Special to The Hawai‘i Herald
The decision to place a loved one in a nursing home or some other residential care facility is rarely an easy one for family members, but there are times when caring for a loved one at home is no longer possible. For a variety of reasons, family members may no longer be able to provide the level of care and constant supervision needed for a loved one to remain safely at home.
When the time comes to find another “home” for parents, grandparents or other loved ones, a wide range of factors need to be taken into consideration, including geography (where is the new home located?), quality of care (does the care provided in the new home meet the needs of our loved one?), physical environment (is the new home — inside and out — arranged in a way that provides the right amount of stimulation for our loved one?), reputation (what do others who are knowledgeable have to say about this place?) and, of course, cost (how are we going to pay for this care?).
Finding the right place for a loved one with increasing care needs can be a serious challenge here in Hawai‘i due to a shortage of available “beds” — the term often used to indicate openings in a care facility. This is especially true if a loved one has Alzheimer’s disease, which is typically characterized by memory loss, changes in personality and problematic behaviors. Such individuals may need special accommodations to ensure that they do not wander out and away from the care facility and become lost or injured. Residents with Alzheimer’s require care by people who have a special understanding of the disease, which will progressively worsen over time. With proper training — using re-directional techniques, for example — trained staff can try to manage behavioral issues using minimal or no drugs. Re-directional techniques help to refocus an agitated resident’s attention from problematic to more productive, positive activities.
When looking for a place to move a loved one with memory impairments due to Alzheimer’s or other types of dementia, the search, ideally, should be for a home — not just a “bed.” After all, this new place will be a new home for our parents, grandparents or other loved ones — not just a bed — and a home is where a person should feel cared for, safe and comfortable.
Since 2005, a memory care residence in Nu‘uanu has strived to set the standard of care for people with memory impairments. Hale Kü‘ike was founded by David Fitzgerald, who was the administrator of the Pohai Nani retirement community in Käne‘ohe for 10 years. Fitzgerald oversaw Pohai Nani’s nursing facility, assisted living and four care homes. His dream was to open his own care home to serve Hawai‘i’s elder population.
This dream was realized when he opened Hale Kü‘ike’s “Town Side” home in 2005 and a second location (“Windward Side”) in Käne‘ohe in 2012. (A third location, also in Nu‘uanu, is in the planning stages.) In addition to his experience at Pohai Nani, Fitzgerald traveled to Scandinavia to study progressive and innovative ways of caring for persons with memory impairments. He brought these ideas back to Hawai‘i and integrated them into the Hale Kü‘ike concept, design and experience. In Hawaiian, Kü‘ike means “to know by sight; to understand or know in advance.”
The “Town Side” home is located at the very end of Kawänanakoa Place, past the Hsu Yun Buddhist Temple and Ma‘ema‘e Elementary School, in a quiet and pleasant neighborhood that provides a peaceful setting before one even steps foot on the grounds of Hale Kü‘ike, which must be entered through a secured gate.
Once on the property, visitors are surrounded by lush, well-tended gardens and trees fronting a stately home that looks more like a graceful and elegant Nu‘uanu residence than a health-related institution. On a recent morning, I joined Scott Gardiner, Hale Kü‘ike’s director of community relations, on a tour of Hale Kü‘ike “Town Side” to learn more about its philosophy and practice of memory care. We met on the veranda facing Kawänanakoa Place, although the road was not visible from that vantage point. The grounds are designed so that it actually feels like the large house sits on a secluded estate. Before entering the home, Gardiner prepared me for my first visitor, who was waiting on the other side of the door. “He’s our therapy dog,” Gardiner said, “and I like to warn people before we enter so they are not startled when they see him.”
Sure enough, as we entered the home, a friendly Labradoodle (part Labrador retriever and part poodle) named Vita happily greeted us. This trained service dog was not only impeccably groomed but also well-behaved and intelligent. After being shut out of an office, Vita found a window to peer in and let it be known that she would rather be inside. The office’s occupant complied, and Vita came in and lay quietly on the carpeted floor, out of the way, but satisfied. (The “Windward Side” home has a trained service dog, as well; her name is Pepper.)
A view of the home’s interior is visible from Gardiner’s office. Some of its residents were having breakfast; others were in an activity group. Still others were in a quiet room, resting on individual recliners. One of them had a cat on her lap as they both relaxed. The ‘‘Town Side” home accommodates 26 residents, and the “Windward Side” residence accommodates 28. Both homes were operating at capacity on the day I visited.
Gardiner explained that they don’t leave residents in their rooms all day. They bring them out to interact with the other residents and find appropriate activities for them to do. Activities vary according to each resident’s desires and health status. The resident’s preferences are accommodated as much as possible. If they had difficulty sleeping the night before and want to sleep in a bit longer, they are allowed to do so. Professionally trained chefs prepare meals from scratch in the home’s spacious kitchen, often whipping up a special dish at the request of a resident. Typically, the meals are a highlight of many residents’ day.
