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A Safe Haven in the Carolinas: Eastern Band of Cherokees Create Memory-Care Unit

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For the Eastern Band of Cherokee Indians, located in Cherokee, North Carolina, the soon-to-open memory-care unit of the Tsali Care nursing facility will meet a crucial need, providing tribal members suffering from dementia with a safe environment tailored to them. Indian Country Today Media Network spoke with David Hunt, Tsali Care Center’s administrator, about the project.

What is the status of the memory-care unit?

The construction of the facility is finished and we have all the necessary permits and approvals. What we’re doing now is getting the furnishings in place—beds, wardrobes, nightstands in the residence rooms. We’re outfitting the day room and the dining room, and we’re in hiring staff and training them.

What special precautions do you have to take for this sort of population?

You do have to take some precautions. For instance, there will be no mirrors on the unit. When someone with dementia sees their own reflection it can provoke fear or anger. We don’t want them to have to deal with that. There are no TVs in the rooms, and all the glass is shatterproof. You have to think about every loose item. When it comes to personal items, you have to keep track of anything that can be ingested—shaving cream or shampoo, for instance, has to be locked up when it’s not being used. Other items like razors and silverware must be accounted for and only used when staff is present. In addition it will be a “locked” unit—meaning all the doors are locked with coded magnetic locks. We have a beautiful, landscaped courtyard enclosed in a wooden privacy fence that is simply a few feet higher than what you might have around your house. This is done to ensure that residents don’t wander off unassisted.

What sort of activities will you offer?

We’ll be doing stimulation through touch and sound, stimulating the senses. With a typical elder-care population you can have group activities centered around reminiscing, or you can play Trivial Pursuit or Bingo. Obviously those would not be good activities on a memory care unit.

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Will you be transferring residents from the nursing home to this unit?

No, we don’t foresee any internal transfers to the unit right now. A resident who would qualify for this unit wouldn’t be safe in the nursing home, and would already have been removed. We’ve had to turn away Alzheimer’s patients in the past, and if nursing-home residents have developed dementia we’ve had to transfer them out to memory-care units in other communities.

What sort of special training will the staff of the memory-care unit receive?

First of all, we will have a higher ratio of staff to patients because of the extra supervision they will need. Working with these residents takes more time; it’s not so much a medical model as a custodial one. These residents might not have physical problems, but they need someone there to make sure they are bathed and fed. As the dementia progresses, they may stop eating on their own. You want these residents to maintain their independence as long as they can. It’s about getting them to engage—feeding themselves, or brushing their teeth or their hair. I’m not a medical doctor, but I think of this as the brain being like a muscle, and we’re trying to exercise that muscle as much as we can. The more we can exercise the muscle, the longer it will last.

Will the unit reach full capacity?

Oh, absolutely. There are 12 beds in the facility, and we’ve already got six people waiting to come. We’ll open around the end of January, and I expect we’ll be at full capacity by March or April. We’ve also had a very positive response with regard to staffing, with many of the current Tsali Care Center staff expressing interest in transferring to the memory-care unit.

What other resources will you have at your disposal?

The Alzheimer’s Association has been on board to help with this project from the very beginning, which has been truly amazing. In fact we actually have a branch office of the Alzheimer’s Association right here in Cherokee. The office has been open for almost a year now, and I believe that this is the first time local branch of the Alzheimer’s Association to be located on Tribal land. This has already been a tremendous help with staff training and community awareness.