New Ways to Aid the Old

The Methodist Home in Washington, on the path to becoming a pioneering home, hosts a happy hour for residents each week in a courtyard garden. "I was just mixing margaritas for the troops," said administrator Sandy Douglass. "No salt on the rim for those with special diets!"

· Person-centered care improves life for people with dementia. A study in a British medical journal found that dementia patients in homes with specially trained staff, a more hospitable environment and family caregivers were less dependent on antipsychotic drugs than were those in more typical nursing homes. Another study found that agitation, aggression and discomfort decreased in dementia patients who received more individualized care. By tapping into people's lifelong interests and offering them new opportunities, such as art and dance, homes such as Providence Mount St. Vincent report that difficult behaviors subside.

· The best doesn't have to cost more. For her recent doctoral dissertation, Amy Elliot at Ohio State University's John Glenn School of Public Affairs found that transformed homes had better operating margins than traditional ones. "Overall, pioneering homes really outperformed the control homes," she said. "It shows it's the right business model."

Reduced staff turnover is part of the reason. Nationally, the cost of turnover among direct-care staff is $4 billion a year, according to a study by Better Jobs, Better Care, a research and demonstration program funded by the Robert Wood Johnson Foundation and the Atlantic Philanthropies. In 2003, when St. John's Home in Rochester, N.Y., became an Eden Alternative home, its turnover was 30 percent; three years later it had fallen to 13 percent. "It's had so many good results," said Al Power, assistant medical director. "Our surveys have been without a major deficiency, and our elder and family satisfaction has gone up every year."

· Leaders must lead. The culture change at pioneering homes depends on the commitment of the administrator, director of nursing and board, say those who have undertaken it. "From the beginning, I tell [employees] I'm a different kind of director of nursing," Havelow said. "I expect interaction [between the staff] and the residents." Administrator Henry models the relationships he wants people to have. "I've never seen another administrator like John," said Deborah Jackson, a cook and veteran of 29 years in long-term care. "If you need a hand cleaning up, he pitches in. He compliments us on the food daily."

"When we eat dinner, I've known him to eat at our table," Geneva Gibbs said. "He's the big boss -- I thought he wouldn't eat with us!" ·

To learn more about the grass-roots movement to transform nursing homes, including stories from the field, research, resources and more, visit:http://www.pioneernetwork.net,http://www.actionpact.com,http://www.edenalt.com,http://www.nccnhr.org,http://www.voicesforqualitycare.org.

Beth Baker is a frequent contributor to the Health section. Some of the reporting for this article appeared in her book "Old Age in a New Age -- The Promise of Transformative Nursing Homes." Comments:health@washpost.com.