Nursing Homes Magazine

From: Subject: Nursing Homes Magazine Date: Mon, 17 Apr 2006 10:20:49 -0600 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0000_01C66208.994600C0" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.2869 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01C66208.994600C0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.nursinghomesmagazine.com/Current_Issue.htm?ID=4929 Nursing Homes Magazine

April 17, = 2006

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Creating the=20 nursing home of the=20 future

Interview=20 with Michael Follett, Administrator, St. = John=92s Lutheran=20 Home, Billings, Montana

What if = the=20 traditional =93nursing home=94=97that (average) = 120-bed=20 structure designed to look like a=20 mini-hospital=97disappeared from the national = landscape?=20 What if people gave up on trying to make such = structures=20 =93homelike=94 and decided to walk away from the = institutional model altogether? What would come=20 next?

How about residents living in = cottages=97say=20 about 12 per cottage, with common dining and = living=20 areas, each with a dedicated, specially trained = staff?=20 Although it sounds like the famous Green House = model=20 conceptualized by long-term care pioneer Bill = Thomas,=20 MD, a set of small structures in Billings, = Montana, has=20 grown independently from the Green House = movement and=20 is on a fast track to replace a 120-bed = nursing home=20 by next year.

These are the cottages of = St.=20 John=92s Lutheran Home, two of which opened = about a year=20 ago on this 40-plus-year-old multilevel campus, = with=20 another five scheduled for construction starting = this=20 summer. The initial cottages=97named Langemo and = Moorberg=20 after former St. John=92s board = chairpersons=97are designed=20 to accommodate persons with mild-to-moderate = Alzheimer=92s=20 disease. The next ones are aimed at broadening = the=20 resident populations served in these intimate = settings=20 to encompass all 120 of the existing nursing = home=92s=20 residents, skilled and otherwise. The cottages, = costing=20 $2.9 million for the two, are approximately = 8,000 square=20 feet each , with all-private rooms with baths, = large=20 open kitchen/dining area, living room with = fireplace,=20 den, and outdoor patio. Monthly rates are $3,780 = for a=20 private room and $4,110 for a deluxe. All = together, 23=20 of the nursing home=92s staff have received 257 = hours of=20 training to function in this setting. Needless = to say,=20 adapting to this has involved extreme staffing = and=20 logistic challenges for St. John=92s management. = Recently,=20 Administrator Michael Follett, who is the = spearhead=20 bringing this to fruition, discussed the whys = and hows=20 in a recent interview with Nursing Homes/Long = Term=20 Care Management Editor-in-Chief Richard L.=20 Peck.

Peck: Why are you replacing = your=20 nursing home with cottages?

Follett: = I=20 think it=92s because we=92ve found that the = nursing home=20 care model is fundamentally broken. Virtually no = one in=20 the country would choose to live in a nursing = home; in=20 fact, people usually feel that they=92re = =93sentenced=94 to=20 this by their physical condition and their kids. = One way=20 the traditional model is broken is in the way we = staff=20 these institutions=97they=92re so = departmentalized, with the=20 wrong idea that =93bigger is better=94 when it = comes to=20 efficiency. We have department upon department = in our=20 organizations: nursing, nutrition, laundry,=20 housekeeping, maintenance, and more. No one=92s = actual=20 home is like this and, as it turns out, the = =93bigger is=20 better=94 approach doesn=92t work the way it=92s = supposed=20 to.

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Peck:=20 But how did you come up with the cottage = idea as an=20 alternative?

Follett: First, a = little bit=20 of history. St. John=92s Lutheran started in = 1963 as the=20 first HUD-financed retirement home in Montana, = and that=20 was followed four years later with construction = of the=20 nursing home. We added on to that structure in = the=20 mid-1970s, as mental hospitals in the area = started=20 emptying out their geriatric populations. By the = 1990s=20 it had been obvious for years that we had an = aging plant=20 and that, no matter how much carpeting and paint = we=20 applied to it, it was still pretty much = semiprivate=20 rooms and less than nurturing bathing = facilities. We=20 began looking at alternatives in the 1990s, such = as=20 =93pod=94 design, but it was still = institutional. Then, in=20 the fall of 2002, I received a phone = call.

My=20 grandmother, the matriarch of the family, had = suffered a=20 stroke. She had made us promise never to put her = in a=20 nursing home, but life doesn=92t work that way, = and we=20 placed her in an institution. However, in spring = 2003 my=20 parents invited me to see her new accommodations = in an=20 assisted living facility in Washington State. It = was=20 located at the end of a cherry orchard, and it = was a=20 Thomas Kinkade=96looking cottage with private = rooms for=20 the residents. I videotaped this and showed it = to our=20 management, and everyone was quite interested. = Then, in=20 early 2004, I heard about the Green House = conference in=20 Tupelo, and found the Thomas Kinkade cottage all = over=20 again. The people managing that faith-based = organization=20 are in many ways similar to us and were happy to = share=20 their insights. I later took three architects = and a=20 construction manager to see it and live it=20 firsthand.

