101. Wall-less Dementia Care with Sue Verdegem and Evon Bergey

Host Amber Bardon welcomes two incredible leaders in senior living innovation: Sue Verdegem, CEO of United Zion Retirement Community, and Evon Bergey, COO of Landis Communities. Together, they explore the groundbreaking concept of Wall-less Dementia Care: a care model that eliminates traditional locked dementia units in favor of inclusive, autonomy-driven dementia care.

What You’ll Learn in This Episode:

• What Wall-less Dementia Care means – Why United Zion never adopted locked dementia units and how Landis is transitioning away from them.
•  Balancing autonomy & safety – How to address elopement and safety concerns without restricting movement.
•  The role of staff training – Why every team member, from maintenance to leadership, receives dementia training through Eden Alternative and Positive Approach to Care.
•  Family & resident education – How to build trust and involve families in this shift toward more dignified dementia care.
• Technology in dementia care – Tools used to monitor safety while supporting independence.
•  Advice for senior living leaders – Where to start if your organization wants to move toward this model.

Why This Matters:

This episode challenges long-held beliefs about dementia care, emphasizing dignity, autonomy, and person-centered living over institutional security measures. Both Sue and Evon share real-life success stories and offer actionable advice for organizations ready to reimagine dementia care.

📌 Mentioned Resources:

• The Eden Alternative
• Positive Approach to Care (Teepa Snow)
• DEER (Dementia Engagement, Education, and Research Program – University of Nevada, Reno)
• Alzheimer’s Association
• Dementia Friendly America
• LeadingAge National

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Transcript

Amber Bardon: Welcome to Raising Tech podcast. I'm your host Amber Bardon, and today I have two very special guests with me, two women that I know and I'm so honored to have on the podcast. One of them has a repeat guest. She's been on the podcast before. Sue Verti is the CEO of United Zion in Pennsylvania, and we also have Evon Bergey, who is the COO at Landis communities, also in Pennsylvania.

Welcome to the show. Thank you. 

Evon Bergey: It's great to be here. 

Amber Bardon: Our topic today is something that I think is so interesting, and I think a lot of our listeners will be really fascinated to hear the details about this topic. So we're gonna be talking about the concept of Wall-less Dementia. And Sue, I know you mentioned to [00:01:00] me that this is something United Zion has, has done for quite a while, and you mentioned that Landis was just starting to explore this, I believe, and the two of you are becoming advocates for this type of care.

You're starting to do lots of presentations about this, lots of conversations. If each of you wanna give just a little bit of background about yourself and then we're gonna dive into the topic of, of what is wall-less dementia.

Evon, let's have you give just a little bit more background on yourself to start with. 

Evon Bergey: Okay, thanks Amber. I've been with Landis Communities nine years and have joined them really with a goal of building a home and community-based service part of the organization and affordable and middle market housing.

And that's in addition to our 65-year-old life plan community, which is Landis Homes.

Sue Verdegem: Sue, so I'm, I'm Sue Verde. I'm the CEO at, uh, United Zion Retirement Community. We're in Lititz, and it might be interesting to [00:02:00] guess to know that Evon and I are neighbors.

I am on one side of Lititz and she is on the other side of Lititz for our locations for United Zion and Landis. So I'm the CEO at, at United Zion. I've been here as. Seven years and excited to talk about our program of Wall-less Inclusive Dementia Care. 

Amber Bardon: So that is just telling me that Lititz Pennsylvania is the place to go if you want to look for innovation and dementia care in senior living, along with rock star production with the Rock Hotel.

Yeah. 

Sue Verdegem: And we are the neighbors of Rock Lititz. 

Amber Bardon: Yes. And, and the one famous guy that Sue saw a coffee shop that had no idea.

Yes. For those who dunno, there is a, uh, hotel called the Rock and Lititz, which I've stayed at, which is where very, all all the famous music producers go there to, um, practice their shows and things like that. I think Beyonce and other people have been there. So that's a side note. [00:03:00] So let's, let's go back to our topic of Wall-less Dementia.

So, Sue, start off by telling us what is, what is that, what does that mean? 

