New Ways to Aid the Old
Tuesday, June 12, 2007
Twenty years after Congress vowed to improve the way we care for the old and the infirm, nursing homes still inspire dread. But some mavericks are working to deinstitutionalize them and make them more like home.
"We want to change the culture of aging," said Bonnie Kantor, executive director of the nonprofit Pioneer Network, a Rochester, N.Y.-based umbrella group leading the effort, "and we're beginning with nursing homes." Rather than warehouse those who are frail or disabled, the advocates of change argue, providers of long-term care need to create genuine communities where people receive needed services while continuing to lead meaningful lives.
Only a few hundred of more than 16,000 nursing homes nationwide have undergone the systemic transformation envisioned, according to the Pioneer Network. Hundreds more, including some in the Washington area, are taking first steps in that direction.
What distinguishes a humane nursing home? Pioneering homes go by a variety of names and descriptions -- Eden Alternative, Green House, Planetree, resident-directed, person-centered -- but share common features: autonomy and choice for residents, homey personal spaces, valued staff and a strong community of residents, staff, families and volunteers.
Some 1.5 million Americans live in nursing homes, including nearly 20 percent of those 85 and older, according to the National Institute on Aging. All receive medical services such as physical therapy, medication management and wound care. Roughly 10 percent of those in nursing homes are short-term patients who need care while recuperating from a sickness or injury.
More than half of nursing home residents use wheelchairs, and nearly half have dementia, according to federal data; 4 percent are bedridden. Nursing homes may be free-standing or share a campus with assisted-living facilities (which offer communal meals and help with dressing and bathing) and/or independent apartments for the elderly.
In 1987 Congress passed the Nursing Home Reform Law, promising fundamental rights to residents. But the law's promise has gone unmet, advocates say. "Rights, respect, being treated as a unique individual, staff who are trained, quality of care and quality of life -- these key principles of the Nursing Home Reform Law are now 20 years old," said Alice Hedt, executive director of the National Citizens' Coalition for Nursing Home Reform. "We're eager for culture change to take hold so that each resident can enjoy truly individualized, person-directed care."
The Pioneer Network wants to see at least 10 percent of the nation's nursing homes overhauled in the next 10 years. The Robert Wood Johnson Foundation boosted such efforts in 2005 when it announced a $10 million program to encourage the creation of 50 Green Houses, innovative models of elder care developed by revolutionary gerentologist Bill Thomas.
The first Green Houses were built in 2003 by Mississippi Methodist Senior Services in Tupelo. They offer a residential setting and specially trained aides who act as caregivers, homemakers and companions, supported by nurses and therapists. Today, Green Houses are operating in nine additional cities, with 15 others in the development stage.
Pioneering homes demonstrate that:
· Nursing home residents want to make their own decisions. In her 20 years of research on quality of life for nursing home residents, Rosalie Kane, a professor at the University of Minnesota's School of Public Health, has found that residents want more control than most have over their daily lives and that this freedom is key to their "well-being, mental health and even physical health." Among the things residents want to decide, Kane's surveys show: how and when they use the phone or leave a facility for visits, who their roommate is, what food they eat, and what time they wake up and go to bed. By getting rid of strict institutional schedules and reorganizing staff time, pioneering homes aim to deliver on these desires.