Beatitudes aims at offering dementia patients—“people who have trouble thinking”—a comfortable decline instead of imposing a medical model of care, which seeks to defer death through escalating interventions. Photograph by Phillip Toledano

Last summer, Frederick C. Hayes was admitted to the advanced-dementia unit at Jewish Home Lifecare, on West 106th Street. It was not an easy arrival. Hayes, a veteran of the Korean War, had been a trial lawyer for five decades. He was tall, and, though he was in his early eighties, he remained physically imposing, and he had a forceful disposition that had served him well in the courtroom. One of his closest friends liked to say that if things were peaceful Hayes would start a war, but in war he’d be the best friend you could have.

Hayes practiced law until 2010, when he went to the hospital for a knee operation. While there, he was given a diagnosis of Alzheimer’s disease. His combative tendencies had become markedly pronounced, and before arriving at Jewish Home he was shuttled among several institutions. Nobody could manage his behavior, even after Haldol, a powerful antipsychotic drug, was prescribed. In the advanced-dementia unit, he appeared to be in considerable discomfort, but when doctors there asked him to characterize his pain, on a scale of one to ten, he insisted that he was not in pain at all. Still, something was clearly wrong: he lashed out at the nurses’ aides, pushing them away and even kicking them. It took three aides to get him changed.

One day in September, a woman named Tena Alonzo stopped by Hayes’s room. Alonzo, the director of education and research at the Beatitudes Campus, a retirement community in Phoenix, Arizona, found Hayes lying in a hospital bed that had been lowered to within a foot of the floor, to lessen the risk that he would hurt himself by falling out of it. His face was contorted into a grimace, she later recalled, and he writhed and moaned. Alonzo, who is fifty-two, has spent the past twenty-eight years working with dementia patients—or, in her preferred locution, with people who have trouble thinking. She crouched next to the bed, and spoke in a quiet, intimate tone. “I’m here to help you—do you hurt anywhere?” she asked, moving her hand gently over his chest, his abdomen, his arms and legs. With each touch, she asked, “Do you hurt here?” When her hand reached his belly, the moaning ceased and Hayes spoke to her. “I hurt so bad,” he said. “I promise you, we are going to fix this,” Alonzo said, and he thanked her.

She told me, “It was heartbreaking, but this gentleman was there to teach us something. He was saying, ‘When I resist, it’s not that I don’t like you, or I don’t want your help. It’s that I can’t stand it when you manipulate my body in that way.’ ” Alonzo explained that it can be particularly hard for people with dementia to identify the source of pain, or to articulate their experience of it. But his body told the story. As Alonzo put it, “All behavior is communication.”

Hayes was placed on a higher dose of pain medication, and he gradually became more verbal—he could now respond, for example, when asked if he was cold. He also largely stopped making threatening gestures. Violence and irascibility are common among patients with dementia, but Alonzo argues that they are not inevitable. Nor are other behaviors that we associate with nursing homes: the man whose persistent, distressed efforts to escape the building must be foiled by frazzled staff; the woman who spends hours slumped before a television, shifting confusedly between dozing and waking.

More than five million Americans have Alzheimer’s or similar illnesses, and that number is growing as the population ages. Without any immediate prospect of a cure, advocacy groups have begun promoting ways to offer people with dementia a comfortable decline instead of imposing on them a medical model of care, which seeks to defer death through escalating interventions. The Green House Project, based in Arlington, Virginia, pushes for the creation of small group homes in which medical care is less intrusive; the Pioneer Network, based in Chicago, urges reforms such as less reliance on psychotropic medications.

Many of these approaches overlap with the methods of the Beatitudes Campus, which, over the past decade, has become an incubator for a holistic model of care. “When you have dementia, we can’t change the way you think, but we can change the way you feel,” Alonzo said. Ann Wyatt, the consultant on residential care at the New York City chapter of the Alzheimer’s Association, calls Beatitudes a “magical place”—a phrase rarely used to describe a nursing home. She is currently coördinating an effort to implement the Beatitudes approach in several New York City facilities, including Jewish Home. “Beatitudes has sort of put the pieces together,” she told me. “It all—embarrassingly and intuitively—makes sense.”

In the advanced-dementia unit at Beatitudes, the elevator is blocked by a velvet rope attached to silver stanchions. Visitors must unhook the rope to proceed. The rope is meant to dissuade a resident from wandering onto an elevator and out of the building; a black square of carpet in front of the elevator performs the same function, since people with dementia have been shown to be unwilling to step onto such a black space, taking it to be a hole. At other nursing homes, exits are often marked with “Stop” signs, or blocked with the kind of fluorescent banners that police use to cordon off crime scenes. The velvet rope at Beatitudes makes a subtle, more positive suggestion: that residents are ensconced in an exclusive club.

The unit is on the fourth, uppermost floor of a nineteen-sixties-era medical building. Its residents are men and women who can no longer live alone safely: they may not remember the location of the bathroom in the house where they have lived for fifty years, and they may have virtually lost the power of speech. (Residents on the lower floors have less advanced dementia, or are undergoing rehab for, say, a stroke.) Across from the elevator is a large, sunny sitting room, where the nurses’ station used to be. “We took that out because they deserved the real estate, and we didn’t need it,” Alonzo told me as she showed me around what is always referred to as the “neighborhood”—a semantic adjustment meant to signal that Beatitudes is a place where residents live, rather than an institution where they are confined.

There are no fixed bedtimes or rising hours at Beatitudes, and no schedules insisting that aides must have residents showered before 10 A.M. Residents may choose when, and if, to bathe, provided that they maintain basic hygiene, and there is no compunction among staff members to get uncoöperative residents spiffed up for visitors. Instead of the intimidating shower rooms typical of nursing homes—safety railings, trusses, plastic curtains—the bathrooms at Beatitudes are spa-like, with aqua tiles, rubbed-pine cabinets for towels, and frosted-glass blocks shielding the shower area.

Research has shown that endorphins released during a pleasant experience have a salutary effect on a person with dementia even after the experience is forgotten. Beatitudes tries to provide residents with pleasurable moments throughout the day. When people with dementia become hungry or thirsty, they are unlikely to look for food or drink independently, or ask for help; as a result, they often have difficulty maintaining their weight. One day when I visited, a plate of cookies and a pitcher of lemonade had been set on a rolling snack cart—an attractive wooden cabinet topped with a decorative cloth. Staff members periodically walk around with a plate of tiny sandwiches or other snacks, offering them like hors d’oeuvres at a cocktail party.