A true change in eldercare culture from the inside out

Second of two parts

The eldercare industry is on the cusp of a long-overdue revolution.

One by one, care providers (mainly in residential settings, like nursing homes, and mainly among not-for-profit providers) are beginning to think and operate in new ways. Nothing in the aging field shows such potential for transforming the care of frail adults.

Called "culture change" and "resident-centered care," the names signal a simple but dramatic shift in paradigm. One of the best examples is taking shape at Garfield County Public Hospital and nursing home in Pomeroy, a tiny farming town (population: 1,400) in the far eastern corner of Washington, which I wrote about last week.

Built in the late 1940s, Garfield County's hospital and nursing home will never win a beauty contest. But come inside, and you'll see how the smiles, the gentle touch of staff and the smells of home-cooked meals prove the adage that you can't tell a book by its cover.

Two basic principals are critical in culture change:

• Residents are at the center of what happens: What are their needs and desires? What can be done to make their experiences better?

• Staff members are hired and nurtured to develop relationships with the people they care for, are held accountable for what happens, are offered opportunities for leadership and are rewarded for good work.

Andrew Craigie, Garfield's CEO, was hired in 2000. Supported by the board of directors, he and staff began to critically evaluate everything they did from the residents' perspective, even to the point of counting steps and using a stopwatch.

They had thought their admissions process was pretty efficient until they realized they were making new residents sign 30 different documents before they moved in. Today, all the paperwork is in one book, requiring one signature.

They sought to make the environment more home-like. Having barely survived financial collapse in the 1990s, they had no money to spend on cosmetics. Operating on a shoestring, they divided the halls into five "families," each with seven to 10 residents, and rearranged the furniture in the day room to feel like a living room. Then, unlike most nursing homes, they allowed residents to get up when they wanted, eat when they wanted and go to bed when they wanted, just as they once had in their own homes.

Based on resident surveys, they decided to provide home-style cooking on demand. But first, the kitchen and dining area needed major changes. While Craigie was out of town one weekend, the staff felt empowered to begin. They gutted the kitchen, built a new counter in the day room, bought and installed a new stove and, by Monday, began cooking breakfast as every resident wanted it, any time.

"A couple of residents used to complain about the food," says Susan Morrow, director of Nursing Services. "But once they could see their meals prepared in front of them, they began bringing in recipes from home and had things cooked from scratch. No more complaints."

One of the most profound changes was the permanent assignment of staff to each resident, allowing both staff and residents to develop deep, ongoing relationships. Specialized jobs, like bath aids and rehab assistants, disappeared. Instead, the facility is working to establish a "Universal Caregiver" model of care, where nurses and nursing assistants are trained and accountable for everything that happens.

"Before culture change," says Morrow, "if you asked an aide a question, the response was often, 'I don't know.' "

Today there's a new attitude, ambition and learning curve. Hierarchy is no longer a big deal, says Morrow, because everybody's job is as important as everybody else's. Whenever a resident's call bell rings, for example, "every one of us goes, including me."

In 2000, Craigie developed a new kind of training, available to everyone from executives to housekeepers. Offering six modules — such as communication, caring and leadership — they're optional, but most staff members do take them because advancement is tied to compensation. In addition, nursing assistants are able to learn new competencies, creating another career ladder that bumps up their pay.

Amazingly, none of this has cost more. Turnover among staff has decreased, as has absenteeism. Fewer staff members are employed, because the hospital and nursing home are operating more efficiently and workers feel better about their jobs.

"Remember, our goal is more 'face time' with residents," says Craigie — more time to find out how residents are doing and feeling. "By expanding our staff's skill sets, they're able to provide more direct care, as well as attend to the dining, cooking, bathing and other needs of the residents in their family groups. It's more efficient this way, and residents are getting better care."

In places like Pomeroy and Providence Mt. Saint Vincent in Seattle, Warm Beach Senior Community in Stanwood, Oatfield Estates near Portland and Elderhealth Northwest in Seattle, plus others, a revolution is brewing that offers hope, finally, to systems of care that have barely changed in 40 years. Government regulations aren't making this happen and can't. It's up to us as consumers to demand that it continue.

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/.