Editor’s Note: A second of two stories on culture change in nursing homes suggests what homes of the future will look like.
Leaders of the culture change movement in nursing home care place Kansas “ahead of the curve,” according to Debra Zehr, president of the Kansas Association of Homes and Services for the Aging.
“Once again, Kansas is quietly and modestly going about being a leader in health reform,” she said, citing past accomplishments in public health and mental health, and now long term care.
Nationally, 31 percent of nursing homes are considered to be culture change adopters, 25 percent strivers and 43 percent traditional, according to a 2007 survey by the Commonwealth Fund.
The Kansas Department of Aging, which has oversight responsibility for nursing homes, has for several years promoted change through an award system called PEAK — Promoting Excellent Alternatives in Kansas nursing homes.
Common characteristics for the award-winning homes include residents’ control over their own activities, including times for getting up, when and how often they will bathe and shower, some choice in meals and choosing what they will wear.
Atchison Senior Village schedules regular trips to Wal-Mart, downtown, the library, zoos in Topeka and Kansas City, and nearby gambling casinos. Residents at Cheney Golden Age Home may attend school plays. At the Johnson County Nursing Center, residents participate in a pen pal program with local schools. Outdoor areas that residents may enjoy are mentioned in several award summaries.
Some larger facilities have subdivided into “neighborhoods” or “households,” smaller groups of rooms centered around living rooms and dining rooms, instead of one large dining facility where everyone eats at once. Staff members work within the neighborhood, fostering a closer relationship between them and residents and better understanding of preferences.
Online reports indicate that new construction favors private rooms, which promote the dignity and autonomy of the resident and prevent the spread of infection. Free access to refrigerators stocked with snacks is a plus.
Pioneer Network, an organization dedicated to person-directed care, indicates that putting residents’ preferences first results in happier residents who gain instead of lose weight and require less anti-anxiety medication.
How residents are treated is always a top priority; equally important is how workers are treated. As a part of a culture change in long term care, no one does only one job, Zehr said. Working with a small group of residents, a person is not just a nurse’s aide, but may also help with housekeeping and meal preparation. A universal worker gets a more complete picture of the resident as “a person who is continuing to live real life — not just as a person here to have a collection of diseases treated.”
Nursing home residents tend to be “older and sicker” than previously, according to Renee Kersenbrock, administrator at Pratt Rehabilitation and Residence Center. It is not unusual, however, for the facility to have one or two residents in their 50s.
“We need to view that as a learning opportunity for us,” she said. “They are able to voice their needs and demands. We all know Baby Boomers are a more demanding group of people. That will be the next generation we will care for.”
The United States Census projects that 57.8 million Boomers (born between 1946 and 1964) will reach the ages of 64 to 84 by 2030.
Most won’t need nursing home care until they reach their 80s, Karen Sipes, communications specialist for the Kansas Department on Aging predicted. Current emphasis on healthier lifestyles and the availability of more in-home services (at an average cost of $1,000 a month, compared to nursing homes at $2,000) may lessen their impact on nursing homes.
Pratt, Kan. —
