Nursing homes need to change culture to feel more like home
The Spring 2007 issue of “Ms” magazine highlights an innovative nursing home in Seattle and applauds its new concept. Providence Mount St. Vincent (“The Mount”) is transforming the culture of nursing homes from an institutional model to one reflecting values of community, independence and empowerment for residents and staff alike.
Having just spent several weeks in a traditional skilled nursing home as I recovered from open-heart surgery, I was fascinated by this new model and called a dear friend, Susan Keyes, who is System Manager for Ministry Leadership Formation at Providence Health Services in Seattle. She was well-known in Spokane for her work with Parish Nursing and the Sisters of Providence, and she has first hand knowledge of the success of “The Mount.” She cited their compassionate service, which is the hallmark of the Sisters of Providence.
Most nursing homes in America are still run on an institutional model with meals at definite times and everything centered at the nurses station, where medications are dispensed and activities are scheduled. These stations are being re-created as genuine homes. Although each residence is unique, they do share some fundamental values: they restore autonomy to residents; they empower the aides. Residents tell the staff what they want and it makes it so much easier than having aides forcing residents to do things they do not want to do. Nationally, turnover in nursing home staff averages 70 percent per year, so it is almost impossible to form long-term relationships with residents. When staff are given opportunities for training with tuition reimbursement, there is a drop in staff turnover.
Transformative homes create community. Laughter, hugs and joking are common. This is in stark contrast to the often somber atmosphere of traditional homes.
Surprisingly, these homes do not cost more to operate (a significant number of residents are on Medicare). Revenues rise as residents are satisfied and stay longer. Nevertheless, these nursing homes are a minority. The Pioneer Network estimates that perhaps several thousand of the nation’s 17,000 nursing homes are beginning to change, but fewer than 200 have truly transformed. Change is hard and the majority of nursing homes are owned by for-profit organizations, many of them corporate chains. But the public is waking up to this new idea.
University of Minnesota Professor Rosalie Kane wrote “Absence of bedsores, absence of depression, absence of malnutrition – these are hardly evidence of a good quality of life or goals to inspire generations of caregivers.”
A small group of self-designated “nursing home abolitionists,” including Dr. Bill Thomas, were quoted in the New York Times of May 24: “Families don’t press nursing homes with hard questions like ‘How do you plan to change in the next year?’ But we should, if we want to hope for something more than safety in our old age.” So, let the questioning begin.
One of the most frequently asked questions from readers concerns my inclusion of poetry in the column. I found a perfect answer in a statement by Christian Wisman, Editor of “Poetry” magazine:
Let us remember … that in the end we go to poetry for one reason, so that we might more fully inhabit our lives and the world in which we live them, and if we more fully inhabit these things, we might be less apt to destroy both.”