The word “Montessori” likely makes you think of young children in an education setting rather than seniors living with dementia in a local memory care facility. While this learning approach has its roots in child-focused learning, research has shown the benefits of applying the same learning approach to those with dementia and Alzheimer’s – which makes it of interest to anyone caring for these individuals, including Chief of Nursing Joelle Margrey, and subsequently, the rest of our team at Loretto.

Over the past three years, Loretto has opened four units dedicated to memory care. Why? According to the New York State Health Department, there are currently over 410,000 people in New York State who have been diagnosed with Alzheimer’s disease alone – and that number is expected to grow to 460,000 by 2025. In Onondaga and Cayuga counties, where Loretto provides services, the Alzheimer’s Association estimates 1 in 10 individuals 65 years of age and older have Alzheimer’s. Loretto is the area’s only safety-net provider, meaning no one is denied care based on their health condition or ability to pay.

The forecasted increase in Alzheimer’s shows unique memory care services will continue to be in high demand in the future.

What is the Montessori Method?

In 1906, Maria Montessori developed a child-based learning approach that gives children the opportunity to identify and strengthen their natural skill sets by allowing choices and encouraging curiosity and independence.

Montessori is about empowerment – and it’s based on 12 principles:

1. The activity should have a purpose and capture interest.
2. Invite the person to participate.
3. Offer choice whenever possible.
4. Demonstrate more. Talk less.
5. Physical Skills—focus on what the person can do.
6. Match your speed to theirs. Slow down!
7. Use visual hints, cues, or templates.
8. Give the person something to hold.
9. Go from simple to more complex.
10. Break a task down into steps.
11. To end, ask: “Did you enjoy doing this?” and “Would you like to do this again?”
12. There is no right and wrong. Think engagement!

Dr. Cameron Camp, a psychologist in applied gerontology, discovered that the same Montessori principles that help children learn can help individuals with dementia and Alzheimer’s find purpose and meaning and help foster connections with others. As Director of Research & Development for the Center for Applied Research in Dementia (CARD), he helps healthcare organizations implement a “Montessori-Inspired Lifestyle,” an evidence-based approach to person-centered care that focuses on the resident’s abilities and their capacity to contribute to their community.

Here is what these principles in practice look like at Loretto:

• Residents play kickball in a circle led by one resident who enjoys the game and keeps everyone engaged.
• A resident welcoming committee was formed with employee support. They create a welcome packet for new residents and show them around when they move onto the floor.
• A Loretto employee kneeling down to speak with someone in a wheelchair at eye level to inquire what they would like to do; would they want to play a game or go outside?
• Loretto employees showed residents how to fold towels and then gave them a stack of dish towels to fold as a way to help their community.
• Residents decide how to arrange the dining room furniture and then help distribute trays during mealtime.
• A Loretto resident who was a waitress volunteered to help with Donut Day each week by cutting the headlight donuts in half and creating “Donut Sandwiches,” which are more accessible for residents to eat. She enjoys the tasks and handing them out to her community members.
• When a resident is agitated, a Loretto employee points to one of the many murals and logos on the walls that feature local landmarks, pictures of pets, and other imagery to begin a conversation. These images are intended to help those with dementia and Alzheimer’s relax and refocus when upset.

Does the Montessori Method really work?

Our team at Loretto is already beginning to see the positive impact of using the Montessori Method with our residents. To understand and appreciate the progress, it’s important to understand where we started. Many of the residents living with dementia came to the Memory Special Care Unit at Loretto from their own homes or apartments. Understandably, when they moved to Loretto, they experienced challenges adjusting to new people and surroundings that were unfamiliar to them. Utilizing the Montessori principles, our staff was not only able to help them transition, but to feel comfortable in a new place. Part of their transition was to learn, and eventually embrace, new routines and activities. Kim Castagnier, one of our nurse managers, has shared two recent Montessori milestones.

In the beginning, activities with these individuals were led by staff. As our staff learned more about each individual, they began to tailor activities to their life experiences to generate their interest and comfort level. Next, they looked for opportunities to give each resident a sense of purpose through taking a turn leading an activity they embraced. While this has taken time, our staff has seen significant progress, as residents now take turns leading activities familiar to each of them, while staff members focus on being active participants.

One of those residents, Mary, is a woman with Alzheimer’s. She arrived at the Memory Special Care Unit at Loretto on multiple medications to address combative issues associated with her Alzheimer’s. Mary struggled with her transition to Loretto and was often aggressive with staff and assertive with others. Together, the Loretto and Montessori team created a plan for Mary that included roles and responsibilities on the floor. Today, she is known as “Loretto’s Greeter,” standing in front of the elevators to welcome guests as they arrive on the floor. 

While much of Loretto’s impact data is in the form of resident stories, there are studies around the world that show the significant impact this method can have. There are two from the American Montessori Society that caught my attention.

• In Spain, most residents with advanced dementia had historically been physically restrained in nursing homes. After adopting the Montessori Method, the use of restraints dropped 94% over eight weeks after starting the program.
• In Switzerland, the use of psychotropic medication in this community has been reduced by 66% in the two years the Montessori program has been in existence. Before employing the Montessori Method, there were seven psychiatric hospitalizations in six months; in the past two years, there was only one.

We look forward to compiling more data of our own, over time, to show the impact this method has had in our community at Loretto. We are committed to continuing to pursue creative and innovative approaches to providing care with excellence to residents like Mary who are living with dementia and Alzheimer’s.