Sue Verdegem: So I should have probably said in my introduction that United Zion has been a retirement community for 120 years. So, we're not exactly new to long-term care. And several years ago, maybe five or six, we begun to have a discussion of adding a secure unit to our campus.

We did not have a secure unit. And, that is certainly, I think, by many thought to be the best kind of care for dementia. And we actually had a resident family member challenge us. We had several people, but the most meaningful challenge was with a, um. A family member whose husband had early onset dementia and actually passed away here, and she loved that we did not have a lock unit, that we did not have our dementia residents [00:04:00] altogether, and she encouraged us to continue to do dementia care as basically we've done it for 120 years.

So what it means to me, to us is we do not have a secure unit on our campus. Anywhere. And we do not have a wing that all of residents with dementia are housed in. So if you live at United Zion and you have dementia, you might live anywhere on our campus according to, somewhat according to your needs, but similar to a person who may have had a stroke or Parkinson's.

Those people are not in a s in a separate unit. And neither are our people with dementia. 

Evon Bergey: Landis Homes about 30 years ago. Wanted to be innovative in caring for individuals and residents with dementia.

And what was innovative 30 years ago was creating these secure units like Sue talked [00:05:00] about. So we created an area on campus where individuals could flow through a continuum with specialized dementia care, beginning with adult day into a secure personal care household. And then into a secure healthcare or SNF household. That was innovative.

The care bases were designed to be in the middle of the household so that the staff could keep a watchful eye on the residents. The lights were soft and it was designed to be peaceful and quiet and secure for safety. And that was innovative 30 years ago. What we are learning and knowing now that is not what we would consider innovative.

So we have begun to have the discussion of. How do we value [00:06:00] autonomy and juxtapose that to safety? What is it that residents want? What is it that their families want and how do we really listen? It's fascinating to me and wonderful that over. The course of the last 10 years, we have gone from five locked units.

And I'm saying locked because that's a little sharper to here and harder to hear than secure. But it is the same thing. We have gone from five. Locked or secure units to one. And so even without being real intentional, we have moved in that direction, are continuing to move. So what Wall-less dementia services means to us and how we are talking about it is that we are approaching this through what we're calling becoming a Dementia Center of Excellence, and we're defining [00:07:00] that as having integrated expertise training across the entire campus so that all.

Team members are trained with some of the same basic principles, the same basic language, the same basic skills to serve and care for residents, whether it's in dining, whether they approach them through housekeeping or maintenance, or with direct hands-on care. 

Amber Bardon: I know you said a few minutes ago that this concept of a locked unit does sound very sharp, dramatic, but in reality, that is how dementia care is provided.

And, uh, you know, and, and most, most places, and of course the reason for that is fear of elopement security. No one likes to think of the idea of, you know, their loved one being, you know, locked into an area or, you know, themself, you know, potentially. But I think, it, it's done in the intention of, of that safety.

So I'm sure what [00:08:00] people wanna know listening to this is how, how do you deal with that? How do you deal with possible elopement? How do you handle safety concerns? Like, you know, I think Sue, for you, I'm interested to hear, you know, 'cause you've never had it. So what has been your approach and then Evon, like how did you shift the mindset at Landis?

And let's, let's actually start with Evon. Let's talk about the Landis side and the mindset shift. 

Evon Bergey: Okay, so we are in the process of doing the mindset shift, and I feel like we're getting to the tipping point where we're hearing different language, we're seeing different techniques. How did we go about it?

We have built a program with five pillars, spaces, technology, research, and innovation. Our foundational pillar is training and education, and so we. Have decided that really training everyone is the most important way to get started, and that's how we've gotten started. We're [00:09:00] using the positive approach to care model, which is EST knows there's several models out there that are great.

That's the one we've chosen, and getting coaches and consultants and trainers certified. In all areas of our communities so that it's not just having folks trained in personal care, which is very important, or healthcare, which is also very important, but training folks in all levels of living in all services.

So that is how we have chosen to begin changing this mindset. We are also in the process of redesigning several of our spaces so that they are engaging in a way that helps engage residents. We believe that if folks are really engaged where they're living, they will not be as prone to look for how to get away or how to, as we use the term exit seek.