By this time we knew we had a=20 shortfall in our organization. Although we take = pride in=20 our continuum, which encompasses skilled = nursing,=20 assisted living, independent housing, and adult = day=20 care, we were lacking in accommodations for = people with=20 moderate Alzheimer=92s who weren=92t in need of = skilled=20 care. We were losing them to other assisted = living=20 organizations in the area. We decided to fill = this niche=20 by building two prototype assisted living = cottages=20 designed to skilled nursing standards. We opened = them=20 last August; they=92re full, and they=92re = meeting and=20 exceeding our dreams and = expectations.

Peck:=20 You have 23 dedicated staff for these = cottages, and=20 you=92ve provided them with 257 hours of = training each.=20 And you call them Elder Sharaths, which sounds a = good=20 deal like the Green Houses=92 =93Shabazzim.=94 = Would you=20 elaborate?

Follett: = [laughs] We=20 wonder if maybe they got it from us! We started = this=20 concept about seven years ago when, in an = attempt to get=20 high school and college students connected with = what we=20 do, we began the =93Elder Chabar=94 program. = =93Chabar=94 is=20 Hebrew for fellowship. The word =93Sharath=94 is = Hebrew for=20 =93serving, attending to, or ministering unto=94 = someone.=20 Our youthful Elder Chabars made $5.50 an hour, = plus $1=20 an hour for every hour worked that went toward a = scholarship for them, and worked a 3:30 p.m. to = 7:30=20 p.m. shift. Several of these kids came back as = CNAs in=20 the summers and one of them now works here as a = nurse.=20 In preparing for the new cottages, we provided = 169 hours=20 of special training as universal workers, plus = another=20 88 hours if they weren=92t a CNA = already.

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Peck:=20 What sort of training did you provide, and = how did=20 you organize it?

Follett: We train = them as=20 universal workers (Elder Sharaths) in various = areas,=20 such as medication administration, CPR and first = aid,=20 self-managed team care, conflict resolution, and = culinary skills. Five other senior managers and = I=97they=20 called us the Six-Pack=97sat through every hour = of their=20 training. Now I know that we have to figure out = how to=20 do this in fewer hours for more people, and = we=92re=20 working on that. The logistics of doing this are = close=20 to overwhelming, what with sequencing staff into = the=20 cottages and bringing in temps to cover for them = during=20 training periods. It=92s a pretty significant = cost=20 altogether, but we feel it=92s worth it in terms = of staff=20 recruitment and retention.

Peck: = Why do=20 you say that?

Follett: Because 95% = of the=20 decision making flows down to frontline staff; = they=20 respond to that with enthusiasm, and they hold = each=20 other accountable. Just recently, we had our = first=20 call-in in months, and staff confronted that = person to=20 the point that a doctor=92s note was brought in = confirming=20 strep throat. Staff is taking ownership of its = roles and=20 responsibilities.

Peck: What = implications=20 do you see in this arrangement for your role as=20 administrator?

Follett: I would = expect=20 that ten years from now, my position won=92t = even be=20 needed. I see the Elder Sharaths =93making = plays,=94 sort of=20 like the University of Texas football team that = won the=20 national championship in January, with the = administrator=20 acting as coach.

Peck:=20 What impact do you see this having on = overall=20 staffing?

Follett: I think we will = require=20 fewer total staff. Take, for example, our = nutrition=20 services department, which today has 65.14 FTEs = serving=20 1,300 meals a day. In the cottages, the Sharaths = are the=20 ones preparing the meals, with our nutrition = department=20 serving as a kind of Costco wholesaler=97for = example, a=20 25-pound roast comes in and nutrition services = divides=20 it up and distributes it among the Sharaths for = cooking.=20 In essence, this operational structure will cut = our FTEs=20 in half.

Is this a bad message to pass = on to=20 existing staff? It could be seen that way. But = you have=20 to make it clear from the start that we will = always have=20 a need for staff whose hearts and efforts are in = the=20 right place in this sort of care. But peoples=92 = jobs are=20 going to change, including my own. Some don=92t = want to=20 hear that, and some can=92t handle it. We = recently had a=20 24-year nurse resign, saying that while she = understood=20 and admired the concept, she just couldn=92t = live it. She=20 had been in an institutional situation her whole = career=20 and didn=92t want to deal with change like=20 this.

Peck: As an administrator, = how do=20 you deal with this rather unsettling=20 situation?

Follett: Right now I = feel that=20 I=92m living in two cultures. The cottages are = functioning=20 pretty independently, but other parts of our=20 organization are institutionally entrenched. It = takes=20 every ounce of energy to cope with these two = cultures,=20 and there are times when it feels like the = tension never=20 ends. But, in fact, these two worlds are = colliding=20 across the United States. I think that, in the = end, the=20 institutional world will explode as the other = world=20 overcomes it. But it=92s an inevitability: The = model has=20 got to change.

