/Users/andrea/_magisterarbeit/korpus/clean/trainkorpus/34/file_260b.html NN ----------------------------------------- : Chapter NP 5 CD Dementia NN Facilities NP Charles NP Silverman NP , , AIA NP Good NP afternoon NN . SENT Today NP I'd NP like VVP to TO share VV with IN you PP an DT experience NN I PP had VHD about RB six CD years NNS ago RB developing VVG a DT dementia NN facility NN . SENT But CC before IN I PP do VVP that IN I PP want VVP to TO reinforce VV something NN that IN Mrs NN . SENT Noell NP said VVD a DT few JJ minutes NNS ago RB , , and CC that DT is VBZ , , that IN changes NNS come VVN with IN aging VVG . SENT The DT following VVG are VBP some DT of IN the DT physical JJ and CC chemical JJ changes NNS that WDT occur VVP in IN the DT aging VVG process NN . SENT tissue NN loss NN , , that's NNS lean VVP body NN loss NN . SENT loss NN of IN bone NN mass NN . SENT loss NN of IN joint JJ elasticity NN . SENT loss NN of IN sweat NN gland NN functions NNS . SENT loss NN in IN renal JJ systems NNS . SENT and CC loss NN in IN lung NN capacity NN . SENT And CC in IN sensory JJ loss NN there EX is VBZ loss NN in IN taste NN , , loss NN in IN touch NN , , loss NN in IN sight NN , , in IN smell NN and CC in IN hearing NN . SENT In IN chemical JJ loss NN there's NNS loss NN of IN water NN content NN , , loss NN of IN oxygen NN to TO tissues NNS , , loss NN in IN digestion NN , , and CC in IN hormonal JJ and CC immune JJ systems NNS . SENT I PP wanted VVD to TO emphasize VV some DT of IN these DT things NNS because IN they're NN very RB important JJ in IN determining VVG how WRB to TO develop VV a DT dementia NN unit NN . SENT These DT losses NNS make VVP themselves PP known VVN in IN several JJ ways NNS . SENT For IN example NN , , the DT loss NN of IN water NN content NN in IN tissues NNS requires VVZ a DT large JJ intake NN of IN fluids NNS . SENT At IN the DT same JJ time NN the DT loss NN of IN muscle NN in IN the DT bladder NN and CC kidneys NNS , , compounded VVN by IN kidney NN failure NN , , causes VVZ a DT higher JJR frequency NN of IN incontinence NN . SENT Hearing NN loss NN , , which WDT is VBZ fascinating JJ to TO me PP because IN I've NP begun VVN to TO suffer VV from IN hearing NN loss NN in IN the DT last JJ five CD years NNS , , is VBZ exhibited VVN in IN the DT psycho JJ acoustics NN of IN speech NN . SENT Modern JJ language NN developed VVN with IN vowels NNS providing VVG an DT emphasis NN for IN speech NN so RB that IN when WRB you PP say VVP , , no UH , , no UH . SENT . SENT . SENT . SENT . SENT , , No UH . SENT you PP hear VVP the DT emphasis NN on IN that DT word NN . SENT the DT emphasis NN provides VVZ you PP with IN some DT contextual JJ meaning NN . SENT Consonants NNS , , on IN the DT other JJ hand NN , , provide VV information NN , , and CC it's NNS their PP$ high JJ frequency NN sound NN that WDT usually RB is VBZ associated VVN with IN old JJ age NN . SENT These DT consonants NNS and CC their PP$ high JJ frequency NN sound NN cannot NN be VB heard VVN in IN a DT nerve NN damaged JJ ear NN . SENT Thus RB , , when WRB you PP ask VVP a DT question NN of IN a DT person NN who WP is VBZ hard JJ of IN hearing NN , , Do VVP you PP have VHP a DT dime NN . SENT the DT answer NN my PP$ be VB , , Yes UH , , it's NP 10 CD . SENT 30 CD . SENT So RB , , you PP have VHP to TO always RB pay VV attention NN to TO these DT issues NNS . SENT These DT are VBP examples NNS of IN issues NNS to TO consider VV when WRB developing VVG a DT suitable JJ environment NN for IN the DT elderly JJ and CC especially RB dementia NN patients NNS . SENT By IN the DT way NN , , there's RB one