Taking your parents to a retirement home is rarely an easy choice because it can be difficult to cope with their inability to live independently. And for them, this loss of independence and their sudden passage into community life can be a source of frustration and confusion.
Add dementia, and this can give way to aggressive behavior and violence.
The Sherbrooke Community Center in Saskatoon is part of a very short list of institutions studied and cited by the Alzheimer Society as having an approach that emphasizes the maintenance of independence.
And that answers, even when this independence increases the risk of injury.
"Traditionally, the philosophies used in long-term care were rather patriarchal, we say know what is best for you," said Suellen Beatty, long-time CEO of the Sherbrooke Community Center.
"But the bulk of the suffering of the frail or disabled is really due to a discomfort of the mind, loneliness, helplessness and boredom."
Sherbrooke CEO Suellen Beatty said that she considered some risks acceptable if she guaranteed greater personal freedom to elderly residents. (Dave MacIntosh / CBC)
Sylvia, one of the residents of the house, is a good example. Living with an advanced form of dementia, she still has energy and even the desire to dance in the hallways from time to time. But she also has a history of falling.
In some long-term care homes, she would be confined to her room to reduce the risk of injury. Other houses could calm her down. In short, to prevent it from falling, she would be discouraged to stand up.
Sherbrooke adopts the opposite approach.
"Let them lead their lives according to how they want to live," said May Abigania, Sylvia's nurse.
Emma may be the only dog in Sherbrooke, but it's not the only one. Many cats and birds live in the facility, all of which are part of the effort to make it a home. (David Common / CBC)
This approach extends beyond locked floors of dementia or "neighborhoods," as the Sherbrooke employees call them. Residents retain considerable control over their own lives: when to wake up, when to take a shower, to have a pet (there are many), what activities to participate in and if to go out alone.
Older people residing in the facility can dine in a large cafeteria, often in small groups. Family kitchens are also fitted out in the living areas, and staff have leeway to offer guests a favorite food from dozens of residents living in the rooms that surround them.
"Everything is a matter of choice here," says Kari Prodahl, a continuing care aide, as she prepares pizzas and salads for a small group of residents. "What makes things easy, because it's a family atmosphere."
Caregiver Kari Prodahl serves pizzas and salad at a regular table in their ordinary kitchen. The meals are not big meals, but rather meetings of nine to ten people with a staff member who knows them well and who often prepares meals. (David Common / CBC)
Sherbrooke is not a millionaire club. This residence of 263 residents receiving public support receives funding comparable to that of many facilities for the elderly in Canada. There are not more staff than others.
This is also not immune to problems.
Inter-resident violence, which is increasingly prevalent in nursing homes in Canada among confused and vulnerable seniors, remains a factor in the institution. And the risks associated with greater freedom can have serious consequences.
Howard Hrehirchuk's family was dismayed, for example, when he was able to wander outside in winter, early one morning of last October. They also complained to the health center and the Saskatchewan Health Authority that the old man with dementia had dropped more than 17 times in six months. They insist that he should never have been able to leave his locked floor.
Hrehirchuk has a bed alarm that goes off when an infrared barrier is breached. His daughter says that the health house sometimes closes it.
Sherbrooke responded by saying that the care home would do it sometimes if the alarm was not the best option to monitor someone.
Beatty says that she knows that Sherbrooke is not a utopia.
"We live the real life here and it's hard," adding that those who come to Sherbrooke are already at a point where living independently is no longer possible.
The Sherbrooke Community Center in Saskatoon is organized in "neighborhoods" to attract more residents. (Melissa Mancini / CBC)
And yet, many residents and their families are fans of the approach.
Federal Seniors Minister Filomena Tassi visited Sherbrooke in September. It has been celebrated to allow residents to have greater flexibility in what they do – like when and what they eat – and have interesting activities to do every day.
Some new employees are uncomfortable and there are workers leaving. Others have remained for decades, convinced that the operation of the facility offers its residents a good combination of care and independence.
The next phase of Beatty's plan involves desegregation. She would like to move the walls between residents with dementia and those who do not have dementia.
Tuesday night is the evening wine club. The residents of Sherbrooke gather to make wine and have a drink of what they have done the previous weeks. It's one of the most popular activities at the community home. (Melissa Mancini / CBC)
Those who are confused can become even more so when they are surrounded by other people with dementia. Beatty therefore argues that the integration of the elderly population with and without dementia into the home will allow a more balanced life for all.
Resident Alice Cowell could be the pioneer of this new approach. Although she does not suffer from dementia, she chooses to live on a floor with those who suffer from it. She sees a common goal: to help and be helped.
"I think they're just people who are nice to them and treat them like ordinary people – you know, like they're good people."