A Quickie

Work is calling so I must be brief. Luckily, I've showered already so I have 15-20 minutes to spare before I have to hike to THAC*.

In reading my Philly Inquirer this morning, two artlcles particularly caught my eye. One, you will have to wait until I get home from work to read. The other is about alternative nursing home care, which I'll post here:

A healthier take on the nursing home

"Green Houses" are smaller, have satisfied staff - and happier residents.

By Michael Vitez

Inquirer Staff Writer

REDFORD, Mich. - Linda Johnson is never going back.

After 14 years as a certified nursing assistant - the bottom of the food chain in the nursing home culture - she has tasted the future.

She is now a "Shahbaz" in a "Green House" - a respected worker in a new model of caring for the frailest elderly.

"I love it," Johnson said. "It's not a rush anymore. We get to spend quality time with [residents]. They think we're family. And we are."

Imagine a world in which the nursing home idea is turned upside down:

Just 10 residents live in a house, rather than the standard 120-180 people, and despite their dementia and infirmities, they're happier and healthier.

Nursing aides, with their new titles, are empowered and love their jobs.

Despite more personalized care, costs are the same or less than in nursing homes.

The Green House was conceived by Bill Thomas, a pioneer in long-term care.

The first cluster of six Green Houses opened three years ago in a continuing-care community in Tupelo, Miss. Based on their initial success, three more groups in Mississippi, Nebraska and Michigan have moved nursing home residents into Green Houses.

Green Houses are also being built in central Pennsylvania, in Palmyra and Mechanicsburg.

The differences between a Green House and a nursing home hit you first from outside. The two Redford Green Houses, opened in August by Presbyterian Villages of Michigan, look like new homes on a residential street, with pitched roofs, shutters and garden. To enter, a visitor rings a doorbell.

"Hi!" says Johnson. "Welcome to our home."

The front hallway feels like a home, with a vase and flowers on a small table. It opens up into one large room with a living area, open kitchen and skylights.

Adjacent to the cooking area is a long, informal wooden dining table, big enough for all 10 residents, the two Shahbazim, and any visiting family.

Along three walls of the house are 10 bedrooms, each with a bed and bathroom.

Residents are just as frail, sick, old and foggy as in any nursing home. In fact, residents at the Redford Green Houses moved in from the nursing home across the way.

Thomas, who last month was awarded a $250,000 Heinz Foundation humanitarian award for his work, first made his mark in long-term care in the early 1990s with the Eden Alternative. This idea was to bring life back to sterile nursing facilities - birds, plants, gardens, dogs. Nursing homes all over the country have embraced the Eden Alternative.

But almost as soon as it caught on, Thomas knew it wasn't enough. The nursing home needed to be abolished. The entire premise was wrong.

Americans should not be looking for the most efficient way to care for sick old people, he said. They should be asking, how do we give our old people the best experience in their frail days?

"The Green House starts with a positive vision," Thomas said during a recent visit to Philadelphia. "How to give the best elderhood possible. It doesn't define their lives in terms of medicines and treatments."

Thomas took the lowly nursing assistant - typically poor, minority and female - and made her the anchor of the new home, empowering her. He so wanted to destroy the old stereotype of nursing assistant that he came up with a new name - Shahbaz - a Persian word meaning "royal falcon."

"They will sail the skies above this land, seeking always to protect, sustain and nurture the people," Thomas wrote in his book, What Are Old People For?

By lifting her up, he elevates the health and satisfaction of all who depend on her.

A challenge in long-term care is attracting and keeping nursing aides, said Robert Jenkens, working with the Robert Wood Johnson Foundation on its $10 million commitment to establish Green Houses in 50 states.

Even nonprofits, he said, have a turnover rate of 70 percent. For Green Houses, the turnover has been around 10 percent, he and others said.

The Shahbaz "gets to know the resident in a very multifaceted way," said Jenkens. "If they do the laundry, they can see an issue with incontinence. When they do the room, they can see if they're hoarding or some indication of dementia."

The results have been dramatic. Some residents who were hand-fed in nursing homes have begun feeding themselves. A few who only sat in wheelchairs have begun to use a walker.

"We are just stunned," said Mariellen Davis, executive director of the Village of Redford Senior Living Community, part of Presbyterian Villages of Michigan. "A switch goes on. The residents discover this is something worth being engaged in."

"I love the meals," said Doris Dalianis, 83, a stroke victim. "Thank God they have gotten around to weighing me."

In the Green House, residents go to bed and wake up when they want. Dalianis, perhaps the most coherent resident here, stays up each night to watch her beloved Detroit Tigers baseball team.

One significant endorsement of the Green House has come from Rosalie Kane, a University of Minnesota professor working to improve long-term care. After spending two years comparing outcomes at the Green Houses in Tupelo with traditional nursing homes, she concluded that residents, families and staff are all happier. Residents gained weight. Staff turnover plummeted.

"This is so dramatic, so radical, it pushes the extreme of what's possible," said Kane, whose findings are awaiting publication in a medical journal. "People would say you can't just have ordinary kitchens in a nursing home, and have residents going in and out of them. You can, and the Green House proves it."

Each Green House in Redford cost about $1 million to build. Supporters say that construction costs are no more per bed than for new nursing homes. And operating costs are also comparable, or less, with medical staff available, as needed, under state law.

In Tupelo, Green Houses have operated in the black for three years with 75 percent of residents on Medicaid, and 25 percent paying privately - a ratio common in nursing homes.

Nearly 1.6 million Americans live in nursing homes, largely built in the 1960s and '70s. Thomas, 46, is confident they will be replaced with Green Houses or other innovative ideas yet to be conceived.

"I hope I live long enough," he says, "to see a bulldozer knock down the last nursing home."

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Contact staff writer Michael Vitez at 215-854-5639 or mvitez@phillynews.com.

posted by Cheryl @ 2:22 PM