CD thing NN I PP do VVP take VV objection NN to TO , , that IN Mrs NN . SENT Noell NP showed VVD . SENT She PP spoke VVD about IN soft JJ seats NNS and CC low JJ sets NNS and CC seats NNS that WDT are VBP not RB firm JJ . SENT I PP would MD venture VV to TO say VV that IN with IN dementia NN patients NNS , , with IN whom WP a DT large JJ amount NN of IN restraints NNS often RB are VBP used VVN , , it PP is VBZ better JJR to TO use VV seats NNS that WDT are VBP too RB soft JJ and CC too RB low JJ . SENT Like IN a DT bean NN bag NN sofa NN which WDT looks VVZ better RBR . SENT you PP don't VVD have VH to TO restrain VV the DT patient NN but CC rather RB you PP make VVP it PP more RBR difficult JJ for IN him PP her PP to IN get VV up RP . SENT This DT is VBZ food NN for IN thought NN , , but CC it PP is VBZ an DT area NN where WRB you PP have VHP to TO digress VV and CC take VV what WP is VBZ not RB the DT causal JJ and CC usual JJ , , and CC look VVP at IN what WP is VBZ different JJ . SENT Six CD years NNS ago RB , , in IN May NP of IN 1989 CD , , I PP was VBD fortunate JJ to TO participate VV in IN a DT workshop NN developed VVN by IN the DT Massachusetts NP Alzheimer's NP Disease NP Research NP Center NP . SENT It PP was VBD sponsored VVN by IN Massachusetts NP General NP Hospital NP , , Harvard NP Medical NP School NP , , and CC the DT Massachusetts NP Institute NP of IN Technology NP . SENT The DT workshop NN was VBD entitled VVN , , oddly RB enough RB , , Blueprint NN for IN a DT Specialized NP Alzheimer's NP Disease NP Nursing NP Home NP Care NP Program NP . SENT That's NP a DT mouthful NN but CC it PP was VBD a DT very RB intense JJ session NN . SENT Its PP$ goal NN was VBD to TO develop VV a DT flexible JJ concept NN for IN creating VVG a DT research NN center NN to TO allow VV exploration NN into IN innovative JJ methods NNS and CC models NNS that WDT would MD extend VV our PP$ knowledge NN of IN care NN . SENT There EX were VBD 13 CD of IN us PP . SENT there EX were VBD researchers NNS , , doctors NNS , , environmental JJ psychologists NNS , , administrators NNS , , health NN care NN providers NNS , , and CC of IN course NN architects NNS . SENT We PP grappled VVD with IN issues NNS ranging VVG from IN ethical JJ considerations NNS of IN care NN to TO preventing VVG staff NN burnout NNS . SENT Staff NN burnout NNS is VBZ an DT item NN that WDT often RB is VBZ overlooked VVN in IN discussing VVG design NN and CC is VBZ very RB , , very RB important JJ . SENT This DT approach NN was VBD not RB unlike IN what WP Dr NP . SENT Syme NP described VVD , , in IN his PP$ tribute NN to TO Roz NP Lindheim NP yesterday NN at IN lunch NN . SENT One CD thing NN was VBD clear JJ then RB , , and CC it PP still RB holds VVZ true JJ today NN . SENT there EX is VBZ insufficient JJ evidence NN to TO support VV definitive JJ standards NNS on IN quality NN of IN care NN for IN dementia NN patients NNS . SENT The DT fact NN is VBZ that IN what WP we PP did VVD see VV were VBD different JJ approaches NNS to TO the DT quality NN of IN care NN by IN groups NNS of IN caregivers NNS . SENT In IN noting VVG the DT successes NNS and CC the DT failures NNS it PP became VVD apparent JJ that IN there EX were VBD difficulties NNS in IN developing VVG data NNS that WDT clearly RB demonstrated VVD what WP works VVZ and CC what WP doesn't NN . SENT The DT bottom JJ line NN was VBD the DT lack NN of IN a DT standardization NN of IN concepts NNS and CC approaches NNS , , further RBR compounded VVN by IN the DT challenges NNS faced VVN in IN research NN and CC corresponding JJ ethical JJ dilemmas NNS . SENT The DT knowledge