Karen Yamamoto Hackler’s mother was one of the first residents of Hale Kü‘ike when it opened. Hackler had been her widowed mother’s caregiver, but as her mother’s dementia worsened, her care needs increased. At the same time, Hackler was going through her own health care challenges, including a journey with cancer. She had just begun chemotherapy treatment. (She is doing well now.) Hackler shared her recollections of her mother’s experience at Hale Kü‘ike with the Herald.
“The facility is beautiful, inside and out,” Hackler said. “Residents can go outside and enjoy the lovely gardens. They can garden or just sit and enjoy being in nature. They are safe outside since a wall and gate with a coded lock prevent them from wandering away.”
Although Hale Kü‘ike is a secure environment, which is needed for people with Alzheimer’s and related dementias, it does not have the feeling of being restricted. It is not prison-like. Alarms, motion sensors and cameras are used to provide surveillance and monitoring, but they are positioned discreetly. Residents are welcome to go outside and walk. Those prone to wander can walk along walkways outside the home to satisfy that need, but they do so with supervision for their safety. Family members and friends can spend time with their loved ones inside or outside the home.
“We welcome visitors,” Gardiner said. “The more visitors the better.”
He noted a few of Hale Kü‘ike’s highlights, including a requirement that staff members be well-trained in understanding dementia and the best practices in caring for those with dementia. They learn the residents’ life stories and employ the “Best Friends” approach, which encourages strong connections and friendships with the residents. They minimize the use of television to occupy a resident’s time and instead provide stimulating activities meant to keep residents engaged throughout the day. Residents can make crafts, join group exercises and listen to live music — to name a few activities. Beauty shop services, a healing garden, spiritual support, therapeutic music and the unconditional love of the Labradoodles enhance the residents’ life experience.
At the entrance to each resident’s room is a “memory box,” or “reminiscent box.” These boxes are attached to the wall and contain special mementos and keepsakes that have special meaning to the residents. Those items can be seen by the residents themselves and by their visitors, adding a personal touch to each room.
Hackler confirmed that family members were always welcomed. She recalled being invited to join her mother for lunch when she visited. “Chefs trained in Hawai‘i were hired to cook nutritious meals which residents ate, family style,” she said. “I was invited to join my mom for lunch when I was visiting. The meals were nutritious and so delicious!”
Hackler has many memories of her mother’s time at Hale Kü‘ike, but two, especially, stand out in her mind to this day.
“Two of my cherished memories of president David Fitzgerald reveal a lot about his caring nature,” she said. “In the first week my mom was at Hale Kü’ike, David called me and asked what brand of ramen (noodles) Mom liked. Though wonderful meals were being provided, she had asked for ramen. David told me that in the transition phase, he wanted to provide comfort food. He wanted to get some of her favorite ramen for the times she yearned for it.”
The second example also involved food. “Another time, David called and said my mom was asking for apple fritters and he wondered where we got them. She loved the Safeway apple fritters that were full of chunks of apple. David went to get some for her.”
Hackler knew she had found the right place for her mother. “These experiences were so revealing of the kind of man David is and the type of place he is running. The thoughtfulness and care that David showered on Mom made me realize that she was in the right hands. He treated her like family. This was truly a loving home, not an institution.”
She also had praise for the nursing staff, whom she said “took care of body and soul.” “One day when I came to visit, I could hear my mom’s laughter and found her laughing in her room with one of the nurses. They were talking story together.”
According to Gardiner, Hale Kü‘ike accepts residents who need different levels of care, “from high functioning to hospice.” However, there are certain residents who would not be appropriate, such as those needing high-end medical assistance. The home is licensed by the Hawai‘i Department of Health as an adult residential care home, which means residents may require assistance in areas such as personal care, protection and health care services. Those interested in learning more about the home can visit its website at www.halekuike.com and tour the home to see whether it is the right match for a loved one. An application form must be filled out, and if there are no spaces available, prospective residents are placed on a waiting list. Monthly costs are $7,680 for a semi-private room and $9,250 for a private room. Residents are “private pay,” (i.e., costs are paid out of pocket) although a number of them use long-term care insurance.
Not everyone can afford the cost of a memory care residence like Hale Kü‘ike, but the principles and practices demonstrated there provide a model when searching for the right place — or home — for your loved one that is within your budget.
Since her experience with Hale Kü‘ike so many years ago, Hackler said she has shared this model of a memory care residence and its founder “glowingly” to others who are searching for a home for their loved one with memory loss.
“It’s not easy to put your loved one in the care of others,” said Hackler, “but I discovered that at Hale Kü‘ike, she was appreciated, nurtured and treasured.”
Kevin Kawamoto is a longtime contributor to The Hawai‘i Herald.