Changes in Eldercare
By: Source: AARP.org
Henry L. Davis
Nov. 21, 2008 (McClatchy-Tribune Regional News delivered
by Newstex) -- Frank Neureuter, sitting comfortably in a
motorized scooter at Beechwood Nursing Home, doesn't
look like anyone ready to join a revolution.
Yet, at 82, the retired Buffalo businessman finds himself embracing a small but growing
movement to fundamentally change the way care is provided to the elderly.
Instead of a corridor lined with residents slumped in
wheelchairs, he lives in a smaller "household" with a bell
and mailbox at the front door.
The nursing station, where staff used to congregate, is gone. So is the call-bell system.
Neureuter can get up in the morning when he wants. He can eat a breakfast cooked to order.
He has a say over how he spends his day.
"It's a world of difference from when I came here four years ago," he said.
The nursing home industry is one of the most regulated businesses in the nation. Nursing home
operations have become so regimented in order to control risks and costs that buildings look
alike, and residents have virtually every decision made for them, from when to get up to what to
eat.
The regulations, although well-meaning, have combined with an outdated payment system to
stifle innovation. There's little incentive to raise quality above minimum standards.
Today, too many nursing homes offer a passionless, hospital-like service built for efficiency. It
may have made sense decades ago, but now the homes turn people off, struggle with high
employee turnover and continue to experience quality problems.
Against this backdrop, reformers in recent years have pushed for a radical rethinking of the
long-term care system that's become known as "culture change."
A few nursing homes around the country have adopted some aspects of the movement. Now,
advocates in Western New York want to turn culture change into a regionwide initiative, making
this community the first in the United States to attempt a transformation in elder care on a large
scale.
"If we continue to provide care and treat staff the way we currently do, we will have a crisis,"
said Robert Meiss, chief executive of Beechwood Continuing Care in Getzville.
Beechwood is among more than a dozen nursing homes and other organizations, working with
funding from the John R. Oishei Foundation, to pull together what's being called the Western
New York Alliance for Person-Centered Care.
The goal: Let their colleagues know there is a compelling alternative to business as usual and
make it a reality.
"All people have ever known in the nursing home industry is the institutional model in which all
choice and variation is removed," Meiss said.
Culture change is a general term describing an assortment of different efforts that have one
thing in common: The priority is care for the elderly, not the demands of the institution.
Sounds simple, except that it calls for an industry resistant to change to reorganize completely
from the top down.
"This doesn't require a fancy proton beam scanner or a wonder drug. It's about cooperating to
do the things we know are right. The problem is we have a system that devalues imagination.
You will never find in the same sentence the words imagination and long-term care," said Dr. Bill
Thomas, a leading authority on elder care.
Thomas in 1991 founded the Eden Alternative, an organization that pushes existing nursing
homes to adopt such policies as treating staff the way they want the staff to treat elders, giving
workers and residents more decision-making authority and making facilities less institutional.
More recently, he has pioneered Green Houses -- small, homelike residences for 10 to 12
people, with private rooms and baths arranged around a kitchen, dining room and living area.
"We need to rebuild the entire field -- everything," Thomas said during a recent stop in Buffalo.
"The system we work in every day betrays whatever noble intentions we have."
Nursing homes felt little pressure to change the design of facilities until 1987, when Congress
required operators to consider resident rights, autonomy, choice, control and dignity.
But even forward-thinking operators face a challenge: How do you reduce the boredom and
anxiety in homes, yet keep them safe and able to cost-effectively provide medical help?
Beechwood offers an example of one strategy. It is slowly converting its 40-bed units into
smaller households and neighborhoods, with 12 to 18 beds per household. The unused
semiprivate bedrooms have been replaced with a kitchen, dining room and living area.
A choice of hot food is served from a steam table instead of residents waiting for a lukewarm
meal in a central dining hall. There's a refrigerator stocked with snacks that is available all the
time.
It is about more than aesthetics.
Household workers no longer rotate throughout the building, allowing them to get to know the
residents and their preferences. No one does only food service or housekeeping or laundry.
Everyone is expected to pitch in, as needed, just like at home.
"The big change for employees is that we're more autonomous. We're expected to get to know
residents and come up with our own ideas to reduce the routine, to make things more fun," said
Jodie Branch, a household coordinator, a new position aimed at smoothing communication
among management, staff and residents.
Beechwood is among a few early adopters of some elements of culture change. Others in the
Buffalo area include ElderWood Senior Care, Briody Health Care Facility and the Catholic
Health System's Renaissance Project in the former Our Lady of Victory Hospital.
The new nursing home at OLV has adopted the household model and also moved to private
rooms.