NN we PP have VHP about IN Alzheimer's NP disease NN is VBZ primarily RB the DT result NN of IN experimental JJ learning NN , , organized VVN and CC interpreted VVN by IN trained JJ observers NNS . SENT And CC that's NNS all RB we PP have VHP today NN in IN the DT area NN of IN research NN . SENT There EX really RB isn't JJ anything NN definitive JJ developed VVN in IN the DT last JJ six CD years NNS , , in IN fact NN , , in IN the DT last JJ ten CD years NNS . SENT From IN this DT we PP concluded VVD that IN there EX is VBZ no DT one NN correct JJ , , or CC even RB best JJS , , approach VV to TO patient JJ care NN . SENT What WP did VVD emerge VV was VBD the DT need NN for IN a DT philosophy NN of IN care NN with IN clear JJ programmatic JJ goals NNS and CC consistent JJ application NN as IN it PP relates VVZ to TO patient NN , , family NN , , and CC staff NN needs NNS . SENT Now RB , , the DT recommendations NNS may MD apply VV to TO the DT care NN of IN all DT patients NNS with IN chronic JJ progressive JJ dementia NN and CC , , for IN purposes NNS of IN this DT discussion NN , , Alzheimer's NP disease NN and CC dementia NN are VBP used VVN interchangeably RB . SENT At IN first JJ our PP$ group NN strongly RB believed VVD that IN all DT patients NNS should MD go VV through IN a DT diagnostic JJ process NN to TO rule VV out RP treatable JJ forms NNS of IN dementia NN since IN this DT will MD have VH implications NNS for IN the DT patient's JJ treatment NN and CC care NN and CC goals NNS . SENT The DT philosophy NN of IN care NN that IN we PP developed VVD was VBD simply RB this DT . SENT we PP differentiated VVD the DT concepts NNS of IN palliative JJ and CC rehabilitative JJ care NN . SENT Palliative JJ care NN , , which WDT is VBZ my PP$ primary JJ focus NN here RB , , minimizes VVZ stress NN that WDT will MD eventually RB lead VV to TO behavioral JJ acting VVG out RP . SENT This DT is VBZ accomplished VVN by IN a DT management NN of IN problem NN behavior NN and CC from IN the DT perspective NN of IN the DT environment NN , , reducing VVG negative JJ stimulation NN . SENT Rehabilitative JJ approaches NNS , , on IN the DT other JJ hand NN , , focus NN on IN improving VVG the DT patient's JJ functionality NN by IN minimizing VVG disabilities NNS attributable JJ to TO life NN history NN , , environment NN , , personality NN variables NNS , , and CC emotional JJ responses NNS . SENT Now RB , , while IN both DT approaches NNS are VBP needed VVN for IN an DT overall JJ integrated JJ program NN , , we PP were VBD in IN general JJ agreement NN that IN rehabilitative JJ care NN was VBD better RBR emphasized VVN for IN the DT early JJ and CC mid JJ stages NNS of IN a DT patient's JJ development NN . SENT One CD thing NN I'd NN like VVP to TO go VV back RB to TO , , in IN terms NNS of IN reemphasizing VVG what WP happens VVZ in IN rehabilitative JJ care NN , , is VBZ a DT paper NN I PP gave VVD on IN the DT elderly JJ in IN a DT prison NN environment NN . SENT Interesting JJ . SENT I'd JJ like VVP to TO digress VV here RB , , just RB for IN a DT moment NN , , to TO discuss VV what WP we PP discovered VVD in IN aging VVG populations NNS in IN prisons NNS . SENT Genetics NP , , socio NP economic JJ conditions NNS , , lifestyle NN , , mental JJ health NN , , and CC access NN to TO social JJ and CC medical JJ services NNS all RB contribute VVP to TO the DT rate NN at IN which WDT aging NN accelerates VVZ . SENT In IN this DT you PP can MD see VV that DT rehabilitative JJ care NN really RB has VHZ to TO do VV with IN a DT person's JJ lifestyle NN . SENT As IN people NNS go VVP through IN the DT various