New Ways to Aid the Old

· Life can have meaning, no matter where we live. Nursing home residents want to be more than just recipients of care, studies show. Pioneering homes find that many residents enjoy making a contribution, whether it's helping prepare meals, caring for a dog, volunteering to teach English to a staff member or comforting another resident who feels low. The more spontaneous and personalized the activities, the more residents remain engaged.

Most nursing homes emphasize custodial care to the exclusion of normal life, said John Henry, administrator at Ruxton Health of Denton, Md. "If I asked you what did you do last week, you wouldn't say, 'I ate, I went to the bathroom, I got dressed.' It's the life beyond that that is fun," he said.

At Ruxton, residents can choose from organized activities or more-spontaneous ones: cooking a favorite dish in the resident kitchen, playing checkers with friends in a comfortable den or inviting a staff member to sit and chat or read to them. Geneva Gibbs, 84, said she's glad to live there. Not that life is perfect -- "I do miss my freedom and being able to walk," she said. But she appreciates that her church comes there to hold services. She loves word games -- "makes me kindle what I've got up there," she said, pointing to her head -- and she values the friends she has made.

· Aides can be caring and competent, given a supportive culture. Industry-wide, the high turnover of nursing home aides -- 70 to 100 percent a year -- makes it nearly impossible to deliver quality care. Researchers who interviewed aides for a study, published in 2003 in the Journal of Gerontological Nursing, found that aides believed supervisors "treated them individually as if they were all unskilled, dishonest, lazy, and stupid." Often working without adequate assistance, aides surveyed in numerous studies say they can't give residents what they most want -- consistent care and friendship.

Transformational homes reduce staff turnover and encourage aides to build relationships with residents.

Ruxton's director of nursing, Lisa Havelow, expects her staff members to talk to residents, show them affection and make their wishes their top priority. That suits geriatric nursing assistant Sheretta Jenkins just fine. "My old jobs, I used to hate to wake up and go to work," she said. "I don't feel that way here. You can be happy. You can joke with residents. You can sit down and read to them."

Other pioneering homes offer career ladders, training opportunities and programs requested by workers. Providence Mount St. Vincent in Seattle, for example, helps workers buy computers for home use.

· Enriching the environment enriches life. Forget hospital hallways and double rooms with flimsy privacy curtains. Some cutting-edge homes have living rooms, country kitchens, private bedrooms and baths -- available to all residents, including those on Medicaid. Families can host potlucks, birthday parties or make a pot of coffee. Many homes have cats and dogs, or gardens with raised beds for people in wheelchairs. Others have on-site day-care centers, with children a normal part of life.

Even those saddled with an old building, such as Ruxton of Denton, can make it homier. Geneva Gibbs is proud of her room, decorated in purple, her favorite color. She also enjoys rocking on the home's front porch. A new spa with plush towels, soft music and a faux fire in the small fireplace turned residents' bathing experience from grim to luxurious, staff members say.