palliative care throughout the major cities of Texas and Southern California.

Our philosophy of care in memory care is a paradigm shift from what would be thought of as a traditional assisted living approach. My background comes from the behavioral health field where I had a prior career for 20 years running a multinational behavioral health hospital company. I know the importance of medical care. I know the importance of great nursing care and psychosocial services. It’s essential that those components come into play for delivering a quality-of-life improvement for people who have memory impairing diseases. It’s also really important for their families to have that support too.

The environment is one that honors the person where they’re at, does not infantilize them, treats them as an adult, and builds on their strengths.

Sanders-Simmons: Ours has been a little bit different. We’ve adopted different principles from different things, but we put it all together into something that we call the best friends approach.

Everyone needs a best friend. Somebody who knows you intimately, who cares about you, who supports you. That’s the background and the founding principles of everything that we do in our memory care neighborhood. We didn’t come up with all these ideas. We learned from others, just like we’re doing here today at this conference.

Shook: We hide all the medical pieces, so you don’t see it. Because nobody wants to live in a nursing home. Nobody wants to live in a medical environment. What you walk into is not a lobby. You walk into a living room with pets, an intergenerational program, so you’ll see children. The children mostly come from our staff, and they’re invited to bring their children to work, and that builds in a great intergenerational program. It’s a holistic model, and we use all the tools available to us.

SHN: Loren, Let’s talk a little bit about staff training and development programs that you do at Silverado.

Shook: We built our own dementia training program. It is part of our 40-hour training program for any new associate. All of our staff in our communities are dementia certified, and they go through a 20-hour program, and they’re tested out of it. They know the different diagnostic groups.

There’s 40 hours of training, three days of didactic, and then in addition to that, we’ve got two days of side-by-siding with other team members.

SHN: Then at Trilogy, how are you addressing staff training?

Sanders-Simmons: Ours is slightly different. We start out with a three-day onboarding, and that’s for all employees across the organization. They also have an onboarding process in their own department. For the first six months, everyone wears a blue badge that lets us know that they’re new. That’s something that I think supports our training so we can identify who those new people are.

For our memory care program specifically in the Best Friends approach, everyone goes through six hours of dementia training initially upon hire. Then any campus that is offering a memory care service line, all of their team members participate through our e-learning system. They have a module that identifies and teaches the principles from our Best Friends approach. They take those modules every month. Then they participate in a specific face-to-face discussion where we will take those principles and apply it to that neighborhood, and to a particular resident.

In addition, we also do daily huddles. These allow you to reinforce your standards and what you expect of people. You’re having that face-to-face discussion so people can ask questions and you can recognize and reward people for the behaviors that you want.

We’ve had excellent success with mentors and apprenticeship programs. Our apprenticeship programs are tracks that allow people to participate. They choose the track that they want. They also earn more money as they complete the apprenticeship programs. That helps keep people really engaged.

Then the mentorship program is where they go to offsite training to become mentors. They’re trained on how to lead and guide new people. We’ve had outstanding results for clinical mentors. 85% is our retention rate. For non-clinical, 92%.

SHN: That also leads into thinking about leadership development and succession planning. Is there anything else that you’re doing along those lines?

Sanders-Simmons: We have our own training programs for those who we believe may be a good leader in the future. We’ll take them through a year’s program. We’ve had excellent results with our administrator and training program.

We have the best retention and the best service results out of those people that we’ve grown on our own. In addition, we have a training and leadership department. Each new leader attends five different classes on leadership. The primary focus there is how do we get relationships and results from their team?

SHN: What about leadership development and succession planning at Silverado, Loren?

Shook: We have several levels of leadership training that we use. One is called Life Leader. We’ll bring in caregiver mentors that we have. We give them four days off-site of learning to be a leader. It starts with learning about themselves.Then they’ll learn a lot of different techniques for managing people.

The next level is for our administrator-in-training program. Experienced administrators that are still relatively new will go through a seven-month program. In that program, they come in every month for about three days. It’s a deep dive into one area or another of operating a community. The nurse leaders are also the most important other leaders in our company. We’ve hired an outside staff member, a full-time trainer, to do nothing but train our nurses.

SHN: Let me shift gears here, and let’s talk about consumerism. How has consumerism and what families and loved ones are asking for shaped your planning and strategies for the future?

Shook: It really revolves around quality of life. It’s all about giving them purpose, giving them connection, and giving those opportunities to live life to the fullest without barriers. We say you can do anything you want with dementia as long as you have the support. We send people on cruises in different countries. People have ridden elephants. They’ve done all kinds of things.

SHN: How has consumerism shaped your plans at Trilogy, Rhonda?

Sanders-Simmons: Families and residents want all of those things, as Loren so eloquently explained. They’re also looking for data. They want us to prove that we have done or that we are going to do what we said we’re going to do.

We’re currently piloting Carefeed, which is a communications platform that also has the ability to connect into the electronic health record so they have visibility with that as well. It makes communicating with your families very efficient and quick. You are providing care at the most intimate time in people’s lives, especially for us where we do a lot of later stages. You do become their family, and they want that. They also want us to prove ourselves. We have to do that through data.

Shook: I just came from one of our communities here in St. Charles and met with families yesterday. The families all said, “I can’t believe what you did for me as a family member.” I never expected that. You just can’t get that same level of service at home.

SHN: Physical plant, environmental conditions. A lot of times we don’t have a lot of options there. It may be an aging property and maybe we don’t want to rebuild it. Is there anything about physical plants that you consider?

Sanders-Simmons: So many operators are looking at taking a wing in your campus or your center to turn it into memory care. We have to look at that and make sure we have enough space to do the programming and do the accommodation.

Shook: We build from the ground up and we also take over other operations and convert them. What we want to do is make sure the physical plant is a supportive structure for people who have a brain disease. Everything we do in that physical plant is designed to achieve that. That’s why we put the memory boxes in. That’s why we take away all barriers as much as possible so they can get outside.

A lot of behaviors that people see with people with dementia, they think that it’s really their disease. This is historically what the physicians would say, what the experts would say over the years. It is not that at all. It’s because they’re so insulted by the environment telling them, no, you can’t do this. You can’t do that. We’d all get mad, too.

The Joint Commission is the nation’s oldest and most trusted standards-setting body in health care and today recognizes more than 22,000 organizations. Serving the full continuum of care, The Joint Commission has served nursing home providers for over 50 years and is proud to now serve assisted living communities with its accreditation and memory care certification programs. To learn more, visit

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