JJ stages NNS of IN dementia NN there EX is VBZ a DT need NN to TO modify VV their PP$ program NN . SENT The DT goals NNS that IN we PP set VVD up RP were VBD very RB simple JJ . SENT The DT bottom JJ line NN was VBD to TO achieve VV an DT optimal JJ quality NN of IN life NN . SENT That DT was VBD the DT overall JJ goal NN . SENT The DT group NN then RB reached VVN consensus NN on IN the DT following VVG goals NNS which WDT supported VVD this DT overall JJ goal NN . SENT To TO ensure VV that IN the DT quality NN of IN care NN is VBZ patient NN centered VVN . SENT To TO provide VV safety NN and CC security NN , , and CC comfort NN and CC emotional JJ support NN . SENT To TO permit VV reasonable JJ privacy NN . SENT To TO provide VV access NN to TO appropriate JJ activities NNS and CC to TO medical JJ care NN . SENT To TO provide VV ongoing JJ assessment NN of IN functional JJ , , medical JJ and CC psychiatric JJ status NN . SENT To TO make VV appropriate JJ modifications NNS in IN the DT individual's JJ care NN plan NN . SENT Behavioral JJ management NN is VBZ the DT next JJ issue NN . SENT Before IN I PP get VVP into IN showing VVG some DT of IN these DT overheads NN , , I PP want VVP to TO talk VV about IN a DT number NN of IN things NNS to TO make VV it PP clear JJ in IN your PP$ minds NNS what WP we PP were VBD trying VVG to TO achieve VV . SENT The DT biggest JJS challenge NN in IN providing VVG care NN and CC managing VVG problem NN behavior NN is VBZ recognizing VVG that DT behaviors NNS vary VVP and CC change VVP significantly RB during IN the DT progressive JJ stages NNS of IN Alzheimer's NP disease NN . SENT However RB , , behavior NN is VBZ also RB a DT form NN of IN communication NN . SENT when WRB you PP lose VVP cognitive JJ control NN , , and CC the DT ability NN to TO write VV or CC to TO talk VV , , then RB behavioral JJ acting VVG out RB is VBZ the DT only JJ way NN to TO express VV your PP$ feelings NNS . SENT In IN acting VVG out RP , , the DT person NN may MD be VB expressing VVG pain NN , , hunger NN or CC emotional JJ distress NN . SENT The DT common JJ behavioral JJ problems NNS that WDT were VBD exhibited VVN were VBD wandering VVG , , agitation NN , , depression NN , , aggression NN , , rummaging VVG , , apathy NN , , withdrawal NN , , sundowning VVG I'll NP explain VV that DT later RBR , , inappropriate JJ sexual JJ behavior NN , , and CC catastrophic JJ reactions NNS . SENT Not RB all RB of IN these DT behaviors NNS are VBP problems NNS in IN themselves PP . SENT For IN example NN , , wandering VVG could MD be VB one CD patient's NNS means VVZ of IN releasing VVG excess JJ energy NN while IN for IN another DT it PP could MD lead VV to TO agitation NN and CC should MD be VB discouraged VVN . SENT These DT behaviors NNS also RB can MD be VB more JJR of IN a DT problem NN for IN other JJ patients NNS than IN for IN the DT patient NN exhibiting VVG them PP . SENT In IN fact NN , , what WP you PP usually RB find VVP is VBZ that IN within IN an DT institution NN some DT patients NNS can't NN live VVP with IN other JJ patients NNS . SENT they PP can't VVD perform VV within IN their PP$ environment NN . SENT There EX are VBP many JJ different JJ problems NNS one PP comes VVZ across IN within IN the DT geriatric JJ community NN , , especially RB in IN relation NN to TO dementia NN . SENT In IN environmental JJ management NN , , while IN our PP$ group NN discussed VVD behavioral JJ interventionsdaily NN routines NNS , , toileting NN activities NNS , , etc FW . SENT we PP focused VVD on IN a DT holistic JJ approach NN recognizing VVG that IN every DT area NN of IN patient JJ management NN and CC provision NN of IN care NN was VBD essential JJ to TO the DT goals NNS we PP had VHD set VVN forth RB . SENT But CC we PP were VBD convinced VVN that IN the DT physical JJ environment NN was VBD important JJ to TO the DT quality NN of IN care NN of IN dementia NN patients NNS . SENT Environmental JJ management NN techniques NNS can MD promote VV safety NN and CC enhance VV a DT feeling NN of IN security NN and CC emotional JJ well NN being VBG . SENT When WRB we PP are VBP able JJ to TO minimize VV the DT challenges NNS that IN a DT cognitively RB impaired VVN patient NN faces NNS and CC reduce VV environmental JJ distractions NNS , , the DT patient NN will MD have VH more JJR energy NN to TO direct VV towards IN his PP$ her PP$ cognitive JJ functions NNS . SENT Also RB I PP believe VVP personally RB , , that IN we PP can MD remove VV environmental JJ constraints NNS . SENT this DT will MD allow VV staff NN to TO function VV more RBR efficiently RB in IN carrying VVG out RP their PP$ mission NN , , and CC in IN promoting VVG an DT environment NN to TO reduce VV staff NN burnout NNS . SENT The DT key NN to TO environmental JJ management NN is VBZ to TO control VV stimulation NN . SENT This DT does VVZ not RB mean VV to TO eliminate VV stimulationyou NN can't NN eliminate VV all DT of IN it PP and CC , , in IN fact NN , , some DT of IN it PP is VBZ goodbut NN , , rather RB , , to TO reduce VV the DT negative JJ effects NNS of IN stimulation NN while IN providing VVG appropriate JJ , , positive JJ stimulation NN to TO enhance VV the DT patient's JJ optimal JJ functioning NN . SENT For IN example NN , , a DT TV NN set NN turned VVD on IN during IN mealtime NN , , or CC a DT heavily RB patterned VVN tablecloth NN which WDT has VHZ a DT lot NN of IN distractions NNS on IN it PP , , can MD inhibit VV a DT patient's JJ ability NN to TO concentrate VV on IN eating VVG . SENT Loud JJ noises NNS , , like IN intercoms NNS , , can MD frighten VV a DT patient NN and CC contribute VV to TO unacceptable JJ behavior NN . SENT Someone NN in IN our PP$ group NN suggested VVD the DT phrase NN , , prosthetic JJ environments NNS . SENT This DT was VBD based VVN on IN a DT experience NN similar JJ to TO one CD I PP encountered VVD at IN the DT Hebrew JJ Home NN for IN the DT Aged's NP Alzheimer's NP unit NN in IN the DT mid JJ seventies NNS . SENT In IN converting VVG the DT health NN related JJ facility NN into IN an DT Alzheimer's NP unit NN we PP were VBD seeking VVG visual JJ clues NNS and CC color NN coding VVG to TO help VV compensate VV the DT patient's JJ cognitive JJ deficits NNS . SENT This DT was VBD an DT existing JJ facility NN , , and CC we PP really RB weren't NN spending VVG very RB much JJ money NN on IN it PP , , but CC what WP we PP did VVD was VBD change VV things NNS around RP like IN lowering VVG the DT nursing NN station NN , , cutting VVG off RP the DT top JJ half NN , , so RB it PP was VBD more JJR user NN friendly JJ . SENT Meeting VVG the DT prospective JJ residents NNS was VBD helpful JJ . SENT we PP discovered VVD that IN one CD gentleman NN , , for IN example NN , , was VBD an DT avid JJ card NN player NN in IN his PP$ lifetime NN and CC one CD woman NN was VBD a DT talented JJ pianist NN until IN Alzheimer's NP disease NN impaired VVN her PP$ abilities NNS . SENT So RB as IN symbols NNS of IN their PP$ lives NNS , , we PP painted VVD a DT royal JJ flush JJ and CC a DT keyboard NN with IN musical JJ symbols NNS on IN their PP$ respective JJ doors NNS rather RB than IN door NN numbers NNS which WDT can MD be VB confusing JJ to TO the DT cognitively RB impaired VVN . SENT Color NN coding VVG of IN bedrooms NNS and CC common JJ areas NNS is VBZ helpful JJ to TO the DT residents NNS in IN finding VVG one's JJ way NN . SENT However RB , , wall NN coverings NNS and CC fabrics NNS with IN prints NNS sometimes RB can MD be VB confusing JJ to TO the DT cognitively RB impaired VVN . SENT Striped JJ carpeting NN can MD be VB perceived VVN as IN a DT tripping VVG hazard NN . SENT this DT also RB is VBZ true JJ for IN non JJ cognitively NN impared VVD older JJR people NNS who WP have VHP diminished VVN depth NN perception NN . SENT We PP went VVD around RP in IN circles NNS on IN color NN choices NNS . SENT we PP didn't VVD agree VV on IN them PP . SENT they PP ranged VVD from IN bright JJ to TO soft RB muted JJ . SENT However RB we PP did VVD agree VV that DT color NN was VBD essential JJ in IN distinguishing VVG and CC locating VVG spaces NNS . SENT We PP also RB agreed VVD that IN an DT optimal JJ size NN for IN an DT Alzheimer's NP unit NN was VBD between IN 20 CD and CC 25 CD residents NNS in IN a DT self NN contained VVD area NN . SENT It PP was VBD noted VVN that IN larger JJR units NNS made VVD observation NN of IN patients NNS by IN staff NN more RBR difficult JJ . SENT Also RB the DT greater JJR the DT number NN of IN patients NNS , , the DT higher JJR the DT agitation NN level NN . SENT There EX was VBD a DT greater JJR propensity NN to TO use VV chemical NN restraints NNS in IN large JJ units NNS and CC the DT incidence NN of IN falling VVG increased VVN . SENT But CC we PP did VVD not RB reach VV a DT conclusion NN about IN the DT optimal JJ number NN of IN patients NNS in IN a DT bedroom NN . SENT Some DT administrators NNS suggested VVD that IN two CD residents NNS in IN a DT room NN was VBD ideal JJ . SENT However RB , , some DT patients NNS cannot NN tolerate VV a DT roommate NN and CC others NNS derive VV comfort NN and CC security NN from IN sharing NN . SENT The DT ultimate JJ goal NN of IN all PDT these DT discussions NNS was VBD to TO design VV a DT specialized JJ Alzheimer's NP disease NN nursing NN home NN that WDT would MD be VB a DT model NN for IN continuing VVG research NN in IN the DT area NN of IN dementia NN . SENT By IN the DT way NN , , let VVD me PP say VVP that IN they PP never RB built VVD this DT facility NN but CC it PP was VBD worthy JJ of IN the DT try NN , , I PP must MD admit VV . SENT Although IN we PP didn't VVD quite RB arrive VV at IN a DT design NN , , in IN the DT days NNS remaining VVG for IN the DT workshop NN , , we PP were VBD able JJ to TO develop VV concepts NNS that WDT provided VVD possible JJ solutions NNS . SENT As IN designers NNS we PP were VBD faced VVN with IN creating VVG what WP Hall NP , , Kurshling NP and CC Todd NP refer VVP to TO as RB sheltered JJ freedom NN which WDT allows VVZ residents NNS a DT degree NN of IN freedom NN and CC dignity NN within IN the DT bounds NNS of IN a DT safe JJ and CC protective JJ environment NN . SENT I PP really RB think VVP that DT is VBZ probably RB the DT essence NN of IN all DT of IN this DT , , to TO provide VV freedom NN and CC dignity NN . SENT We PP knew VVD that IN in IN Alzheimer's NP disease NN , , or CC any DT kind NN of IN progressive JJ cognitive JJ chronic JJ disease NN , , there EX is VBZ a DT point NN at IN which WDT quality NN of IN care NN for IN the DT patient NN becomes VVZ meaningful JJ because IN of IN severe JJ cognitive JJ disability NN . SENT However RB , , we PP felt VVD that DT dignity NN of IN life NN , , and CC the DT maintenance NN of IN that DT dignity NN , , was VBD still RB very RB important JJ . SENT At IN the DT Riverside NP Nursing