Advocates say that if nursing homes are serious about the dignity and autonomy of residents,
as well as preventing the spread of infections, they will incorporate private rooms in new
facilities.
OLV is carpeted and filled with natural light. There is no longer an overhead paging system.
The nurses station is hidden. The residents eat on china and not plastic.
The hallways aren't filled with laundry carts and the smell of dirty diapers. An effort is made to
offer a choice of food and serve it hot.
"We want people to see and smell food being prepared, just like you do in your home," said
Aimee Gomlak, vice president for strategic redevelopment for the Catholic Health System.
Like other nursing homes most engaged in culture change, OLV and Beechwood report that
residents are more satisfied and healthy, and workers are happier.
At OLV, the facility is seeing weight gain among residents and a reduction in the use of
nutritional supplements, as well as a reduction in the use of anti-anxiety medications, Gomlak
said.
One key to success will be signs of lower staff turnover, a chronic problem at nursing homes.
"You can't implement an expensive program, train your employees and then have them leave,"
Gomlak said.
A survey released this year by the Commonwealth Fund found that only 5 percent of nursing
homes describe themselves as completely adopting culture change.
Resistance is about more than an unwillingness to change.
Operators question whether regulators will punish them for doing things differently. They remain
skeptical about the costs, especially with a reimbursement system biased toward acute care.
They worry about lawsuits from families if giving residents more independence leads to injuries.
At Beechwood this summer, officials spent days deciding whether to allow an elderly woman to
sit outside by herself and read a book, something they would not have allowed in the past.
"All you think about is whether they're going to fall or walk away in confusion and get lost," said
Susan Moran, the facility's neighborhood director.
"For us, it was such a big deal to let her out that we celebrated," she said.
There is evidence that culture change makes good business sense in addition to being the right
thing to do, but advocates must make the case.
"You have to do well to do good, and we have to sell this as good business. The good news is it
is," said Bonnie Kantor, executive director of the nonprofit Pioneer Network, a national
advocacy group that formed in 1997 to promote reforms.
If you ask Neureuter at Beechwood, there is no doubt.
"I've lived both ways, and I like what's happening now," he said. "You get to do things how you
want to do them."
hdavis@buffnews.com
http://bulletin.aarp.org/states/ny/articles/sea_change_in_elder_care.html
By: Source: AARP.org
Henry L. Davis
Nov. 21, 2008 (McClatchy-Tribune Regional News delivered
by Newstex) -- Frank Neureuter, sitting comfortably in a
motorized scooter at Beechwood Nursing Home, doesn't
look like anyone ready to join a revolution.
Yet, at 82, the retired Buffalo businessman finds himself embracing a small but growing
movement to fundamentally change the way care is provided to the elderly.
Instead of a corridor lined with residents slumped in
wheelchairs, he lives in a smaller "household" with a bell
and mailbox at the front door.
The nursing station, where staff used to congregate, is gone. So is the call-bell system.
Neureuter can get up in the morning when he wants. He can eat a breakfast cooked to order.
He has a say over how he spends his day.
"It's a world of difference from when I came here four years ago," he said.
The nursing home industry is one of the most regulated businesses in the nation. Nursing home
operations have become so regimented in order to control risks and costs that buildings look
alike, and residents have virtually every decision made for them, from when to get up to what to
eat.
The regulations, although well-meaning, have combined with an outdated payment system to
stifle innovation. There's little incentive to raise quality above minimum standards.
Today, too many nursing homes offer a passionless, hospital-like service built for efficiency. It
may have made sense decades ago, but now the homes turn people off, struggle with high
employee turnover and continue to experience quality problems.
Against this backdrop, reformers in recent years have pushed for a radical rethinking of the
long-term care system that's become known as "culture change."
A few nursing homes around the country have adopted some aspects of the movement. Now,
advocates in Western New York want to turn culture change into a regionwide initiative, making
this community the first in the United States to attempt a transformation in elder care on a large
scale.
"If we continue to provide care and treat staff the way we currently do, we will have a crisis,"
said Robert Meiss, chief executive of Beechwood Continuing Care in Getzville.
Beechwood is among more than a dozen nursing homes and other organizations, working with
funding from the John R. Oishei Foundation, to pull together what's being called the Western
New York Alliance for Person-Centered Care.
The goal: Let their colleagues know there is a compelling alternative to business as usual and
make it a reality.
"All people have ever known in the nursing home industry is the institutional model in which all
choice and variation is removed," Meiss said.
Culture change is a general term describing an assortment of different efforts that have one
thing in common: The priority is care for the elderly, not the demands of the institution.
