Troubled minds find a home in Brooklyn Center

The staff at Summit House knows that when 75-year-old Joan Wagener wants some of your candy, you share it or risk getting whacked with a cane -- a move that got her ejected from one nursing home.

When she hooks her thumbs into the top of her slacks, they know to get her to a bathroom pronto so she won't urinate in public -- a problem that cut short her stay at another assisted-living facility.

But life has changed for Joan at Summit House, a 14-bed unit within Prairie Lodge assisted living in Brooklyn Center. Opened in October, it is one of just two assisted-living facilities in Minnesota and a handful nationally that specialize in people with dementia who may become violent.

"After going from crisis to crisis, Joan is finally in a place where they have the time and training to really help," said her husband, Terry, 76, a retired math teacher and businessman from Shoreview. "How many places can you get kicked out of? Let's see, for us it was four in one year."

The combination of dementia and behavioral problems can overwhelm families.

The combination can even overwhelm care facilities, said Annette Peterson, an Alzheimer's Association counselor in Bloomington who talks every day with weary and sometimes frantic family caregivers.

"All nursing homes and many assisted living facilities can deal pretty well with dementia," she said. "But they're just not staffed to handle severe behavioral problems," she said.

When those problems arise -- screaming, biting, kicking, punching and sometimes aggressive sexual behavior -- the resident often is sent to a hospital psychiatric ward. Part of the solution there may be a heavy dose of psychotropic drugs.

Workers at Prairie Lodge used to agonize over discharging residents with violent behavior. Brainstorming with their bosses at Ecumen, the state's largest nonprofit provider of nursing home and senior housing, they designed a different way to care for those residents. When they opened Summit House, Jane was their second resident.

After five months there, her dosage of the antipsychotic drug Seroquel has been halved. She is no longer on the antianxiety drug Ativan.

"Drugs may be a good answer, but it should never be the first answer," said Janelle Meyers, director of Prairie Lodge. "A resident isn't trying to be nasty or disruptive. It's the disease talking. If someone is screaming, they're trying to communicate something. We need to figure out what that is."

Too doped up to walk

Terry was on vacation in Florida last fall when the nursing home his wife was in called. She had grabbed a visitor's cane and hit him when he didn't share his candy.

The staff, after three months of Joan's disruptive behavior, called a halt. They wanted to send her to a hospital psych ward for evaluation -- it would have been her third visit -- "but I refused," Terry said. "The last time, she walked in and left in a wheelchair because she was so doped up. She had to learn how to walk again."

Diagnosed with Alzheimer's disease in 1998, Joan attended a day care program for two years and entered an assisted living facility in 2004. She was there less than a month before her behavior overwhelmed the staff.

"They were all good places, and I understand why they couldn't keep Joan," Terry said. "They have to protect their other residents if somebody's always acting up."

At the last nursing home, workers told Terry about Prairie Lodge, which had just opened Summit House.

"I thought, well, let's try it. Joan already had been kicked out of another nursing home and two assisted living places, and I was really stressed out," he said. "After every visit I'd wonder how long before the next crisis. Sometimes I'd just stand in the middle of my living room and scream."

At Summit House, "Joan is doing so well, it's amazing," he said. She walks slowly, speaks seldom and softly, and when she has too many visitors she may close her eyes to shut them out. She pokes into other residents' rooms, pilfering a book or trinket that later gets put back. "Now she's usually -- not always -- at ease."

But it costs. The monthly fee is $5,500 -- about as much as a nursing home and $1,000 more than Prairie Lodge's other memory care.

With a staff ratio of one to five -- triple what is typical -- "we're very proactive," said Andrea Plankers, a nurse at Summit House. "We get to know residents pretty well so we usually can head off problems before they get out of hand."

In western Hennepin county, Wellstead of Rogers offers similar care to 42 residents in three households.

"People from around the country come here to see what we do, but there are very, very few other places like us or Prairie Lodge," said executive director Arlyce Severson.

"Only a small percentage of people with dementia need this kind of care. But for those few, if we can't provide it, the only other place may be a mental hospital," she said. "Even most nursing homes are not set up to deal with very disruptive or violent behavior. They'd prefer the nice little old grandmother who is confused."

Some peace at last

Like many caregivers, Terry Wagener beats himself up sometimes, thinking of ways he might have kept his wife at home longer.

"I'm just starting to get a life again," he said. "I'm still in my caregiver support group, but I'm beginning to socialize again."

His eyes glistened as he talked of how his wife has changed -- from a homemaker who raised a son and daughter, to a confused and disruptive woman, and now still confused but more often at peace.

"It seems like such a little thing, but I was over there recently and Joan said the first entire sentence in months that made sense to me," he said. "She said, 'You know, I feel so good.'

"And today, at least, so do I."

Warren Wolfe • 612-673-7253