Montessori techniques are bringing purpose and independence to assisted care

Loss of independence and the possibility of needing to move into an assisted care facility are some of the things people fear most as they age. Losing opportunities to participate in activities that bring happiness and the simple act of being able to make choices about everyday life are often listed as some of the biggest concerns Americans have about growing older.


“But it doesn’t have to be that way,” says Delainey Smyth, a speech-language pathology master’s degree student at Central Michigan University.


Smyth, alongside associate professor Natalie Douglas, is studying ways to create a more positive perception of long-term care for the elderly; one that's centered on happiness, empowerment and independence.


Smyth says her motivation for the project is personal, “My great-grandmother was outgoing, extroverted, and loved being around people, but her husband died, leaving her alone in a house, by herself with no one to talk to," she recalls. "When she moved into a home, she became involved in the people and the activities there because she was back in her element. She was happy. From my perspective, her experience in a home really enhanced the end of her life, and I think it’s extremely important for everyone as they approach the end of their lives to not be isolated and to be able to do the things they love.”


To improve the quality of life in assisted care facilities, Smyth and Douglas are studying the application of Montessori education to the elderly population.


A philosophy of early childhood education first implemented in 1907 as part of an urban-renewal program in Rome, its success spread around Europe and eventually made its way to the United States.


“Montessori is about purpose, self-identity, having a sense of control over your life, and independence,” says Douglas. “All of us, at any age, strive for that, and Montessori really allows these older adults to hone in on those things even though they’re in a home far away from what they’re used to.”


She says it’s a philosophy of care that incorporates the whole person, taking into account an individual’s motor skills, interests, and the act of choice.


For example, the Montessori approach might offer activities like sewing, carpentry, or preparing food. These movement-based activities wouldn’t be scheduled and assigned to everyone, but rather offered as options. Residents are able to choose based upon their personal interests.


For older adults entering long-term care, it can be a difficult transition going from a life full of choice and independence into a life with more restrictions. Douglas says the Montessori approach can help make that transition less difficult by preserving as much self-reliance as they can. That's because a major underlying principle of Montessori is feeling like you have a purpose and a role in the community,” explains Douglas. In a facility using this method, residents can choose roles and responsibilities that contribute to the greater community within the facility; clearing tables, watering plants, or greeting visitors.


“Whenever we’re talking about older adults in long-term care, the major issue is to make the care person-centered with as much dignity as possible," says Douglas. "Montessori is a tool to get there. It helps care get to a place of respect.”


Smyth agrees, and sees this approach helping families consider the option of an assisted-care facility in a different way.


“Typically, people think they’ll lose all their independence and the ability to do all the wonderful things that made them happy, but it doesn’t have to be that way," she says, "and that’s why this work is important. We want to shift the mindset; that facilities can offer support without taking people’s lives away.”


Both Smyth and Douglas say the key to making this philosophy work in assisted care facilities is convincing the staff to buy into the method and then educating them on how to implement it with residents.


“When my kids were little and they were learning how to dress themselves,” says Douglas, ”it was so much easier for me to just dress them. It took forever for them to do it on their own, they made a huge mess. Sometimes you find that with older adults: sometimes it's easier for staff to just do something for a resident. But we need to change the mindset to ‘maybe they can dress themselves or brush their teeth or feed themselves.’ It might take a little bit longer and it might be inconvenient to the institution, but the outcomes are so much better for people who are allowed to continue to do things for themselves for as long as possible.”


But the big question is - does it work?


Both Douglas and Smyth answer “yes!”


“The research shows that when you implement this kind of an approach, you see a decrease in anti-psychotic medication use, a decrease in falls, and a decrease in agitation,” Douglas says. “What we saw in Grand Rapids were positive impacts in what’s called ‘perceptions of positive affect’. For example, we had different observers come in and watch things like body language, facial expressions, and whether people were engaging in activities or not, and we saw so many positive changes in those outcomes.”


Smyth and Douglas also say the benefits of this approach don’t just extend to the residents.


“There is also preliminary evidence that shows decreased caregiver burden and increased job satisfaction once the program gets rolling. Granted, it's hard at first. It requires a culture change within the facility, but it ends up being so worth it.”


What do Smyth and Douglas see as the next phase of their work, now that preliminary research is complete?


“We will do anything we can to contribute to a long-term care culture change to one of choice, dignity, respect, and continue to collect data to show third-party payers and Medicare that approaches like Montessori aren’t more expensive. The change is slow, but the more we do and the more data we collect, the more people we can help.”

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