Jan. 15, 2001 -- At the Fairport Baptist Home near Rochester,
N.Y., residents spend their days in a community living room and dining room --
not hallway corridors.
At a group of 11 nursing homes in Wisconsin, bladder and bowel
accidents occur less frequently. A few years ago, such accidents cost these
facilities a total of $3.7 million in staff time per year. In 1999, they
reduced that number by $1.3 million, more than a third.
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And, in Marlton, N.J., the Wiley Mission is spending $6.9
million to renovate its nursing home and double the size of residents'
bedrooms. But management first asked the nursing assistants for their input,
wanting to make sure the renovations would mean a more home-like atmosphere,
and make it easier for them to do their jobs.
Across the country, some nursing homes are finding ways to
enhance their services despite cutbacks in government funding, staffing
shortages, and a trend toward older and more fragile patients. They are working
hard to make their residents more content and to reduce the hospital feel of
their institutions, says Rose Marie Fagan, project director of Lifespan, a
community-based agency in Rochester. "A hospital is not based on a
relationship," she says. "We need a long-term care model."
Some, like Fairport, have reduced the medical environment by
eliminating long corridors and strict schedules, and creating little
"neighborhoods" within the facility. Each neighborhood has its own
living room, dining room, and kitchen area. The bedrooms form the circumference
around these rooms, similar to many college dormitories. Residents eat when
they want; no one gets up before they're ready. Dogs, cats, birds, and children
-- a daycare center is attached -- are welcome.
In Wisconsin, 11 nursing homes have formed an alliance called
Wellspring Inc. Concentrating primarily on quality of care, the homes have
dramatically increased training levels.
"The industry tends to say we're not paid enough," says
Sarah Greene Burger, interim executive director of the National Citizens'
Coalition for Nursing Home Reform. "They are no way making use of the
assets they have; they've paid no attention to the good use of staff. They work
things on a medical model, [instead of] going outside of the box, to suit the
residents' needs instead of their own needs."
Such rethinking is occurring primarily in nonprofit nursing
homes, according to those interviewed, but not exclusively. A case in point:
The for-profit Apple Health Care group in Avon, Conn., has adopted a more
social model, transforming its 21 homes in Massachusetts, Rhode Island, and
Connecticut into places that respond more to residents' wishes, according to
Tracy Wodatch, director of corporate nursing services.
"We are empowering [nursing assistants] to make more
decisions," says Robert Greenwood, associate director of public affairs for
the American Association of Homes and Services for the Aging. "It makes
them more satisfied; they know the residents the best. ... It's not the
traditional way medical facilities operate."