How To Find a Village: Elders in Search of Nursing and Rehabilitation Centers

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It takes a village to raise a child, right? Well, maybe not exactly a village, but likely parents, grandparents, aunts, uncles, teachers, friends, neighbors, babysitters, and in many cases, nannies, au pairs, coaches, trainers, and personal assistants. Children, according to our society, need and deserve assistance from every possible source. Adults, on the other hand, should grow up and become independent. And seniors should fight to remain independent-at all costs.

Dr. Bill Thomas argues that this archetype is severely flawed. Joining a strong support network and becoming interdependent, he says, will help seniors live longer, healthier lives and is the answer to the impending eldercare crisis.

“We all have to accept the idea that aging is developmental. We have to understand that people grow old-and that growth is an important part of the process,” says Thomas. An international authority on geriatric medicine and eldercare, Dr. Thomas founded The Eden Alternative, a non-profit organization committed to improving the care received in institutional facilities. The Eden Alternative was born of necessity.

Thomas recalls, “My wife, Jude, and I were working in a nursing home in the early 1990s. Our first-hand experience led to the reform strategy that is the heart of the Eden Alternative.” Years later, Thomas took the strategy one step further. He explains, “We thought, ‘what if we could build a facility from the ground up, instead of trying to work with what was in place?'”

Dr. Thomas started over. He created a new model for nursing homes, and with a team of experts, prepared to build his village. Their efforts resulted in the Green House Project, a philosophy for designing, constructing, and operating long-term care facilities that is a dramatic departure from current standards.

Facility size, interior design and layout, staffing patterns, and the methods for delivering skilled services were all altered in the Green House plans. Homes will be much smaller than the average nursing home, housing only 15-20 residents, and will be more user friendly for both residents and staff members. Green Houses will be licensed as nursing homes, so that residents can receive care regardless of their physical condition, and services will be covered by Medicare.

The Green House Project even redefined staffing procedures for long-term care facilities. Green House staff members are trained shabazi, professionals who work to enhance the lives of the elders they serve. Thomas points out, “Our Shabazim are unique. They are trained in nursing, housekeeping, culinary arts, shared decision making, and teamwork.”

Dr. Thomas goes on to explain how the Green House Project did away with the departmental model so prevalent in nursing homes, in favor of an environment that fosters team work. “There is no boss or administrator in a Green House. R.N.s visit with patients on a regular basis to meet their medical needs, but the Shabazim take care of creating and maintaining a healthy ‘rhythm of daily life.’ They work as a team, and they feel like a team, and they really know the residents,” he says.

The pilot Green House was opened in Tupelo, MS in 2003. The home, called Green Houses at Traceway, has been deemed a success by its residents, staff members, and by industry professionals. Rosalie Kane, of the University of Minnesota, did a two year study on the Green House. Thomas notes, “Her evaluation showed better clinical outcomes, better staff and elder satisfaction, and proved that the Green Houses were financially viable, that they can be operated with the same amount it takes to run a nursing home in Mississippi.”

The positive outcome of the study led to the decision of the Robert Wood Johnson Foundation to provide an endowment for the program. The ten million dollar grant will result in the creation of Green Houses in all fifty states.

“America is loaded with nursing homes that are aging faster than the people in them. We have to decide whether or not we are going to rebuild them-or if we are going to choose to build something different in their place,” Thomas says. He feels confident that America is prepared for a change. He states, “I’ll make a bold prediction: Someday America will have 100,000 Green Houses, and there will be one million Shabazim.”

Not satisfied to focus only on seniors in need of high levels of assistance, Dr. Thomas has recently shifted his attention to active adults and independent seniors. He is attempting to create the interdependent environment fostered in Green Houses in communities that are mixed-use and made up of mixed-age residents. He calls these communities EldershiresT. EldershireT communities promote the idea that health and well-being are tied closely to the nature and quality of the community that surrounds us. Better communities are the surest path to a better quality of life.

EldershireT is based loosely on the Danish concept of co-housing. In the 1950s, the Danish government began to construct co-housing communities, developments of small homes built close together with several common areas among them. These planned communities foster connections among neighbors and offer distinct environmental and social benefits. In recent years, co-housing developments have begun to catch on in America.

Playing off the uniqueness and success of co-housing communities, Dr. Thomas and his team began planning EldershireT communities. EldershiresT are unique in their “focus on the value and worth of aging citizens as an important building block of a healthy community,” according to Thomas. He continues, “So much of what we hear about aging revolves around how awful it is and how terribly expensive it can be. We are saying that aging is an importation cornerstone of any community and that elders are a vital resource.” Dr. Thomas and his wife are in the process of planning the pilot community in Upstate New York.

The inspiration for EldershireT was to create a viable alternative to what Dr. Thomas terms the “aging in place paradigm.” He explains, “Today, aging in place is the Holy Grail; it is perfection. Seniors strive to remain independent in their own homes even if it means being lonely, isolated, or possibly in danger.”

Anything less than living independently, he says, “is seen as a defeat.” While remaining in a long-time home or a familiar environment is the first choice for most seniors, it may be a choice that is detrimental to their health-and the health of their communities. “Where do you think the term ‘shut-in’ came from?,” asks Thomas.

Isolated seniors are robbed of the opportunity to contribute to their community, and their communities, likewise, are denied their knowledge and expertise. EldershireT communities will tap into this resource by allowing seniors to “age in community,” instead of aging in place.

Dr. Thomas firmly believes that living in a supportive community can give individuals the opportunity to remain involved, engaged, and most importantly, interdependent. He concludes, “The number one reason people end up in long-term care facilities is social, not medical. I would argue that every nursing home resident in America has an exact clinical double living at home. It is the social network they have in place, whether that is children, friends, or an entire community, that allows them to live at home.”

If Dr. Thomas’s EldershiresT come to fruition individuals will age in communities and receive necessary support from their friends and neighbors. If care needs become great, residents will turn to home health providers, but until then, they will take care of their own-regardless of their age. They will be caregivers, and they will receive care. They will be comfortable in their dependence on each other. They will grow old, and they will continue to grow. They will be a village.

Dr. Thomas is the author of two books, the critically-acclaimed, What are Old People For? How Elders Will Save the World, and the soon to be released, In the Arms of Elders.

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