[00:10:00] Yeah, that makes sense. 

Sue Verdegem: It's interesting. As Evon and I have talked, you know, we're both on an educational journey. We are currently educating all of our team members as well, and we're, we're using the Eden alternative again a similar training technique.

And one of the things that Evon said. That I resonate with is it really is training for everyone. So for the Eden Alternative, which is is new for our team to be going through, but every team member is going to, needs to go through the Eden Alternative Training. So that's me, that's, um, the direct caregivers, that's maintenance, it's housekeeping, it's culinary.

If you work for United Zion. Probably by the end of next year you will have went through the Eden training. And that's just, just helping us all have the same training of techniques of, uh, words, the words we [00:11:00] use words matter.

Every single person is critical to our dementia care here at United Zion. So when we talk about, what I think families often fear the most is that ex exit seeking. We call that exploring. Uh, we used to call it wandering. Now we've moved to exploring and they're exploring what's somewhere else, and they may have forgotten what's there.

So it, it really, it may mean that I'm taking five minutes from my day to sit in the Trinity Terrace with somebody who has dementia, who just wanted to go outside and wanted to know if it's cold today. Or they want to know where the elevator goes. So. Somebody, oftentimes not a caregiver, but one of the support staff will take that walk with that person so that we can we can explore together.

Amber Bardon: So you, you both of you spoke about the training and education that your, your teams [00:12:00] go through. How about when it comes to the family side, the resident side. What is communicated to them? 

Sue Verdegem: The Eden Alternative Training that we're doing right now. We have opened that to, uh, resident families.

We've opened that to volunteers. Uh, we, we do have a, a monthly, uh, family support program for our residents with dementia that we invite families to. We provide various education at those meetings. Our Eden Alternative residents who. Just happen to live on campus and don't have a dementia diagnosis, are invited to come to the training.

Evon Bergey: We have trainings that are delivered by our dementia friendly. Experienced director quarterly trainings are offered to residents. This was by their request. Um, we also do trainings that are open to the community and including families of [00:13:00] residents here as well as I'm sure.

Everywhere. Independent residents in residential living want to remain in their home as long as possible, and so they have been asking for consultations and trainings. How do I care for my loved one? Who's experiencing some cognitive changes. And so we are, um, providing consultations by our trained consultants for them and trainings, and they are.

Very appreciative of that. And more often than not, it allows for adjustments to be made in the daily routine or understandings learned by the caregiver that really allow that individual to stay independent longer. Yeah, 

Amber Bardon: Just listening to you both talk about this, I mean, the, the amount of effort and time you're putting into this. I mean, dementia is something that runs in my family and both my grandmother and my aunts were in locked [00:14:00] units at the end of their life.

And, um, you know, I just, I can imagine that the families appreciate this approach and the amount of time you take, making sure that every person is aware of the care and the. You know, the empathy, I would call it almost with the level of training you're, you're doing that goes into that. Let's talk a little bit about the technical side.

How and if are you using technology to help support this approach? 

Evon Bergey: We have two different technologies one in personal care and one in healthcare.

Many of those residents wear what we call a nurse call device, and so if there is someone that is felt to be truly at risk. We are able to lock doors before that individual might explore too far.

And so that does allow for that. And in personal care it's something a little bit different, but that allows us to know when [00:15:00] someone is exploring. I love the word exploring, so I'm gonna adopt that today. What we are talking about and we'll be experimenting with is how do we expand those guardrails?

So for example, the example I used of someone who we do have the capability through technology to lock a door as someone approaches it. How might we expand that guardrail as far out as possible for those that actually might need that? 

So. 

Amber Bardon: Yeah. Yeah, I agree. I mean, I, I think that the technology has a long way to go on this, and I'm excited to see some innovation in this area.

I mean, I know that there's some innovation with you know, types of wearables but those are easy to take off, you know, they're not, you have to change the batteries. I know there's sensors you can put that might be. Where the future's going that are more, pa passive sensors that can just detect movement in [00:16:00] rooms and things like that.

But I think it's always, you know, gonna be a challenge to balance, you know, the safety aspect with you know, the empathy and the care aspect. If you were to give advice to another community that's interested in starting this approach, either from like a brand new service line, or they wanna make this transition from locked units to unlocked, what would your advice be?

