Sue Winn, R.N.
Visualizing the Ideal Setting
Imagine dropping in to visit at a friend’s home. You ring the doorbell and are ushered into the house, where the sounds of several other friends gathered around a piano singing Christmas carols greets you. A Christmas tree and many other seasonal decorations adorn the great room, while a cozy fire in the fireplace illuminates the scene. Freshly baked cookies are waiting on the counter to sample, and a delicious-smelling lunch is simmering on the stove. Your friend’s warm smile, hug, and sincere “I’m glad you came to visit! Can you stay for lunch?” are the finishing touches to the scene.
The Setting in Reality
There is nothing out of the ordinary in the above visit that I recently shared with a friend. However, there are some exceptions. The friend was not “at home” in the sense we usually mean, but was working in one of two recently built “cottages” at a long-term care facility. The other friends gathered around the piano were elderly residents of the cottage, all in the early stages of dementia.
A New Model of Long-Term Care
Welcome to a new model in long-term care: The Cottages at Saint John’s Lutheran Ministries (SJLM) in Billings, MT. The first two of the Saint John’s 8,000-square-foot cottages opened their doors in August 2005, after years of planning and two years of intensive preparations. Images like the one described above are lived out daily in each cottage “home.”
Mission
The mission of SJLM is to “provide living opportunities within nurturing environments of hope, dignity, and love.” Note the emphasis on nurturing, hope, dignity, and love, all of which are too often lacking within the traditional nursing home environment.
The Eden Alternative™
Dr. William H. Thomas developed The Eden Alternative™ in response to the sterile environment he found in nursing homes and the triple “plagues” that were all too common in this environment: loneliness, helplessness, and boredom. Plants, animals, and children, as part of the daily life in an Eden facility, all help to keep these problems at bay.
Even though SJLM had been certified as an Eden facility and consistently found ways to live out its mission as such, there was a feeling that the facility still wasn’t nurturing enough to the staff or to the residents, mainly because of its size. So the search began for a way to improve the nursing home environment even more than The Eden Alternative had already done.
A new model of caring was developed that created major changes in the physical environment, staffing patterns, and philosophy of care.
The Differences
The previous model at SJLM (like at most nursing homes) included a hospital-type model of care, the traditional health care hierarchy, resident rooms with double occupancy and a shared bathroom, a large dining hall that allowed no one but kitchen staff in the kitchen preparation areas, and a centralized nurse’s station in each unit. Family and friends were welcome to visit, but were not usually involved in daily routines.
In comparison, the new cottages are a “family” with an elder-centered model of care. The work teams are self-managed with those at the level of care closest to the elders empowered to make decisions. Each resident room is private with its own bath. The dining room is in the center of the home with meals served family style around a handcrafted 16-person table. The elders, along with their family members and visitors, are encouraged to help in meal preparation and cleanup. In place of the traditional “nurse’s station,” there is a centrally located home office. Visitors are welcome to join with the cottage family in the everyday routine, as well as in celebrations.
In addition, there are no noisy “call lights” like those found in a traditional nursing home setting. Instead, the workers can be summoned when needed by a private paging system. During my recent visits to the cottages, this system was not needed as the workers were always present with the elders, anticipating and taking care of needs as they arose. There are no cumbersome “med carts” either; instead, there are locked medication cabinets in each bedroom, cleverly disguised as decorative wall cabinets.
The Universal Workers
The workers who make up the cottage family are called “universal workers,” since they take care of all daily tasks, such as personal care; food planning, preparation, serving, and cleanup; light housekeeping and laundry; and activities, in addition to scheduling workdays and maintaining a budget—just like at home! The SJLM term for these workers is “elder sharath,” which translated literally is “one who ministers or serves the elders.”
New Partnerships
These changes were greatly influenced by the mentoring relationship with Cedars Health Center owned by Mississippi Methodist Senior Services (MMSS) in Tupelo, MS. In 2003, MMSS opened the first “Green House” project in the United States.
The SJLM cottages are not certified Green Houses like those in Tupelo, due to differences in building setup. However, according to Nancy Fee, the “guide” for the cottages, the Saint John’s project “could not have ever been done without the guidance of our friends in Tupelo.”
Changing the Culture of Long-Term Care
This project was the beginning of a huge cultural change in long-term care, a cultural change long overdue and an outgrowth of the work of Dr. William Thomas with The Eden Alternative™. At the heart of this change is a paradigm shift from the “anti-aging” view commonly seen in our society to a “developmental view of aging.”
Focusing on resident preferences rather than institutional schedules helps to validate the feelings of the elders and to lead them away from despair in their final stage of life.
Another driving force is the aging of the U.S. population. Today those over 65 make up 12 percent of the population; by 2030, they will make up 20 percent of the population. These “baby boomers” have made enormous changes to our society in their lifetimes, and now they are influencing this long-term care culture change as well.
The Impact of Baby Boomers
According to Mike Follett, the nursing home administrator at Saint John’s: “The boomers won’t accept the way things have always been done and are going to demand facilities like this. No one wants to move to a typical nursing home. If we can give the elders, in their final years of this life, the best place they’ve ever lived, then we’ve done our job. We just need to keep going and build more cottages as soon as possible!”
The Future of SJLM
Plans are being developed to build 10 more cottages in the spring of 2006. These will be like “mini nursing homes,” in that they will be able to meet the needs of skilled care residents rather than focus just on assisted living. However, the emphasis will be on home rather than nursing home!
If funding is secured to build 10 cottages, then the general nursing care wings will be shut down and those residents moved to their new homes. Currently, there are many success stories from the elders and their families about the improvement in their quality of life, which is expected to accelerate.
Kent Burgess, the president and CEO of Saint John’s, reports: “At this point it may not be making us a lot of money to build the cottages, but it is absolutely the right thing to do for the elders. Since opening in August of 2005, I have not had even one single complaint call from a family member. I have had lots of calls saying how wonderful things are in the cottages. It’s just amazing!”
This a new caring model for nursing homes, with a great emphasis on caring and home. May this trend not only continue, but also spread to other nursing homes around the country!
Resources
Green House Project: http://thegreenhouseproject.com/
The Eden Alternative: http://www.edenalt.com/
Thomas, W. H. (1999). The Eden Alternative handbook. Sherburne, NY: Summer
Hill.
References
Feil, N. (1993). The validation breakthrough. Baltimore: Health Professions
Press.
Institute for the Future. (2003). Health and healthcare 2010. San Francisco: Jossey-
Bass.
Thomas, W. H. (1996). Life worth living. Acton, MA: VanderWyk & Burnham.
Comments and question about this article can be directed to Dr. Marie Caputi at mcaputi@waldenu.edu.
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