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End of the Line

Reforming the System

WebMD Feature
Reviewed by Craig H. Kliger, MD

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."

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