Deb Burcombe can imagine what she'd feel like ("gnarly and mean") if she were living in a nursing home and was forced to eat breakfast at dawn when she'd rather sleep in. So she's eager to promote the Utah Health Care Association's new "culture change" initiative.

That change "is going to be what we baby boomers want," says Burcombe, deputy director of the UHCA, looking ahead to the day when her generation requires full-time care. "I'm going to want say-so over my life," including the choice of what and when to eat.

One of the nursing homes that has embraced this change is Hillside Rehabilitation Center in Salt Lake City, which on Thursday invited staff members from other nursing homes to learn about its "5-meal-a-day" program.

According to Warren Walker, Hillside's administrator, six months after the facility adopted the more flexible eating plan — more menu choices, breakfast from 7 to 9:30 a.m., three meals and two snacks a day — the use of antidepressants among the residents dropped 35 percent. The blood-sugar levels of diabetics stabilized, he says, and complaints about the food have gone from three or four a week to one or two a year.

At the heart of the culture change initiative, says Burcombe, is the desire to "empower" residents and to make the facilities less institutional. Holladay Healthcare Center has launched a community garden. Heritage Park Care Center in Roy has a jukebox. At places like Hillside, gone are the hallways with white linoleum floors, the fluorescent glare, the line-up of people in wheelchairs being spoon-fed their medications.

Call lights have been replaced by porch lights. The dining room is decorated with a nice wood hutch and table cloths. There is now a separate kitchen where residents can help make cookies or can grab a yogurt in the middle of the night. Soon, Hillside will launch a short-order-cook system, where residents can choose lunch from a menu. The nurses' stations will be replaced by small desks, making the staff more accessible.

Hillside is planning art exhibits in its hallways, and "neighborhoods" in each wing, says Gary Kelso, president of Mission Health Services of Huntsville, which runs Hillside. Some new nursing homes around the country are even going to a "household" model, with pods that include a dozen or so bedrooms and a separate kitchen.

Nursing homes are still filled with frail, disabled people, some of them unable to do much more than stare at a TV. The facilities "are never going to be the place we'd want to wake up in if we were healthy and independent," acknowledges Burcombe. But they can be places where we can feel "at home and in charge of ourselves," she says. "We want it to be a place you don't dread," whether it's to live in or visit.

"I want the public to know that our state's nursing homes aren't what they were five years ago, even three years ago," she says.

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