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.
Meals might be served restaurant or buffet style, and residents choose when to eat. Some facilities offer five meal sittings, and residents can pick which fit their desires. There are "neighborhood council" meetings. Staffers are assigned permanently to a neighborhood, to foster more community. And speaking of communities, they're getting out into them more and inviting them inside the facilities, as well.
The silo-style management must "flatten out" to accomplish it, he said, so the resident or those closest to him have more say. Pinon looks for workers who "serve the resident, not a workforce that serves" a department supervisor.
But he warns that as the changes occur a "gradual transformation and a tough transformation" nursing home operators must be prepared to have deficiencies noted when they're surveyed by government. Rules of inspection haven't changed to keep up with the evolving face of the facilities, and focus is shifting in so many ways that "things fall through the cracks." What emerges, though, is worth the extraordinary effort.
"We're converting from institutions to habitats," said Jerebker.
The benefits from increased resident satisfaction counter some of the growing pains. When his facilities targeted services to residents who are unhappy or act out, complaints decreased, and so did many of the behaviors. Their needs, it turned out, "were really not a big deal, but things that get overlooked."
Changes that would seem to hurt the facility's bottom line help it. Pinon took a 78-bed nursing home down to 64 rooms, putting more space into living, dining and common areas. Revenues went up, in part because they had a higher occupancy rate and less staff turnover.
"Home" is how Jeaniene Sanone, 62, a resident at Hillside Rehabilitation Center in Salt Lake City, describes where she lives. The staff is family. She can sleep in if she wants because meals aren't served on a now-or-never schedule. And sometimes, she marvels, "they bring you the things you need before you know you want it."If I'm lucky, I'll get to spend the rest of my life there."