Dick Harron's buddies think he's off his rocker when he tells them "how much fun it is" to visit his 99-year-old mother at her nursing home. "It sounds strange," says the Oshkosh, Wis., retired sales manager, but "when I walk in there, I feel good." Central to his peace of mind is the easy warmth of the nurses and aides, whom Harron likens to "kid sisters" or his own daughters. Most have been Dorothy Harron's caregivers for all seven years she has lived at the Evergreen Retirement Community in Oshkosh. Harron enthuses over their respectful yet playful interactions with his mom and the good-night kiss on her cheek when they help her into bed. "It's an informal, pleasant place," he says. "It's jovial." And it's a far cry from the usual nursing home image.
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Like a growing number of progressive homes, Evergreen focuses on listening to residents, creating an environment less like a nursing home and more like a real one and giving employees uncommon flexibility and freedom. It's a movement that aims to revamp nursing homes from the inside out, stripping away a culture that has dominated American nursing-home care for decades. "There isn't a person around who would want to be in an institution," says Bonnie Kantor, executive director of the Pioneer Network, an advocacy group leading the charge. So residents' wishes and dignity are put first. Restrictive visiting hours are disappearing; arrangements are being made for opposite-sex roommates. "This is how care can and should be delivered," says Kantor.
At Evergreen and other homes in the vanguard of the trend, nurses don't pass out medications to entire units or floors; drugs are delivered individually, timed to each resident's schedule. Belts and other physical restraints to keep residents from falling out of bed or a wheelchair, once commonplace, are absent. And many homes have silenced the constant overhead dinging of resident call bells. At the Madlyn and Leonard Abramson Center for Jewish Life in North Wales, Pa., such requests go directly to phones worn by nurses and their assistants.
At nursing homes that have made a commitment to the new model, most residents live in "households" or "neighborhoods" of 10 to 30 people, each usually with its own communal kitchen and living room, not in rooms lined up along hospital-like corridors anchored to nursing stations. Residents often wake up when they choose instead of being roused early to ensure they make it to breakfast at 7:30 and are back in time, say, for an 8:30 shower. "All that's gone now," says Steve Lindsey, chief executive officer of Garden Spot Village in New Holland, Pa., of the facility's old rigid scheduling. Instead of tending to residents in large groups as before, staff now care for them individually, making breakfast to order in the household kitchen whenever residents wake up, for example.
The majority of today's nursing homes grew out of a hospital model that emphasizes clinical efficiency over making a stay calm and pleasant. If checking blood pressure at 5 a.m. is logical only because that's when a new nursing shift begins, so be it. A hospital stay, though, is usually short. "A nursing home is where people live," says Matthew Wayne, assistant professor of medicine at Case Western Reserve University School of Medicine in Cleveland and medical director at two nursing homes. Blanket protocols like those in hospitals, such as putting everyone with a heart condition on a no-salt diet, may preserve life but diminish its quality.
In progressive nursing homes, by contrast, homey touches of normalcy abound, such as pets that drop by for a visit. "Not a day goes by that you don't see two or three animals, especially ones that once belonged to residents," says Cecilia Nitzberg, 95, who is part of a 27-person household at Abramson. "It's one of the wonderful things we have here," Nitzberg says of the encouraging attitude toward pets, a given for many residents when they lived independently.
Viewing residents as active participants in their care rather than passive recipients is a recurring theme. "In the old model, we tell [residents], 'Now it's time for us to take care of you,' " says Lindsey, as if they are helpless. In the new model, it's not uncommon for willing residents to help prepare meals, set the table for dinner, dust, or sweep, he says. It offers them the sense of purpose and control they had when they were living independently. One household at Garden Spot Village has been doing service work, gathering to sew bags, packed with a ruler and notebook, to send overseas for children lacking school supplies.
Corrected on 01/14/10: An earlier version of this article mischaracterized the waiting list status at Evergreen Retirement Community in Oshkosh, Wis. The nursing home facility does not have a waiting list.