Providers putting 'home' into nursing home

Utah's long-term care providers are struggling with quality of life issues as they try to rethink how they care for residents. They are trying, quite simply, to put more "home" in "nursing home."

It's not a painless process, according to Jeff Jerebker, president and chief executive officer of Colorado-based Pinon Management, which operates 28 long term-care facilities. But it's a rewarding one. And it's the direction the industry must move if it is to survive the aging of baby boomers who see nursing homes "as the most dreaded alternative."

Jerebker spoke Friday morning at the launch of We CARE — the Coalition for Advancing Resident-centered Environments. The reform effort includes care providers, government agencies, social workers, geriatricians, lawmakers and community groups.

Nursing homes long have been based on a hospital-like, institutional model of care, he said, the schedule for meals and baths and events devised to meet staff needs. Residents do the adjusting.

The buildings tend to look like hospitals, not homes, with long corridors spiking out from a nursing station and shared bathrooms. The goal is to see how many residents can be "stuffed" in to maximize profits. Care quality has been judged on "efficiencies" tightly prescribed by the government, which pays through Medicaid and Medicare for the majority of care.

Those who grew up in the Depression accepted that. But with the emergence of more options for aging and an entirely different generation soon to cross the facility threshold, "the new generation utterly rejects this model," he said.

"Sometimes change is good. ... In this case, change is the only way to go," said Deb Burcombe of the Utah HealthCare Association. It's not about "making it homelike. These are their homes."

Change starts with how a facility thinks about the services it provides and the population it serves, Jerebker said. Providing choice is essential. The goal of the reform is to get the decisionmaking "as close to the residents as possible."

In one of the nursing homes Pinon runs in Colorado, the long corridors have been broken into "neighborhoods," each with a distinctive flavor clear to the art on the walls. They have porch lights, not call lights, and "front doors" that you need to knock on, denoting that this is someone's home.