At some homes, residents even contribute to plans for large projects. Intending to build swimming facilities, Evergreen wanted to remove any barriers that might discourage residents from taking the plunge. Surveys indicated that the new facilities would go unused if the plans didn't address privacy concerns (so individual changing rooms were included), cold feet (heated floors), and dripping wet suits to carry back (speed-drying machines). The pools—one set at 88 degrees, the other warmed to 94 so that less vigorous residents don't get chilly—are a huge success, says Ken Arneson, Evergreen president and CEO.
The larger Oshkosh community is welcome to use the popular pools, along with several other amenities at Evergreen: a new restaurant featuring low prices and chairs that residents voted most comfortable, a lapidary with tools for shaping stones into jewelry and artwork, and monthly showings by local Oshkosh artists. Besides bringing in new folks to meet, the mingling might change how they define "nursing home," perhaps even aging in general. Arneson thinks so. Evergreen has a waiting list in its assisted-living residences and an occupancy rate in its nursing home in recent years of about 95 percent; the average for nursing homes is 86 percent, according to the Centers for Disease Control and Prevention.
Evergreen embeds constant reminders to caregivers, visitors, and residents themselves that each person living there is more than the sum of his or her ailments; before they arrived, they all had real and often fascinating lives. On the wall outside each room at Evergreen is an "identity box," an open wood case the resident is encouraged to fill with items that reflect his or her life story and interests. Arneson recalls one identity box that showcased a piece of the USS Lexington, the aircraft carrier that was the former resident's home base during World War II, and another that held a former teacher's first contract, earning her $30 a month.
Honoring residents' individuality also means avoiding the convenient labels common to old-style nursing homes. An institutional model typically shunts people with Alzheimer's disease and dementia, for instance, onto a single floor with the door locked to prevent them from roaming. At Evergreen, Abramson, and Garden Spot Village, however, many such residents are in households with folks who are still mentally sharp. The approach, says Lindsey of Garden Spot Village, seems to reduce the incidence of behavioral issues like anxiety and agitation in residents with dementia, a common concern. "She's always included, not just by the staff but by the other residents, too," Mary Anne Duffy of Lancaster, Pa., says of a 101-year-old friend with dementia who has lived in a household at Garden Spot Village for three years. Not only do residents consult Myrtle Tremblay, a former artist, on her eye for color during group craft-making sessions, but her caregivers give her nails a new shade of polish just about every week, says Duffy.
Good relationships between caregivers and residents improve medical care. And this is best established through "consistent assignment," as it's known in the industry. Instead of rotating nurses and other caregivers throughout the facility, which old-school nursing-home veterans defend because it allows all caregivers to know all residents, they always work with the same residents, explains Abramson's Valerie Palmieri, residence administrator and vice president. The reality of a floating staff, she says, is that "you get inconsistent outcomes." A nursing assistant who sees your dad only every few days, for example, may not notice a subtle change in skin tone that could be an early sign of a pressure ulcer due to inactivity. With Abramson's consistent-assignment approach, Palmieri has seen a significant drop over the past four years in pressure ulcers, falls, and weight loss—three particularly pressing challenges for nursing homes.
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.