Sounds simple, except that it calls for an industry resistant to change to reorganize completely
from the top down.
"This doesn't require a fancy proton beam scanner or a wonder drug. It's about cooperating to
do the things we know are right. The problem is we have a system that devalues imagination.
You will never find in the same sentence the words imagination and long-term care," said Dr. Bill
Thomas, a leading authority on elder care.
Thomas in 1991 founded the Eden Alternative, an organization that pushes existing nursing
homes to adopt such policies as treating staff the way they want the staff to treat elders, giving
workers and residents more decision-making authority and making facilities less institutional.
More recently, he has pioneered Green Houses -- small, homelike residences for 10 to 12
people, with private rooms and baths arranged around a kitchen, dining room and living area.
"We need to rebuild the entire field -- everything," Thomas said during a recent stop in Buffalo.
"The system we work in every day betrays whatever noble intentions we have."
Nursing homes felt little pressure to change the design of facilities until 1987, when Congress
required operators to consider resident rights, autonomy, choice, control and dignity.
But even forward-thinking operators face a challenge: How do you reduce the boredom and
anxiety in homes, yet keep them safe and able to cost-effectively provide medical help?
Beechwood offers an example of one strategy. It is slowly converting its 40-bed units into
smaller households and neighborhoods, with 12 to 18 beds per household. The unused
semiprivate bedrooms have been replaced with a kitchen, dining room and living area.
A choice of hot food is served from a steam table instead of residents waiting for a lukewarm
meal in a central dining hall. There's a refrigerator stocked with snacks that is available all the
time.
It is about more than aesthetics.
Household workers no longer rotate throughout the building, allowing them to get to know the
residents and their preferences. No one does only food service or housekeeping or laundry.
Everyone is expected to pitch in, as needed, just like at home.
"The big change for employees is that we're more autonomous. We're expected to get to know
residents and come up with our own ideas to reduce the routine, to make things more fun," said
Jodie Branch, a household coordinator, a new position aimed at smoothing communication
among management, staff and residents.
Beechwood is among a few early adopters of some elements of culture change. Others in the
Buffalo area include ElderWood Senior Care, Briody Health Care Facility and the Catholic
Health System's Renaissance Project in the former Our Lady of Victory Hospital.
The new nursing home at OLV has adopted the household model and also moved to private
rooms.
Advocates say that if nursing homes are serious about the dignity and autonomy of residents,
as well as preventing the spread of infections, they will incorporate private rooms in new
facilities.
OLV is carpeted and filled with natural light. There is no longer an overhead paging system.
The nurses station is hidden. The residents eat on china and not plastic.
The hallways aren't filled with laundry carts and the smell of dirty diapers. An effort is made to
offer a choice of food and serve it hot.
"We want people to see and smell food being prepared, just like you do in your home," said
Aimee Gomlak, vice president for strategic redevelopment for the Catholic Health System.
Like other nursing homes most engaged in culture change, OLV and Beechwood report that
residents are more satisfied and healthy, and workers are happier.
At OLV, the facility is seeing weight gain among residents and a reduction in the use of
nutritional supplements, as well as a reduction in the use of anti-anxiety medications, Gomlak
said.
One key to success will be signs of lower staff turnover, a chronic problem at nursing homes.
"You can't implement an expensive program, train your employees and then have them leave,"
Gomlak said.
A survey released this year by the Commonwealth Fund found that only 5 percent of nursing
homes describe themselves as completely adopting culture change.
Resistance is about more than an unwillingness to change.
Operators question whether regulators will punish them for doing things differently. They remain
skeptical about the costs, especially with a reimbursement system biased toward acute care.
They worry about lawsuits from families if giving residents more independence leads to injuries.
At Beechwood this summer, officials spent days deciding whether to allow an elderly woman to
sit outside by herself and read a book, something they would not have allowed in the past.
"All you think about is whether they're going to fall or walk away in confusion and get lost," said
Susan Moran, the facility's neighborhood director.
"For us, it was such a big deal to let her out that we celebrated," she said.
There is evidence that culture change makes good business sense in addition to being the right
thing to do, but advocates must make the case.
"You have to do well to do good, and we have to sell this as good business. The good news is it
is," said Bonnie Kantor, executive director of the nonprofit Pioneer Network, a national
advocacy group that formed in 1997 to promote reforms.
If you ask Neureuter at Beechwood, there is no doubt.
"I've lived both ways, and I like what's happening now," he said. "You get to do things how you
want to do them."
hdavis@buffnews.com
http://bulletin.aarp.org/states/ny/articles/sea_change_in_elder_care.html
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