Putting the ‘home’ back in nursing home
County officials briefed on small facilities that aim to empower residents, offer cozy atmosphere
By Jennifer Buske
Washington Post Staff Writer
Thursday, December 10, 2009
Forget the drab walls, mass dining area and sterile hospital feeling often equated with life in a nursing home.
Instead, picture a traditional family house where the aroma from the kitchen fills the air and where just a handful of residents live, setting their agenda and getting one-on-one attention from staff members.
Conventional senior care is being transformed as localities nationwide embrace a new philosophy about long-term care that emphasizes independence and puts control in the hands of the country’s aging population.
“We used to think of [long-term care] as institutional nursing homes, and that is no longer the case,” said Courtney Tierney, director of the Prince William Area Agency on Aging. “It’s all about consumer choice now and resident-directed care.”
Tierney briefed the Prince William Board of County Supervisors last week on the Green House Project and how it can fit into the county. The project, the brain child of New York geriatrician William Thomas, aims to de-institutionalize care for the elderly and place people who need assistance back in the community in a Green House, where personal care and clinical services are provided in a more relaxed and homelike setting. The supervisors took no formal action on the issue.
“Nursing homes were modeled after hospitals, and no one wants to live in a hospital for potentially years; people want to live in a home,” said Ruta Kadonoff, Green House Project deputy director. “There is a growing desire to create an environment that allows people to grow and thrive and live no matter what their medical or cognitive needs may be, and that’s where the Green House fits in.”
The concept has grown from a single Green House built in Mississippi in 2003 to 73 across the country, Kadonoff said. She said the closest ones nearing the construction phase in the region are in Baltimore and Harrisonburg, Va.
Green Houses, so named because they are intended to be places of continued growth and life, are built for seven to 10 people. Residents are the primary decision makers and are not subject to the monotonous schedule often found at nursing homes, according to the Green House Project. The houses have kitchens and family rooms where residents can gather as well as individual bedrooms they can decorate. A medical staff is on hand, with nurses providing medicine and care on an individual basis, not at a centralized nursing station.
Tierney said one of the reasons for the shift away from traditional care is efficiency. If residents and staff members are happier, the facility will be more efficient with less turnover and medical costs could potentially be lower, she said. People want to age in place, she said, and regulations are mandating that nursing homes become less institutional.
Research shows the cost to operate a Green House is similar to that of a traditional nursing home, Kadonoff said. Medicaid coverage is also the same at both facilities. According to the 2009 MetLife Market Survey, the average cost for a private room in a traditional nursing facility is $219 a day. People might pay a little extra out of pocket, depending on which Green House they choose.
Although the Green House Project is focused on building houses instead of traditional nursing homes, Tierney said the Green House philosophy can be adopted in existing facilities. Prince William County, Manassas and Manassas Park have five nursing homes and 14 assisted-living facilities. Nursing homes, she said, can change their staffing structure to allow for more one-on-one interaction or turn hallways into “neighborhoods” or small communities to make the facility feel more like home.
Tierney said the 85-plus population in the Prince William region will nearly triple from next year to 2030 to an estimated 10,000 people. But most seniors will remain healthy and active contributors to the community.
“The Green House is a philosophy, and you can change your philosophy of operation in any setting,” Tierney said. “I think it’s very forward-thinking of the board [of county supervisors] to consider the well being of people who need long-term care services and that they are interested in ways we can better serve people and keep them in community because they are all vital members of the community.”