Thursday June 10^th / Friday June 11th / Monday June 14^th (Cambridge / Boston / Woburn / Salem / Hearthstone Foundation / Cambridge Cohousing):

Weather – mixed / cloudy

On Thursday, Friday and Monday, I spent time with the Hearthstone group of organisations and my visits were hosted by the fantastic Sean Caulfield. The core philosophy of Hearthstone is to utilize non- pharmacological approaches, which aim to improve the quality of life for those living with Alzheimer’s / Dementia and reduce the need for pharmacologic interventions, such as anti-psychotic and anti-anxiety medications. Hearthstone essentially believes that the four predominant behavioural symptoms linked with the disease (agitation, aggression, apathy and anxiety) can be reduced without the use of unnecessary medication. Therefore the external and internal design and architecture of all Hearthstone facilities (including the grounds and gardens) are designed specifically for this aim, as are all care programmes, activities and staff training programmes.

Hearthstone is made up of both a ‘for-profit’ company and a ‘not-for-profit’ arm of which the ‘ARTZ: Artists for Alzheimer’s® project led by Sean is sometimes a part.

The ‘for-profit’ Hearthstone Alzheimer’s Care provides care and assisted living services to older people with Alzheimer’s / Dementia and their carers. This part of the group runs several care facilities in Massachusetts and New York, with affiliates in other parts of the U.S. (New Jersey) as well as internationally (Australia).

The ‘not-for-profit’ Hearthstone Alzheimer’s Foundation focuses on researching and developing care, treatments and interventions which reduce or minimise pharmacological management of sufferers and the care programmes developed within this part of the group are integrated into the work of the group as a whole.

As previously mentioned, my visits with the Hearthstone Alzheimer’s Foundation were hosted by Sean Caulfield who leads the ARTZ programmes.

The ARTZ programme includes the following (all current projects are free to participants and partner organisations due to a three year grant from a local benefactor):

• A project whereby professional artists volunteer their time to work with people with Alzheimer’s / Dementia and their carers. The minimum commitment is one hour per year, however many artists volunteer more time. Artists work with participants in a variety of ways, both as participants and audience members. Activity takes place in a range of community and care settings.
• A project entitled the ‘ARTZ Massachusetts Museum Network, (coordinated by Peggy Cahill), works in partnership with the following museums in the Massachusetts area:
• Peabody Essex Museum in Salem
• Fuller –Craft Museum in Brockton
• Harvard Museum of Natural History in Cambridge
• Decordova Museum and Sculpture Park in Lincoln
• National Heritage Museum in Lexington.
• The ARTZ team work with each of the above museums to develop and design an evolving schedule of facilitated visits for people with Alzheimer’s / Dementia and their carers. Tours happen within each venue once every five weeks. Each tour will involve participants experiencing a pre-selected range of exhibits / artworks or pieces. Works are selected in order to elicit the maximum amount of stimulation, reaction and experiential discourse within each tour group. Tours usually consist of eight participants plus staff and frequently there is more than one tour per venue. The ARTZ team lead the coordination of most project tasks including training with museum staff and volunteers plus recruitment and coordination of tour participants. Tours are planned and led jointly by the ARTZ team and the education teams within each Museum. This model of working has also been developed by ARTZ nationally and internationally with museums and galleries including the Louvre in Paris and the Museum of Modern Art in New York City (MoMA now facilitates its Alzheimer’s program independent of ARTZ). Speaking to Ellen Soares, Education Manager at the Peabody Essex Museum in Salem, I learned more about the practicalities involved in delivering these tours from the perspective of a Museum as well as the benefits to both participants and the museum itself.
• An interactive cinema programme, entitled, ‘Meet Me At The Coolidge...and make memories’ project. The core idea is that ARTZ staff work in partnership with local cinemas (in this case an independent arts cinema in Boston called The Coolidge Corner Theatre and their Foundation). Specially programmed screenings are developed and shown in which short clips from famous old movies are shown to the audience in order to stimulate a reaction and experiential discussion amongst audience members. Discussions are not specific to the movie or to the era and are often discursive based on the history or as-is memory of audience members. It is hoped that this project will be developed further. The program has also been done in collaboration with the Tribeca Film Institute in New York City, with public programs offered in 2007 and 2008. Future showings are currently in development.

During my time with Hearthstone Alzheimer's Care, I spent a day at the 'Hearthstone at New Horizons' care facility in Marlboro Massachusetts and would like to thank their Programme Director Michelle Bioardi and all the residents for being so welcoming and helpful. Hearthstone at New Horizons is what the Americans call an ‘assisted living’ facility in which residents live and are cared-for on-site. (I will clarify further about the differences between this type of facility and what in the UK we would refer to as residential / nursing care in due course before writing my final report). All residents have a diagnosis of some type of Alzheimer’s / Dementia and there are three main care programmes:

• The Cognitive Strengthening Program for people with Mild Cognitive Impairment and Early Dementia – designed to maximise cognitive functioning and ally the onset of the disease through stimulation, learning, exercise, and personal empowerment;
• The Life Quality Program for those in the middle stages of the disease – designed to support people with a developing condition to remain as active and stimulated as appropriate;
• The Enhanced Life Program for late stage dementia and those with dementia compounded by other conditions that require more intensive services.

All care programmes are designed to maximise the participation of all residents in individualised and group activities and stimulation, therefore within each typology mentioned above, activities usually run between 10am and 7pm. There is little or no distinction made between ‘support / care’ and ‘activity’, therefore all staff and management are trained and expected to support and facilitate the delivery of the daily schedule and individual / group activities which include meals. A typical schedule for people within the Cognitive Strengthening Program may therefore include:

· The morning meeting

· Exercise and hydration

· Cooking group

· Computer cafe / internet / email sessions

· Art stroll – there is a painting trail and Art Stroll packs available at each facility

· Lunch

· Book club (facilitated by staff but led by residents themselves - recent books have included “To Kill a Mocking Bird”, “True Compass, the biography of Ted Kennedy”, “The Great Gatsby” etc

· Art sessions

· Snack (prepared by residents each morning)

· Exercise and hydration

· Coffee and life stories

· Bingo

· Dinner

The above programmes have been developed over time following research by Dr Cameron Camp, the Hearthstone Director of Research and New Product Development based on a ‘Montessori-approach’ – building on each person’s abilities and personal choice through procedural learning.

The New Horizons facility and its grounds have been designed to maximise easy orientation and to reduce stress and confusion in order to mediate potential anxiety, agitation, aggression or apathy. Individual care regimes aim to reduce or minimise the use of medications of which the daily schedule mentioned above will form a core part. Residents rooms are filled with their personal possessions and furniture and each room is identifiable due to a life history box (usually a framed photo-montage or collage) on the wall next to their door. The garden has been designed equally to engage residents, maximise their participation and reduce stress / anxiety and includes an intergenerational sensory garden developed with local children and younger people.

I will write more about the Hearthstone philosophy and programmes within my report to Winston Churchill Memorial Trust, suffice to say that I had a fantastic time and learned a great deal.

Hearthstone website: http://www.thehearth.org/index.html

ARTZ website: http://www.artistsforalzheimers.org/index.html

Whilst staying at Cambridge Cohousing, I also learned about the Harvard

Institute for Learning in Retirement which I shall reference further in my final report to WCMT: http://www.hilr.harvard.edu/