NP Home NP in IN the DT Bronx NP , , where WRB I PP was VBD involved VVN with IN the DT design NN , , we PP created VVD the DT concept NN of IN front JJ stoops NNS where WRB residents NNS could MD sit VV and CC watch VV the DT day's JJ activities NNS . SENT While IN this DT appears VVZ to TO be VB a DT passive JJ activity NN , , the DT concept NN was VBD to TO encourage VV participation NN and CC communication NN with IN staff NN and CC passersby NNS . SENT We PP discovered VVD that IN certain JJ corridors NNS , , having VHG a DT high JJ degree NN of IN staff NN activity NN , , were VBD aptly RB named VVN Fifth NP Avenue NP and CC Times NP Square NP by IN residents NNS and CC the DT staff NN alike RB . SENT We PP realized VVD then RB that IN by IN an DT accident NN of IN design NN we PP had VHD developed VVN a DT main JJ street NN and CC town NN square NN where WRB residents NNS could MD enjoy VV the DT community NN with IN others NNS . SENT Thus RB in IN our PP$ workshop NN we PP looked VVD at IN the DT concept NN of IN a DT nursing NN home NN as IN a DT small JJ community NN with IN residential JJ households NNS which WDT were VBD resident NN rooms NNS . SENT and CC with IN neighborhoods NNS which WDT were VBD resident NN wings NNS of IN 20 CD 24 CD beds NNS , , and CC with IN main JJ street NN activity NN centers NNS . SENT Let VV me PP show VV you PP some DT of IN the DT ideas NNS that IN we PP came VVD up RP with IN . SENT Here RB we PP were VBD able JJ to TO provide VV , , you PP can MD see VV here RB , , six CD bedrooms NNS . SENT There EX could MD be VB five CD , , there EX could MD be VB four CD . SENT There EX could MD be VB , , certainly RB , , a DT lot NN less RBR but CC in IN this DT macro NN cluster NN we PP were VBD providing VVG a DT living VVG front NN porch NN , , staff NN kitchenette NN , , dining VVG areas NNS , , decentralized JJ utilities NNS , , bathrooms NNS , , and CC basically RB a DT wandering VVG pattern NN all RB around RB here RB so RB that IN people NNS could MD wander VV or CC , , in IN the DT evening NN , , sun NN down RB . SENT This DT was VBD the DT beginning NN concept NN which WDT gave VVD us PP this DT residential JJ housing NN cluster NN . SENT We PP then RB followed VVD with IN an DT idea NN whereby WRB these DT four CD to TO six CD bed NN clusters NNS were VBD all RB surrounding VVG a DT staff NN activity NN , , an DT outdoor JJ activity NN area NN and CC a DT path NN which WDT allowed VVD wandering VVG through IN these DT areas NNS , , coming VVG back RB again RB to TO the DT same JJ door NN where WRB they PP entered VVD . SENT There EX were VBD non JJ poisonous JJ shrubs NNS and CC other JJ foliage NN around IN there RB . SENT Then RB there EX was VBD a DT primary JJ circulation NN pattern NN which WDT was VBD called VVN Main NP Street NP . SENT So RB , , you PP had VHD the DT four CD to TO six CD bed NN cluster NN and CC , , if IN you PP recall VVP , , it PP had VHD dining NN and CC activities NNS . SENT And CC then RB bring VV this DT up RP to TO a DT whole JJ series NN of IN stages NNS where WRB we PP now RB have VH staff NN activities NNS and CC support NN . SENT And CC then RB , , finally RB , , to TO the DT macro NN of IN what WP could MD be VB done VVN at IN this DT facility NN . SENT Also RB , , it's NNS important JJ to TO remember VV that IN this DT was VBD going VVG to TO be VB a DT fairly RB large JJ facility NN . SENT it PP wasn't VVD our PP$ ideal NN of IN 24 CD beds NNS but CC many JJ more JJR . SENT There's RB the DT outdoor JJ area NN where WRB they PP can MD wander VV through RP and CC circulate VV and CC then RB right RB through IN