For further information, call (406) 655-5600 = or visit=20 http://www.sjlm.org/. = To send=20 your comments to the editors, e-mail 2peck0306@nursinghomes= magazine.com.

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Cohousing: The=20 next senior housing=20 option
Interview with Zev Paiss, Cofounder, = Elder=20 Cohousing = Network

Imagine a=20 group of seniors getting together, deciding they want = to start=20 a little community of their own, raising the money, = working=20 with professionals to develop the structures and plan, = and=20 then running it as a consensus group. =93Far out!=94 = comes the=20 distant cry of 1960s commune dwellers. But this = isn=92t =93out=20 there=94 at all. It builds on a Denmark-inspired, = 30-year-old=20 community-planning model called = =93cohousing=94=97developed=20 typically for intergenerational populations=97and the = past two=20 years have seen a new focus on the over-55 side of the = age=20 continuum. At least three senior cohousing communities = are in=20 various stages of development in Davis, California; = Abingdon,=20 Virginia; and Boulder, Colorado, and more are on the = drawing=20 boards. They comprise some of the most active=97and=20 activist=97older citizens in our midst, and they=92re = offering yet=20 another independent housing option that long-term care = providers might do well to study and learn how to live = with.=20 Recently, Zev Paiss, cofounder of the nationwide Elder = Cohousing Network, described the concept, its = implementation,=20 and its implications for long-term care in an = interview with=20 Nursing Homes/Long Term Care Management = Editor-in-Chief=20 Richard L. Peck.

Peck: Is this what we = children=20 of the 1960s used to call a =93commune=20 movement=94?

Paiss: No, it=92s really = more in the=20 nature of a group of seniors coming together; = coalescing into=20 the idea of developing a small neighborhood of people = who like=20 living and doing things together; financing it = conventionally=20 with bank loans, usually as a limited liability = partnership;=20 and working with professionals to develop the housing = and=20 amenities. There=92s really a balance between privacy = and=20 community-mindedness. It=92s similar to a town house = or=20 condominium development run by a homeowners = association, but=20 with residents doing more things = together.

Peck:=20 Just how involved are residents in actually planning = and=20 developing the property?

Paiss: The = future=20 residents provide input every step of the way=97site = plan, floor=20 plans, ongoing focus groups for prospective residents, = and so=20 on. They meet on a regular basis to learn the skills = of=20 running an association via = consensus.

Peck: How=20 would communities like these be operated day to day? = Is there=20 someone=97an executive director, say=97who is =93more = equal=94 than=20 others?

Paiss: They have typical boards = of=20 directors and officers. My community has 11 = households, all of=20 which are represented on the board, including four = officers.=20 We meet monthly, with a much higher level of = participation=20 than in the typical multihundred homeowners = association. Daily=20 problems or situations that arise become the = responsibility of=20 individual committees to deal with. But this is not a=20 =93faceless=94 form of government; most of the people = have known=20 each other for years before going into this, and = it=92s pretty=20 easy to get people together to address issues, do = budgets and=20 the like, and develop consensus.

Peck: = What=20 would be the =93typical=94 population of a community = like=20 this?

Paiss: They range in age from 55 = to 75;=20 are usually well-educated, with lots of professionals = both=20 retired and working; and are definitely socially and=20 politically involved. Specifically, they tend to be=20 entrepreneurs, people in the helping professions, = civic=20 activists, writers, and artists. They=92re of the = population=20 group that has recently been called the =93Cultural = Creatives=94=20 (and there=92s even a Web site called www.culturalcreatives.org). = It=92s been=20 estimated that this group consists of some 50 million=20 =93self-starters=94 who are interested in alternative = approaches=20 to life. There is also a growing interest among = religious=20 communities in this approach.

Peck: What = implications might this movement have for long-term = care=20 providers?

Paiss: That is a key = question. In=20 fact, many actively involved in developing senior = cohousing=20 are discussing this issue right now. This all began = with the=20 assumption that residents would start off generally = fit and=20 active, but there=92s realization that this won=92t = always be the=20 case. More and more, these places are being designed = for aging=20 in place, with universal design elements and an = emphasis on=20 home care. But Alzheimer=92s disease is another = matter, and more=20 thought is being given to how to handle this. The = basic model,=20 though, is bringing as much supportive service and = care to the=20 resident as possible, along with providing space in = common=20 houses for treatment and rehabilitation and on-site=20 professional caregivers. One interesting model that = many=20 readers will no doubt be familiar with is the PACE = (Programs=20 of All-inclusive Care for the Elderly) model, which = many are=20 studying. It=92s conceivable that cohousing could = someday=20 replace today=92s models for CCRC-based independent = living and=20 assisted living, with separate provisions for skilled = care=20 added. This movement, though, is just springing out of = the=20 ground and has a long way to go.

For further information, contact the Elder = Cohousing=20 Network at info@eldercohousing.org=20 or visit http://www.eldercohousing.org/.

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