Lakeview Ranch: Reducing "Challenging Behaviors" in Dementia

Lakeview Ranch residents Bernie (left) and Sheila-Roo the wallaby with Judy Berry

Summary:  Lakeview Ranch provides specialized dementia care for people who are at high risk of repeated hospitalizations because of behavioral issues.   With careful attention to residents’ emotional and spiritual needs, in addition to their physical needs, the staff is able to reduce residents’ behavioral problems, decrease medications, and prevent behavior-related hospitalizations.  This type of care reduces the total cost of caring for a person with dementia who has challenging behaviors, says founder Judy Berry.  

Judy Berry was a Regional Sales Manager for a barbecue company, selling ribs to stores and restaurants throughout the Midwest.  She was calling on customers when she got a phone call that her mother, Evelyn, was in the hospital.  Evelyn had dementia, and accidentally overdosed on her medications. 

This turned out to be the first of many such calls for Judy.  Each time, doctors would stabilize Evelyn enough for her to return to a nursing home or dementia care residence, and each time, her “challenging and aggressive behavior” would land her back in a hospital psychiatric unit.  Judy was disheartened by this cycle of increased medications, problems with nursing home staffs, hospitalizations and transfers.  In the last year of her life, Evelyn spent much of her time drugged, strapped into a chair and calling for help.

Her mother died in 1996, but Judy dreamed of starting a place where people with dementia could get the specialized intensive care her mother had needed.   Industry experts told her it was too expensive to provide this kind of care.  At age 55, single, with little savings and no formal training, she had problems finding startup funds.

New Model of Care

Ignoring these barriers, she sold her house and used the proceeds to start Lakeview Ranch, a residential home in rural Minnesota.  Lakeview Ranch provides specialized dementia care for people who are at high risk of repeated hospitalizations because of behavioral issues.  With the help of experienced healthcare workers, Judy developed The Lakeview Ranch Model of Specialized Dementia Care™.   Rather than relying solely on psychotropic medicines, the Lakeview Ranch model is based on the idea of identifying and meeting the needs of each resident in a home-like atmosphere.   It requires a 1 to 3 staff to resident ratio and a dedicated Registered Nurse to monitor residents and coordinate care with physicians.  

“Most of what others call challenging behavior symptoms -- wandering, sundowning, physical and verbal aggression, etc. -- are brought about by unmet needs, often emotional,” says Judy.   “I have learned that emotional needs such as fear, frustration, anger and grief are often heightened in persons with advancing dementia.  As care partners, we must find the underlying cause of the behavior and meet the individual needs of each person, including their emotional and spiritual needs in addition to their physical needs.”

Music therapist Dayna, resident
Bernice & other residents and staff

One of the tools Lakewood Ranch staff use to help identify the needs of each resident is a detailed written biography.  They work with families to understand the person’s family history, profession, hobbies, habits and lifelong likes and dislikes.   This information can be used as a basis to respond to signs of depression, agitation or aggression – perhaps a resident is refusing to stay in bed at night because he’s always been a night owl, for example. 

Since opening in 1999, Lakeview Ranch has grown to two homes, 30 residents, a staff of 75 and a dedicated group of volunteers.   Day programs and respite care are available for people with dementia living in the surrounding community.   Lakeview Ranch also collaborates with healthcare professionals and universities in the surrounding community.  It is a clinical training site for new Registered Nurses, and provides service learning and internships for high school and college students.  In 2010, Judy’s efforts were recognized on an international level when she received a Robert Wood Johnson Foundation Community Health Leaders Award. 

Donations Needed

Despite that award, and years of successfully caring for residents, things are not easy for Judy.  Lakeview Ranch cares for people with dementia whether or not they can pay the full cost.  For those with no funds, Medicaid helps, but pays only about a third of what this kind of specialized care costs.  A study by researchers at St. Cloud State University showed that overall use of medicines for behavioral issues is reduced by 36 percent for people living at Lakeview Ranch.  For residents with previous psychiatric hospitalizations, 93 percent of them were not hospitalized again after admission to Lakeview Ranch.   Hospitalizations and medicines are expensive, and this data suggests this model of specialized dementia care may reduce the overall cost of care.

 Lakeview Ranch is not compensated for lowering overall costs, and in fact receives less reimbursement from Medicaid and other funding sources if behavioral problems are reduced.  “Unfortunately, the current government payment system -- Medicaid, Medicare, etcetera -- pays much more for symptom treatment  than for the prevention of symptoms that comes with high quality personalized dementia care,” says Judy [more on this in another post].   She started the Dementia Care Foundation to raise funds for facilities that provide care using the Lakeview Ranch Model of Specialized Dementia Care™, but as the economy has worsened, donations are down 60 percent.

You can make a donation to the Dementia Care Foundation online or by mail.  For more detailed information, check out the websites at www.lakeviewranch.com and www.dementiacarefoundation.org, call 1-800-546-5175 (within the U.S.) or email lakeviewranch@yahoo.com. 

 

 

Comments

[Richard Taylor]

Hello, some folks complain while others act. Some folks act (busy) but don't take any personal risks. Judy Berry Acted and Risked her life savings, community reputation, and future in favor of creating LakeView Ranch.

I've been there and witnessed the impact she has on her staff and those they all serve. What they do is amazing. How they do it is amazing. How it impacts them and all they serve is amazing.

Thanks Judy.

[Margaretmassey.wordpress.com]

Great to hear about this amazing place, though sad to hear about their financial struggles when they're a much needed model for the future.

Thank you.

[Bradley H Hoke]

To me this article holds the key to proper patient management. No Doctor can see someone once or twice, have them subtract from a hundred in sevens, draw a clock showing four fifteen, etc., then draw acurate conclusions about their mental state. In my opinion if all physicians followed Judy's practice of obtaining and studying a thorough patient biography FIRST, there would be many less misdiagnoses.