"Brave New Home" opens the door to changing nursing-home culture

The nursing-home industry got off to a rocky start in the mid-1960s when Congress established Medicare and Medicaid to pay for the care of very old, very frail people.

Millions and then billions of public dollars poured into a system that had little accountability. As a result, the wrong people entered the business and, as many readers undoubtedly remember, newspaper headlines describing deplorable care appeared across the nation throughout the '70s.

To this day, almost every older person's mantra is, "I'd rather die than go to a nursing home." I've long wondered what might have happened had the care been loving, clean and decent from the beginning — would we age with greater grace and optimism today?

We'll never know.

What we do know is that nursing homes did get better. The handful of facilities that were excellent remained excellent, while the rest advanced from deplorable to merely mediocre — where most stayed.

My dad lived in a mediocre nursing home for two years. The experience for me was a lesson in powerlessness. Staff turnover was epidemic, as were staff shortages; call bells were ignored; the food was unappetizing and lacked nutrition. It didn't matter that we were paying more than $6,000 a month. Complaints to the administrator, the head nurse, the government and even the corporation's CEO went nowhere — it was like punching cotton candy. While the facility's care was better than the "bad old days" of the 1970s, it wasn't good enough.

Nursing homes are among the most regulated industries in this country, with revenues of $115 billion a year. If state inspectors and family members with my background can't fix them, I wondered, who can?

Well, I have good news. Are you sitting?

For the past decade, a few wild-eyed revolutionaries and independent thinkers have been cooking up dramatic, wonderful changes for nursing homes. The fact that so many different people have come to similar conclusions at the same time tells me, as Arlo Guthrie exclaimed in "Alice's Restaurant": "It's a movement!"

On Thursday, you can catch an hour's presentation of these changes on an extraordinary film produced by KCTS and hosted by Enrique Cerna, called "Brave New Home: Changing the Culture of Nursing Home Care," on KCTS-TV, at 9 p.m.

Laughing, animals, kids, plants, activities, zany jokes, caring, twinkling eyes.

Sound like a nursing home you know? Probably not. Not yet. Very few nursing homes have embraced this new paradigm — but it's clear more will in the future.

The first principle of this "culture change": Honor the resident. Turning away from rigid medical models of care, residents become the center. Rather than being required to get up at a certain time for breakfast, for example, they're allowed to stay in bed as long as they want and eat when and what they please. Staff supports them in making choices — what to wear, do and be. These sound like small things, but they're the difference between an institution and a home.

The second principle: Honor the staff, the backbone of all eldercare. In traditional facilities, the aids do most of the hard work — yet suffer from miserable wages, poor benefits and few choices in what happens to them or the people they care for. They rotate among residents, rarely developing friendships.

This changes dramatically under the new paradigm. Nursing aids are part of decision-making teams. They're assigned to specific residents and get to know them on a consistent, caring basis. Their good performances are recognized.

"If you don't take care of your staff," says a nurse at one of the featured facilities, San Juan Rehabilitation and Care Center in Anacortes, "they're not going to take care of your residents." It's as simple as that.

The film highlights the brightest lights of this movement, including:

• Bill Thomas, a maverick physician from New York who, in 1991, started the Eden Alternative, a de-institutionalized nursing-home model, and later the Greenhouse Project, an "intentional community" that's even more homelike.

• Charlene Boyd, head of Providence Mount St. Vincent in Seattle, who talks about changing the scale of her large facility. "I've taken floors longer than football fields," she says, "and divided them into neighborhoods, each with 20 to 24 residents."

• Nora Gibson, director of Elderhealth Northwest, which operates Buchanan Place, in Seattle (which I wrote about last April) as an assisted-living facility offering a "really high quality, comfortable small-scale environment for people who would otherwise be in a nursing home."

Even the federal government is involved. In 2002, the Centers for Medicare & Medicaid Services (CMS) launched a national program to support meaningful culture change in nursing homes. Contracting with CMS to work with willing facilities in our state, Qualis Health, a private, nonprofit health-care quality-improvement organization, underwrote the KCTS special, as well as an excellent resource guide that accompanies it. You can see it at www.qualishealth.org.

Immediately before the film, at 8 p.m. on "KCTS Connects," host Cerna addresses issues related to the film and nursing-home care.

Liz Taylor's column runs Mondays in the Northwest Life section. A specialist in aging and long-term care for 30 years, she consults with families and their elders. E-mail her at growingolder@seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder/.