Reply With QuoteOne potential problem: budgeting.
Sounds interesting: Nursing home movement to let residents live on own terms offers potential payoffs, challenges - TwinCities.com
An odd couple live in adjacent rooms at the Waverly Gardens nursing home in North Oaks.
Behind the door to the right is Doris Osborne, an 82-year-old who wakes at 6 a.m., beats the crowd to breakfast and finds hot chocolate with whipped cream waiting for her.
"I've always been an early riser," she said.
Behind the door to the left is Marie Kappel, an 85-year-old who lingers in bed until 10 a.m. and has an eat-in breakfast of a fruit cup, coffee with two creams and a roll. She's not much for social graces first thing.
"Early in the morning?" she said. "I'm not for that."
That either can be so picky is a new concept in nursing home care.
For years, nursing homes told residents when to wake, when to eat, even when to use the bathroom. Waverly Gardens is one of a series of homes that has re-oriented its scheduling and its philosophy around what residents want rather than what is easiest and most efficient for the staff.
It may sound more like common sense than revolution, but leaders of Waverly's parent organization, Presbyterian Homes, and others say putting residents' desires first is a major change in thinking for U.S. nursing homes and offers great potential payoffs. Nursing aides might come to work happier if their jobs are focused on the residents instead of on what they have to do for the residents. Homes might save money if active residents suffer fewer health complications or disabling falls. Residents might enjoy more of their time in nursing homes, which the majority of seniors currently fear and want to avoid.
"They have their own individuality, their own identity," said Cathy Dougherty, a clinical coordinator for Waverly Gardens. "This is home."
The concept is most challenging but potentially most rewarding for the rising number of seniors with dementia, whose struggles with memory and communication can make them agitated and prone to outbursts. Something as simple as positioning a bed so they can get up on the left side — because they've always risen on the left side — can be calming.
Presbyterian has introduced the Liberty program during the past year to its more than 30 eldercare facilities, including Waverly Gardens and the new Boutwells Landing in Stillwater.
Senior advocates have been advocating this type of reform statewide through the Minnesota Culture Change Coalition, an organization that provides training and fresh ideas.
Listening to residents' desires can seem difficult for short-staffed homes that are inspected and graded on whether they keep residents safe, fed and free of preventable falls or pressure sores, said Deb Holtz, Minnesota's long-term care ombudsman and a member of the coalition.
"Many places are doing a great job with it," she said. "Other places are just starting to talk the talk. Some are so challenged by their physical environments and staffing levels that they can't quite get there."
One of the national models is the Green House project in Tupelo, Miss., where nursing home residents were moved into smaller 10-person homes with nursing assistants specially trained as "universal workers" to handle their needs.
The key is making a real commitment to putting residents' interests first and not just using the concept as marketing, said Dr. Robert Kane, a long-term care expert at the University of Minnesota.
"Is it just a few things for show or real decision-making?" he asked. "Whose preferences trump? Remember, this is the field where letting residents care for a plant had a profound effect."
Residents at Waverly Gardens complete a "My Best Day" questionnaire and also participate in regular chat circles with the nursing staff.
One of the first chat circles in March was a bit awkward, as the dozen women who attended were uncertain why they were being asked what they wanted.
Encouraging residents to speak up has been one of several challenges, said Brandi Barthel, the care center administrator for Waverly Gardens. The facility also lost some veteran workers who didn't want to change how they cared for seniors.
The March chat circle started with simple memories of Easter and Mother's Day.
"My brother and I tried really hard to make breakfast in bed," a nursing assistant told the group. "It didn't always turn out that well, but a mother never tells you that."
Most of the women sat quietly and smiled at Easter tales of painted eggs and chocolate rabbits. Marie Kappel spoke up.
"My mother baked a poppy-seed coffeecake" for Easter, she said. "That was traditional."
Alice Bidon could only mumble when it was her turn. She suffers from dementia. She also is an example of how a little understanding of her past can make a difference. Bidon's husband worked at Coca-Cola, so the nursing assistants discovered they could brighten her day by placing a Coke at her table.
Learning residents' habits and histories is critical, said Helen Kivnick, a U social work professor who is leading the training of Presbyterian nursing staff in the Liberty concept. The problem, she said, is that some workers think they don't have time to chat or that their bosses will think they are slacking off by chatting with residents.
Nursing assistants who make time for their residents, Kivnick, said, "often look like they must be having too much fun to be working."
The rule at Waverly Gardens is that nursing assistants who need a break should sit with residents and talk. The overall approach requires a higher staff ratio of about six or seven residents per nursing assistant, compared to a 10-to-1 ratio elsewhere, Barthel said.
To offset the cost, nursing assistants are required to do laundry and serve food. Administrators such as Barthel are trained as nursing assistants and fill in when needed. They also are encouraged to use their own personal interests.
Jaime Hujanen, a clinical administrator on one of Waverly's units, has started a gardening club. On a sunny March day, she met with a dozen women to discuss their favorite summer vegetables and what they should plant together.
One resident, Millie, said she loved melons. Hujanen offered a childhood memory of putting fresh green onions in a glass at the dinner table.
"We'd dip them in a little bit of salt," she said.
The Liberty concept might be easier in new places like Waverly Gardens, which has a large atrium for the gardening club, kitchens built into the nursing homes so late-night snacks are easy to reach, and the financial resources of a large organization with profitable apartments to supplement the struggling nursing homes.
Presbyterian also received more than $5 million in state grants to train workers over the next three years in how to interact with residents and to juggle multiple tasks. Aging Services of Minnesota, a nursing home trade group, has likewise received a grant to offer an apprenticeship program in this kind of patient-centered approach to care.
Kivnick said it doesn't necessarily take money or grants and the economic downturn isn't an excuse. The favorite success story at Presbyterian is a resident who dreamed of making snow angels. The staff at her nursing
home found a way to lift the woman and her wheelchair into the snow.
"The goal of everything you do shifts away from accomplishing a particular task and toward helping the elders to experience meaningful daily lives on their own terms," she said. "That is really different than saying 'my job is to get you to the dining room by 6:30.' "
The day after Mother's Day, the ladies of Waverly Garden were walked and wheeled to a dimly lit auditorium. Soft piano music was playing.
Strawberries, whipped cream and pastries greeted them at the door.
It was the long-awaited tea party. Osborne and Kappel sat at adjacent tables. Two daughters and a stepdaughter joined Osborne. The women at Kappel's table exchanged pleasantries about Mother's Day and their children and grandchildren.
Barthel busily served pastries and filled empty cups. She wished she would have found spring hats for the event, but the women enjoyed the music and excitedly drew names to give away the floral centerpieces.
It was, after all, what they wanted.
One potential problem: budgeting.
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