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Alzheimer’s “Search for Meaning”: Here’s Who Gets It Right

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By Susan Saldibar

I don’t know how many of you have read Viktor Frankl’s Man’s Search for Meaning. It was singularly the most influential book I have ever read. In his book, Dr. Frankl recounts his experiences in Auschwitz and other concentration camps and his struggle to find purpose and meaning against all odds in an unimaginably horrific environment. Surviving the experience, he goes on to develop his own form of psychotherapy.

I thought about Frankl’s book back when I wrote about Abe’s Garden, an exceptional senior living community located in Nashville, Tennessee. What made the connection for me is Abe’s Garden’s embrace of a philosophy called I’m Still Here®, developed by Dr. John Zeisel, President of Hearthstone Alzheimer Care. I’m Still Here® involves helping those challenged with dementia to find meaning in their lives. It made me think of Frankl’s own challenging conditions at Auschwitz. Frankl was, after all, “still here” too.

I spoke with the folks at Sage Age (Faith Ott sits on the Hearthstone board) about Hearthstone, as I thought it would be interesting to share what they are doing with Senior Housing Forum readers (Sage Age is a Senior Housing Forum partner). They agreed, so here goes.

If you haven’t heard of I’m Still Here® you’ll find this interesting.

First, for those of you who are not familiar with Hearthstone, they opened their doors in 1992 with a mission to “create a life worth living for those with memory and cognitive challenges by enriching lives and offering hope”. Central to everything they do is their I’m Still Here® methodology, a “nonpharmacological” approach to treating Alzheimer’s disease and other dementias.

The goal of I’m Still Here® is to connect individuals who have Alzheimer’s to meaningful and purposeful living by tapping into abilities that haven’t been diminished by the disease. These abilities might involve art, music and physical aspects like facial expressions and the sense of touch. The idea is that, by pulling these abilities to the forefront and building in “memory cues” to keep them there, you can remove many of the sources of frustration and confusion for those with dementia. This leads to a much higher quality of interaction with the world around them.

It’s about finding a sense of purpose and meaning in everything you do.

The I’m Still Here® methodology forms the foundation for Hearthstone therapeutic concepts, which include the following:

  • “Memory Health” – not “Memory Care”:  The I’m Still Here® approach Hearthstone practices, emphasizing health, not disability – supporting each person’s skills and abilities despite the level of memory loss she or he is experiencing.  

  • I’m Still Here® programs:  Persons experiencing cognitive challenges often become passive; they feel they no longer have a voice – that their opinions and wishes no longer matter. The I’m Still Here® innovative communication training approach creates opportunities for each individual to continuously express their preferences and choices. This leads to increased self-confidence (“My opinion matters”), sense of self (“I know who I am”), and well-being. Residents don’t only take part in clubs and classes – they lead them – gaining a sense of ownership and control.

  • Evidence-based:  I’m Still Here® is backed by over 25 years of research and field-testing. Hearthstone is a recognized world leader in the development and utilization of evidence-based non-pharmacologic (ecopyschosocial) interventions for persons with memory challenges.  

  • Engagement Replacement Therapy:  Hearthstone’s proprietary Engagement Replacement Therapy (ERT)™ reduces Alzheimer’s symptoms such as anxiety, agitation, aggressiveness, and apathy by ensuring that each resident engages daily in meaningful and purposeful experiences. They do not “participate in activities.” As committee and club members, residents with dementia have social roles, make decisions, and continue to learn.

  • Training regimen:  No staff member is permitted to provide care in a Hearthstone residence without extensive training in Hearthstone’s highly specialized I’m Still Here® approach. After completing training programs, each staff person is mentored for 5 days by an on-the-floor seasoned peer-coach.

I’ve only scratched the surface here of what Hearthstone and I’m Still Here® involves in terms of their many programs. You can read more about it here.

Are you using Hearthstone programs? If so, it would be interesting to hear how they are working for you. I, for one, am impressed by any program formed around the realization that the way we have traditionally approached individuals with dementia is antiquated, unenlightened, and, I think, even abusive.

I applaud Hearthstone for embarking on their own “search for meaning” in the everyday lives of the residents and communities they serve. And that also goes for communities like Abe’s Garden for making that philosophy central to the lives and wellbeing of their own residents.

I think my 93-year old mom would like this. Maybe your residents would too.


For more information about Hearthstone, you can visit their website. And, you can learn more about Abe’s Garden here:

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