Planned assisted living complex will include dementia floor.

The onset of dementia is often subtle and slow.

Caused by a variety of diseases and conditions, most commonly among the elderly, dementia makes affected individuals unpredictable, and their care difficult.

Don Roose, an operator of assisted-living communities on Bainbridge Island, sees the march of dementia force residents out of his facilities as families look for specialized care elsewhere.

“It’s a disturbing process, really,” Roose said. “You’re wanting to take care of these people but you’re realizing your building and staff aren’t equipped to do the job. At a certain point you have to tell (families) that, ‘we can’t take care of your mom or your dad anymore.’”

In an effort to keep more of those specific types of residents on the island, Roose has decided to include 31 dementia-care units in a 47,300–square-foot assisted-living facility planned for Madison Avenue south of the First Baptist Church. Roose is one of three partners developing New Brooklyn Assisted Living, which will be built alongside a planned medical center.

Original plans for the building were for 53 assisted-living units dispersed between the two floors. Roose said the decision was made to dedicate the top floor to dementia care following conversations with his staff.

“I think we made a fairly significant departure from the original intent of this building,” Roose said.

Gayle Helseth-Kenison, a long-term care ombudsman for Kitsap County, said there is already high demand for dementia care in Kitsap, especially on Bainbridge. Many island families seek out dementia services in North Kitsap and beyond, she said.

That said, Helseth-Kenison believes the largest unmet need is for facilities with Medicade and Medicare contracts, a service that won’t be provided in the New Brooklyn facility, which will be private-pay only.

“There is a huge need for dementia care, with the caveat that there is also a need for Medicaid and trained staff,” Helseth-Kenison said.

In the New Brooklyn facility, dementia-care units will be arranged in pods of three to four on the top floor. Residents will have their own bedrooms, but will share activities and meals with other residents from the pod. The dementia floor will be autonomous from the assisted-living section with its own laundry and food preparation facilities.

Roose said both the assisted living and dementia floors will provide larger and more upscale quarters than his other assisted-living facilities. The New Brooklyn center will include an indoor pool and physical therapy center.

While some planned island housing developments are on hold because of the shaky economic climate, Rolf Hogger, one of the New Brooklyn developers, said the market for assisted living is steady. The project could break ground in late 2009.

“This is an existing niche that we feel comfortable in,” Hogger said.

The bulk of dementia care on Bainbridge is offered by Messenger House, a skilled-nursing facility on Skiff Point. Messenger house is starting out fresh this year with a new administration and mostly new staff from one year ago.

The home is currently operating at 80 percent capacity, which is not unusual for the winter season. But administrator Terry Myers said that with the baby-boom generation entering retirement the demand for dementia care will spike in the next decade.

“We’re going to be hitting an all-time high of folks needing dementia care,” she said.

Messenger House has been experiencing a wholesale shift of its own, with the addition of Myers, and nursing director, Mona Jones. When Myers started six months ago, most of the home’s positions were filled by personnel from staffing agencies. Since then there has been a roughly 90 percent turnover, Myers said.

“We’ve been replacing agency people with people who belong to us, so that is a positive change,” Myers said.

Messenger has 96 beds; 49 in a secured wing where patients with more severe dementia are prevented from hurting themselves and others with constant vigilance from staff.

Residents of Messenger House come in equal numbers from homes, hospitals and assisted living facilities, often because they could not receive adequate dementia care where they were living. More than 60 percent of its residents have been diagnosed with Alzheimer’s.

Messenger staff is continually trained in Gentlecare, a form of dementia care that focuses on careful observation of the subtleties of the behavior of each individual and passive, rather than physical responses when possible. Messenger staff try to keep residents engaged and active for as long as possible, Jones said.

“The way we deal with it in this facility is to try to walk in their shoes, and find out what’s going on in their world,” Jones said.

Often that means not confronting a dementia patient with objective reality and instead finding ways to connect with them in the reality they are living.

Helseth-Kenison said she was optimistic about the changes at Messenger House.

“I’m impressed and hopeful,” she said. “I think they’re going to do some innovative things there.”