Examples of New Models of Nursing-Home Care
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The stigma associated with nursing home scandals in the 1970s and 1980s, which led to the 1987 federal Nursing Home Reform Law, continues to some degree to this day. Many clearly substandard nursing homes still exist, and the industry has much room to improve. So diligence is still required, of course, but someone looking at nursing homes today is less likely to find the kind of warehousing and abuses that existed years ago.
Some efforts have been devoted not just to improving existing nursing homes but also to creating new models of care. The following sections highlight three examples.
The Eden Alternative was created in 1971 by Dr. William Thomas as an effort to de-institutionalize nursing home care. Eden Alternative does not own or operate Eden Homes; instead the organization works with facilities and individuals to create a caring community for elders (his preferred term for older adults).
People live in small houses of 10 to 12 residents, and care partners — the people involved in daily activities — are given a major role.
The emphasis is on placing the person as the center of the care and doing away with the hierarchy associated with the medical model of care. Medicaid funding may be available in some states. Facilities implement the Eden Alternative in different ways, so it is still important to visit and observe.
Green House Project
An offshoot of the Eden Alternative, the Green House Project was also founded by Dr. Thomas. The project, funded by the Robert Wood Johnson Foundation, has more than 100 homes in 32 states, with more in design.
The basic idea is a new way to create senior housing by building or converting residential homes into settings that can provide high levels of care. Some of these homes are licensed as nursing homes and others as assisted-living communities.
Green Houses take advantage of technology such as adaptive devices, computers, pagers, and ceiling lifts. They also try to live up to their name: In this case green means living in the natural world, with plants, gardens, and access to outdoor areas. The site has an interactive map that shows the homes operating and in development by state.
Comfort First, a program started at The Beatitudes Campus, a continuing-care retirement community in Phoenix, Arizona, works with people who have dementia by creating a personalized homelike environment, anticipating the resident’s needs so that discomfort (and the behaviors that are often the resident’s only way of expressing discomfort) is avoided.
Personal comfort is promoted at all times. The program was started when Beatitudes partnered with Hospice of the Valley to create a model program in dementia care. The model is being tested in three New York City nursing homes, and training is available at the campus.
All the efforts to improve nursing-home care come under the general heading of culture change, which means creating a person-centered environment. The Pioneer Network, a group of long-term care professionals, was formed in 1997 to move nursing-home practice from hospital-like management to a person-centered approach, which better integrates quality of life with quality of care.
The Pioneer Network has a consumer’s guide to finding a nursing home involved in culture change. The guide has many key questions, such as:
How is your nursing home involved in culture change?
Do the certified nursing assistants (CNAs) take care of the same group of resident each time they work or do you rotate assignments?
What is your policy regarding food choices and alternatives?
Do you have a rehabilitation team and access to therapists such as speech pathologists, physical therapists, and occupational therapists?
Do you measure the turnover of your staff? If so, what is the turnover rate for your direct care workers? (Any number under 40 percent is good; the national average is 70 percent.)