Evon Bergey: I would suggest that a community start with having the conversation about values. What are your values? Where does dignity and respect come? How do you define safety? Vis-a-vis autonomy, that conversation is critical to get to some common understandings of our values. And from there then the rest is okay, how do we build this?

If I was starting from scratch, I would say, how do we make, how do we make our guardrails around the entire [00:17:00] community 

So that somebody could explore the entire campus, whether it's a hundred acres or 10 that I would start there and also then choose an educational approach so that everyone learns the same skills, the same shared language.

So there's a common understanding of how we support individuals.

Amber Bardon: I love that you said to start with your values, because at the end of the day, that's what it comes down to. You know, why do you wanna do this, right?

How does it support the values of the organization, your mission, and your leadership? And so I, I, I love that you brought that up and that that is the place to start. Sue, what would be your advice? 

Sue Verdegem: I agree with what Evon has said, and I think as people are talking about this, I think it's important to do the research to, to find out that, you know, we, we've created these locked or secure units because we want to keep residents safe.

It's really out of a [00:18:00] heart of. Of deep care. And so when we think about these secure units, we might look at our values and say, yes this is because we want to take the best care possible, but it's probably important to do the research and, and really. Become aware that lock units cause increased anxiety.

We know that residents in lock units, or at least some of them end up with higher blood pressure, anxiety, medicines really stress from knowing they're in a locked unit and can't get out. So kind of having that education of. We are monitoring risk. Being in a locked unit does have negative impacts on your physical wellbeing.

Being able to. Explore at will, may have you on the main highway right next to our building. So which, which risk are you sort of addressing? So facilities that are thinking about this need to. [00:19:00] Need to get some comfort, some understanding, really research. One of the organizations that we have looked at is Deer, which is a dementia.

I wrote this down. Dementia Engagement Education and Research Program. It's out of the University of Nevada reno, their School of Public Health. And they're doing a lot of good research on the negative impacts of locked units. So it is. It is doing that research, understanding what you're committing to.

Also knowing that, you know, Evon said 30 years ago, they were leaders in creating these secure dementia units and we have done a wonderful job of. Really educating people that this is just the best, and now all of a sudden we're looking at it and we're saying maybe it's not so you have that education of which risk are you monitoring which risk is most important to you?

And sort of, uh, what [00:20:00] Evon said is, going back to your values, how do your values translate into which risk you're willing to take for residents with dementia? 

Amber Bardon: I like. I like that you said that, Sue. 'cause actually that's was exactly leading into my next question is how, Evon was saying back when Landis started this, their approach is very innovative and now it's shifting.

And I think you guys are definitely on the front line of this shift, but what do you see as the future? I mean, do you think that the industry's going to swing back in this direction? Do you think it'll remain more focused on lock units or, you know, what would be your, your best guess?

Sue Verdegem: I believe so strongly in the direction that we are going with not with, you know, um, dementia care, inclusive dementia care without a locked unit. And I have been in this industry for a very long time. So I remember when, um, it came out that, uh. Restraints were damaging [00:21:00] to residents. That residents actually died from restraints and all of a sudden we decided to go restraint free.

And we didn't think there was any way we could do it. I think we're at that tip here. We're gonna say, okay, secure units do cause harm and we need to move away from 'em. And we're kind of at that phase where we're saying. That's, this is the right thing to do, but it's impossible. And similar to how we worked through with posy restraints and now none of us would ever think of having a Posey restraint in the building.

I think we're moving there. But it is gonna take exploring technology, it's gonna take a lot of the things that we did. Being creative, being innovative, listening to our caregivers that are on the front line, that are having to respond to what we've historically called behaviors, but we now call unmet needs.

[00:22:00] So when residents are having these behaviors, we say that's an indication of an unmet need, and we have to figure out what that unmet need is and, and rise to it. But it's, it. It really does take being open to your team and being open to the people who know the residents the best. 

