Dr. Peggy Noel founded MemoryCare in Asheville, N.C., in 2000. The unique organization provides specialized care for older adults with memory loss and their caregivers.
The Duke Endowment has supported the program with multiple grants. Most recently, Trustees approved a multi-year grant to the Greenville Hospital System in Greenville, S.C., to replicate the MemoryCare model. Dr. Noel will lend her expertise to help Greenville establish the program.
Noel, now director emeritus, graduated from UNC School of Medicine and completed her residency and a two-year fellowship in geriatrics at Wake Forest University. Board Certified in Internal Medicine with Added Qualifications in Geriatrics, she has helped educate medical residents and other students in the field of aging.
“My patients and their families have taught me so much in my 22 years of geriatric practice,” Noel says. “With the help of the community and our incredible staff, we have been able to take those lessons learned and translate them into MemoryCare. I think that is the secret to why it has been so successful.”
She talks more about her work in the following interview.
What was your goal when you created MemoryCare?
We are making great strides in treating cancer and heart disease, with associated increases in life expectancy. But for many people, [longer life] is riddled with cognitive impairments that make functioning independently no longer possible.
I wanted to develop a model that would uphold the dignity of persons with dementia who are too often neglected by our fractured health care system and incorporate their caregivers into the evaluation and management process. Failure to do so leads to delayed diagnosis, poor management and great frustration among caregivers.
What happens when a family comes to you?
We start by going over the complete medical record. After that initial interview, the physician has time alone with the family to hear their frank observations regarding their loved one’s functional abilities while the patient goes through detailed neurocognitive testing with a nurse or social work care manager.
Then the doctor and care manager switch places. The physician fully examines the patient and the care manager provides resources to the family that are tailored to their needs.
We switch off again and the physician has another period alone with the family. We end with a written detailed plan of care.
This whole process takes three to four hours. But at the end, we have put everybody on the same team at the same time.
What happens in the traditional model of care?
Due to privacy safeguards, a physician in a primary care practice doesn’t always feel comfortable talking to anyone other than the patient, yet the diagnosis of early dementia often relies on the observations of someone other than the patient. The greatest frustration for caregivers is that the medical system will not engage them.
But the bigger barrier is time. For most of our patients, it would take a long time for you to recognize there’s something wrong. They are very socially intact. If you sat with them for 15 minutes, they might start to ask the same question over and over—but the typical medical appointment is seven to nine minutes because of limited Medicare reimbursement.
Does MemoryCare help people develop a plan?
One of the early things in dementia is not so much memory loss as it is the loss of judgment and reasoning—what we call ‘executive function.’ So we try to help our patients and their families define their wishes in regard to their advanced care. We help people realize there may be a few really good years of independence here if you are just in the wings with a plan.
Do you have a waiting list of families?
One of our biggest challenges is growth. Our waitlist is four to five months right now.
Our current director, Dr. Virginia Templeton, is leading us forward. She joined me at MemoryCare in 2002 and assumed the role of director in 2010. We are so fortunate to have her at the helm.
I understand that MemoryCare has never been replicated. Why?
We’ve had people enquire, but we are a charitable organization and half of our operating revenues comes from donations. That makes people pause. Getting that community support takes a serious commitment.
Maybe at some point, Medicare or state funding will change when people recognize that a program like this ultimately saves money because people are able to keep their loved ones at home longer. We get calls from all over the country asking if there is a MemoryCare model in their area.
Part of your mission is to provide community education. How do you do that?
One of our grants from The Duke Endowment funded what I call “Caregiver College.” We bring in family members for six two-hour programs that build on each other. They learn about what is happening, what causes dementia, and how they as a caregiver can manage behavior and take care of themselves.
We’re also working on a version for the professional community.
What inspires you day-to-day?
It is a joy to assist a caregiver who is willing, in a combination of love and duty, to try to ease the difficult journey of someone afflicted with dementia.
They show up for the job when exhausted, justifiably angry and grief-stricken. Their loved one may have been an exceptional spouse, friend or parent; but just as often they had significant shortcomings and they still care for them. They inspire all of us with their example.
Lin B. Hollowell III
Director of Health Care