here RB was VBD a DT main JJ street NN with IN service NN support NN . SENT And CC in IN the DT main JJ street NN we PP could MD have VH an DT ice NN cream NN parlor NN . SENT Don't NP forget VVP that IN in IN Alzheimer's NP , , or CC progressive JJ stages NNS of IN chronic JJ dementia NN , , there EX are VBP periods NNS of IN lucidity NN . SENT There EX are VBP periods NNS where WRB people NNS have VHP cognitive JJ control NN . SENT Therefore RB we PP felt VVD that IN a DT lot NN could MD be VB provided VVN within IN an DT institution NN . SENT In IN fact NN in IN Massachusetts NP where WRB we PP did VVD this DT , , this DT was VBD in IN Boston NP , , they PP even RB have VHP a DT tavern NN because IN in IN Massachusetts NP the DT residents NNS are VBP allowed VVN a DT medicinal JJ tot NN of IN a DT drink NN . SENT They PP can MD have VH scotch NN , , beer NN , , whatever WDT they PP like VVP . SENT We PP talked VVD about IN the DT clinic's JJ activities NNS , , aquariums NNS , , zoo NN when WRB I PP say VVP zoo NN I PP mean VVP domestic JJ animals NNS , , these DT are VBP not RB wild JJ animals NNS , , aviary NN . SENT In IN Riverdale NP we PP were VBD able JJ to TO build VV a DT very RB large JJ cage NN and CC a DT very RB large JJ aquarium NN for IN fish NN and CC for IN birds NNS . SENT In IN fact NN , , we PP had VHD a DT problem NN in IN the DT beginning NN because IN the DT birds NNS were VBD getting VVG pulmonary JJ pneumonia NN and CC dying VVG on IN us PP . SENT We PP found VVD out IN they PP were VBD put VVN in IN a DT path NN where WRB there EX was VBD a DT draft NN . SENT We PP took VVD care NN of IN that WDT very RB quickly RB . SENT There EX was VBD a DT nursery NN . SENT there EX were VBD gardens NNS and CC dance NN halls NNS . SENT So RB you PP can MD see VV this DT was VBD the DT concept NN that IN we PP were VBD trying VVG to TO provide VV that WDT would MD help VV us PP in IN what WP we PP envisioned VVN . SENT It PP also RB was VBD envisioned VVN that IN each DT residential JJ household NN cluster NN would MD be VB a DT research NN center NN for IN discovering VVG what WP works VVZ , , measuring VVG it PP against IN the DT results NNS of IN other JJ clusters NNS . SENT So RB one CD cluster NN might MD have VH more JJR people NNS with IN advanced JJ Alzheimer's NP or CC other JJ diseases NNS and CC others NNS would MD have VH people NNS with IN less JJR advanced JJ diseases NNS . SENT The DT clusters NNS would MD allow VV for IN congregating VVG residents NNS in IN various JJ stages NNS of IN dementia NN and CC with IN varying VVG ability NN to TO perform VV activities NNS . SENT Most RBS important JJ , , we PP saw VVD this DT idea NN as IN a DT means NN of IN deinstitutionalizing VVG the DT nursing NN home NN and CC of IN providing VVG an DT environment NN that IN encouraged JJ participation NN and CC activity NN . SENT We PP believed VVD , , too RB , , that IN the DT smaller JJR more JJR manageable JJ units NNS allowed VVD better JJR help NN by IN staff NN and CC afforded VVN a DT higher JJR , , more RBR individualized VVN quality NN of IN care NN , , possibly RB reducing VVG staff NN burnout NNS . SENT And CC , , finally RB , , we PP believed VVD that IN the DT feeling NN of IN a DT normative JJ community NN in IN a DT non JJ institutional JJ setting NN would MD encourage VV friends NNS and CC family NN to TO visit VV , , further RBR enhancing VVG the DT residents NNS well RB being JJ and CC assuring VVG the DT families NNS that IN their PP$ loved VVN ones NNS were VBD living VVG with IN the DT care NN and CC dignity NN they PP deserved VVD . SENT Thank VV you PP . SENT