Evon Bergey: Yes, I agree with Sue. I don't think the industry is gonna go back. Um, although Ziegler data would state that secure units are still being built Oh, yes. At an increase of 1.8% a year. So they're still being built. Um, Sue and I presented a couple months ago at a health. Conference. So it was a broader group, not just senior living.

And in our presentation, a gentleman who works in the IDD world, that's intellectual and developmental disabilities mm-hmm. He said, you guys are still locking people in. Mm-hmm. [00:23:00] He said, we haven't been allowed to do that for a long time. So that was. I think we knew that, but just the way he said it was impactful for me.

I do think the regulations will eventually catch up with the research. 

Sue Verdegem: Mm-hmm. 

Evon Bergey: Yeah. 

Amber Bardon: Yeah. No, I mean, that just goes back to Sue's point about restraints seeming like so out of date today, and it seems like that's the way he's viewing this still being a practice in the industry. 

Sue Verdegem: And I, I do feel like you know, at that conference.

That group of people is someone we are gonna need to talk to the people who they had to move away from that years ago, and what did they learn? We're gonna have to learn those same things, and we would be wise to tap into what they've learned. 

Amber Bardon: So Evon, this, I mean, this topic I think is, is just so pertinent to the times today and as we start to see. You know, the thing that we've been hearing for years and years, the aging of the baby [00:24:00] boomers, the growth of the industry, more and more people coming in.

And I think that's just bringing innovation in many, many aspects from the type of care we're providing to the food that's being offered, um, to the technology aspect and. You know, I haven't heard a lot of conversation about this change in dementia care. And I think even the term dementia has keeps changing.

It used to be memory care and now it's dementia care. And so, you know, continue to see it evolve and having both of your communities and your leadership being at the front run of this, um, you know, I really value you taking the time to come on this podcast and talk about that, and I'm excited for both of you to continue to have these conversations and get out there and help just educate the industry overall about this.

So. What what advice would you give or is there anything we haven't mentioned yet you think listeners should know about? And if listeners want to get involved or they want support with this how should they should reach out? What should their approach be? 

Evon Bergey: We're happy to talk to anyone that's interested in hearing our journey. Um, some other suggestions I would say is take a look at your [00:25:00] local Alzheimer's association and the National Association. The breadth of resources that they offer is excellent. Um, there's also an initiative called Dementia Friendly America.

Mm-hmm. Which is fascinating and we are partner partnering here with that and. Lancaster County. There's a lot of resources there, so tap into your local and national resources, um, would be what I suggest. Great. 

Sue Verdegem: And I think that I am also open and. United Science is also open to talk to people about our journey and the decisions we've made.

I mentioned earlier, dear, which is, uh, the Dementia Engagement Education and Research Program outta University of Nevada Reno at leading age National also provides some education. On this topic. And I think that's a, that's a good resource. And you know, and that Tippa Snow, the Eden alternative, [00:26:00] much of what we've mentioned as, as using is, is good places to start.

Amber Bardon: And we'll put links in our show notes to all of those resources as well. 

Evon Bergey: Good. Well, 

Amber Bardon: thank you so much to both of you, not only for coming on this podcast for, but for being a part of this and being willing to speak about this and share your expertise in leadership. 

Sue Verdegem: I've become somewhat passionate about it actually.

I've become passionate about, not somewhat, I've become passionate about it as I think Evon has. And it's exciting to talk about it. 

Evon Bergey: Yes, it is. I feel like we're doing the right thing. There's something. Really rewarding when you see a team, a community, multiple communities getting behind something that is really gonna make a difference.

Amber, uh, near the beginning, you mentioned that dementia, is in your family. Everyone has a personal story. Mm-hmm. There's no one that. Cognitive changes and [00:27:00] brain changes has not impacted in some way personally. So there's a lot of personal stories and I think to be doing something that can change the discourse, change the path is exciting to be on that journey.

Amber Bardon: Yeah, 

Evon Bergey: absolutely. I would, 

Sue Verdegem: I would add, um, yeah, we all have it in our future. My mother passed away in November, 91 years old in a dementia unit, a skilled care facility. Yeah. 

Amber Bardon: Thank you so much. Appreciate you. 

Sue Verdegem: Appreciate you, Amber. Appreciate you Evon. You too. Have a good day. You.