LeadingAge Magazine · March-April 2018 • Volume 08 • Number 02

The Montessori Approach: Purposeful Living in Memory Care

March 12, 2018 | by Jennifer Brush, Chris Simons and Renee Van Y

The Montessori approach, which has been adapted for those with dementia, is helping to promote and preserve quality of life. This provider tells us how.

Maria Montessori was a doctor and educator, born in 1870, who focused on affording children the opportunity to explore and develop at their own level of ability, according to their own unique needs and interests. She developed an approach to education based on scientific observation of children from birth to adulthood. It is an approach that values the human spirit and the physical, social, emotional and cognitive development of the person.

Dr. Montessori developed special materials that allow individuals to learn and work both independently and cooperatively. In the classroom, children are empowered to choose their own work, use it appropriately, and then put it away.

However, Montessori isn’t just for children. Montessori is a way to view and approach lifelong learning at any age.

Prepared Environment 1
An example of the “prepared environment” that supports an
individual’s roles and activities. The Montessori approach
emphasizes that such an environment should not be limited to
just one area, but to the entire community.

Clark Retirement Community, Grand Rapids, MI, has taken a journey with the Montessori model for aging and dementia. This approach is a philosophy of life which focuses on engaging the older adult in an environment that is adapted to support memory loss and sensory impairment and facilitate independence. As a result, older adults are empowered to care for themselves and others, make contributions to their community, and engage in meaningful activities.

Our role is to serve as a guide to help our elders actively participate in all of the things they love to the very best of their abilities.

The Ongoing Journey: Using Montessori in Memory Care

In July 2015, LeadingAge held a Dementia Think Tank meeting, attended by a variety of LeadingAge members and dementia care experts. Jennifer Brush, a member of the Association Montessori Internationale (AMI) Advisory Board for Montessori for Aging and Dementia, was invited to speak about her experiences.

Brian Pangle, CEO of Clark Retirement Community, was there. He could immediately envision how this philosophy could complement and enhance the person-directed environment at Clark. After securing grant funding, Brush partnered with Chris Simons, Clark’s director of dementia and life enrichment services, to roll out a year-long implementation plan and program evaluation. The goal: to bring the AMI Montessori for aging and dementia program to elders living in the Clark community.

A Clark Retirement resident uses metal insets to maintain and
improve fine motor coordination and attention to task, to
practice pincer grasping (which can transfer to holding eating
utensils), and to practice matching shapes.

The program began with educational workshops for all life enrichment staff. The same staff then completed a 6-month, in-depth study to become AMI certified practitioners in Montessori for Aging and Dementia, making Clark the first community in the U.S. to have 5 staff earn this certification. Simons, along with Rene Van Y, life enrichment specialist, held a number of informational meetings for residents, staff, family and volunteers to inform all stakeholders about Montessori, create a strong team, and gain support from the entire community. Gradually, more and more staff were educated, and changes were made to the physical environment to make a variety of Montessori activity materials available at all times.

One of the most important parts of the process was creating a prepared environment. The goal is to have an environment that is designed and arranged so well that a person with cognitive impairment can function with as little assistance as possible from the care partner. The prepared environment should support the individual’s roles and activities by placing needed memory, visual, auditory, tactile and olfactory cues in the environment. It is important to remember not to limit the prepared environment to just one area—for example, the activity or multipurpose room. Montessori life should permeate the entire community. It includes the routines of the community as well as the physical space and the behaviors and attitudes of staff and family.

Examples of the Prepared Environment at Clark

  • All members of the community wear easy-to-read, high-contrast name badges (first name only). Staff, volunteers and elders have the same name badge. They are also offered to family who visit often.
  • Bedrooms are marked, with the person’s name in large print and a large photo of the individual that he or she recognizes.
  • There are no staff signs, supplies, materials, or equipment visible. Everything placed in the environment is for the use of the older adults.
  • Wayfinding cues such as high-contrast signage and landmarks are used for all destinations.
  • Visual cues are used to invite individuals to use the materials, e.g., “Please shine the shoes” or “Please help yourself to a drink.”
  • The décor and arrangement of the furniture influences one’s ability to complete practical activities in the space. The furniture is arranged to allow adequate space for movement, carrying of materials, and placing it on tables. The area is free from clutter.
  • Individuals have donated beautiful pieces of art to display in the living areas.
  • Snacks and beverages are available in a manner that encourages individuals to help themselves.
  • There are accessible shelving units in the environment to hold materials.
  • Materials are placed in clear boxes, on trays, or in baskets with an accompanying plastic mat that contrasts in color from the table’s surface.
  • Activities reflect the elders’ culture and offer relevant hands-on experience. For example, a person who used to garden enjoys an activity of watering and tending to plants and a person who is Catholic enjoys an activity that enables her to say the rosary with others.
Prepared environment 2
Another example of the “prepared environment.”

Society often focuses on what people with dementia can no longer do and overlooks individuals’ abilities, needs and interests. Montessori methods focus on the abilities that remain and work with those, rather than defining people by abilities they have lost.

The goal of our program is to maintain a person’s roles and identity throughout the full course of their life with dementia. Identity and belonging are key factors in happiness and in maintaining a good quality of life. Staff have created activities and daily roles in which the residents can participate—such as setting the table, caring for plants, making cards for other residents, working in the community shop, and reading to each other. As a result, residents leave their room more often, initiate conversations with staff and other residents, participate in a larger number of self-directed activities, and take ownership of a variety of community tasks. Best of all, we noticed a true sense of community develop as a result of our Montessori project.

Jennifer Brush, MA, CCC/SLP is director, Brush Development Company; Chris Simons, CTRS, CDP, is director of dementia and life enrichment services at Clark Retirement Community; and Renee Van Y, CTRS, CDP, is life enrichment specialist at Clark Retirement Community.