Some encouraging signs that eldercare is on the mend

Second in a series.

In my last column, I started a series adapted from a speech I gave early this month to an association of long-term-care providers about the need to dramatically improve the quality of eldercare.

Today's excerpt begins the story of why I have hope that day is near.

I started my career in the aging field in the "mean old days" of the 1970s, when much of the care in nursing homes was horrible. Today, the quality is better in home care and residential, including nursing homes — but it's still not good enough. Finally, thanks to a few providers with a new philosophy, there's a growing movement that's proving it's possible to provide not just good but exceptional eldercare.

This change isn't the result of regulations. I'm convinced the government will never be able to mandate high-quality eldercare. After 40 years of trying and laws upon laws, it's not going to happen.

Instead, this is a grass-roots effort by a few pioneers committed to going in new directions. It's the most important change in long-term care in the industry's history. It's the most important change I've seen in my career. Finally, for the first time, I have hope.

This movement goes by different names. "Culture change," "resident-centered care," "Wellspring," "Green House," "Eden Alternative" — these are all names you'll hear, and there will be others in the future for a new philosophy that has put the old mediocre ways of doing eldercare in the trash. It isn't a single model, but a concept. I started writing about it two years ago. The communities I wrote about are only examples of what's beginning to be available in pockets around the country:

• Outfield Estates in Milwaukee, Ore., one of the most amazing assisted-living alternatives I've ever seen.

• Elderhealth NW's two supportive living communities in Seattle. What makes Elderhealth's model so unusual is that, in addition to caring for people who pay privately, Elderhealth also cares for people on Medicaid, the poorest of the poor.

• Warm Beach Senior Community, a nursing home in Stanwood, part of a large Continuing Care Retirement Community that cares, in part, for people on Medicaid.

• Garfield County Public Hospital and nursing home in Pomeroy, a tiny town in the southeastern part of our state, that went from near bankruptcy to solvency and superior care.

Culture change isn't a single idea but a concept that signifies a new, different attitude about eldercare. It has three basic principles, each critical to the whole:

• One, the people who receive care are at the center of what happens: What are their needs and desires? What can be done to make their experience better? The answers are often amazingly simple.

At Warm Beach, for example, when staff asked residents the question, "What do you want?," the residents said something they'd never thought about before: change the bathing routine — it's too rigid, and the process is institutional and cold, set up to move as many people through the process as quickly as possible.

Down came walls. Sinks and mirrors were lowered so people in wheelchairs could groom themselves, and residents were allowed to decide which bath day and shift they preferred. Some residents even began bathing themselves. This kind of solution-finding is a key part of culture change: What do the people who receive the care want, and how can we make it happen?

• The second principle of culture change is environmental. The emphasis is on creating a setting that feels homelike and more intimate and private, similar to where residents lived in their homes. Outfield Estates and Elderhealth NW were able to start from the ground up, and they built small — their cottages house no more than 12 to 15 people, and each person or couple has a private room (even those on Medicaid). Compare this to the "big-box" assisted-living facilities that are popping up everywhere, or Medicaid recipients who routinely share two or three bedrooms with strangers.

Not everyone can start from scratch, of course. Warm Beach is a huge nursing home with long, hospital-like halls. Even Pomeroy's small nursing home has long halls. Neither had the financial resources to start over — so they made do with what they had. Using color and furniture to break up the long halls, they created close-knit, small-scale "neighborhoods" of eight to 12 residents, strengthening group identity and relationships among neighbors. Even with small budgets, there are things we can do to bring intimacy, privacy and connectivity into the lives of long-term care residents.

• But the most important part of the culture change, in my mind — what's truly revolutionary — is its focus on staff: What do the direct-care workers need and want in order to do their jobs well? Staffing drives everything in eldercare — its successes, its failures and its mediocrity. It always has and it always will — and here's where this new paradigm is moving mountains.

Next week: A new way to treat caregiving staff.

Liz Taylor's column runs Mondays in the Northwest Life section. With 30 years experience in the field, she writes and lectures on a host of aging topics. 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/.