Old Age in a New Age: The Promise of Transformative Nursing Homes

Introduction

  1 Introduction The shift from the old culture to the new is not a matter of adding on a few items that were missing, but of seeing almost every feature in a different way. —Tom Kitwood, Dementia Reconsidered I came to this story in a roundabout way, while writing a piece for the Washington Post on an unusual line of medical research. Scientists were quantifying what many people feel instinctively—that there are health benefits to being around nature. As part of my reporting, I tracked down Dr. Bill Thomas. He and his wife, Jude, had created a new kind of nursing home, one enriched with houseplants, a vegetable garden, cats, dogs, birds, and children . He called this model the Eden Alternative. By the time I interviewed him in 2002, he had won many converts to the radical notion that people in nursing homes could lead rich, rewarding lives. Here was a much larger story than my original one. As Bill Thomas put it, “How do you take something as sterile, as institutional, as a nursing home and inject this normal pulse of life into it? That is the challenge.” Our conversation stayed with me. I went on to write articles about the movement, of which Bill Thomas is a part, to transform how we live in old age. The more I learned, the more I wanted to know. The leaders of this movement intrigued me. Bill Thomas, a blue-jeaned Harvard-educated physician , lives off the grid in rural New York and calls himself a nursing home “abolitionist.” Steve Shields, a former oil prospector turned nursing home administrator, is the all-American can-do guy who led a nationally recognized transformation of a retirement community in Kansas. Charlene Boyd, sophisticated and dynamic, helped create a vibrant community of staff and elders at a Catholic long-term care facility in Seattle, and Eric Haider, an earnest, India-born visionary, turned a county poor farm in rural Missouri into one of the most liberated nursing homes in the country. 2 Old Age in a New Age Their backgrounds, stories, and organizations were unique. Yet somehow, independent of each other, they arrived at similar strategies for transforming the lives of both residents and staff of nursing homes. They hope to be in the vanguard of a fundamental cultural shift in our society. Eldercare in our country is a patchwork of housing and health services that includes short-term rehabilitation facilities, intermediate and skilled care, assisted living, small board-and-care homes, home-health services, adult daycare, and continuing-care retirement communities offering a spectrum of options. In this book, I focus on two important pieces of this patchwork— nursing homes and, to a lesser extent, assisted living. In part, this is where the trail of the story led me. But I also recognized that nursing homes are the most intractable and dreaded of these places. If we can find a way to make them right, the rest will fall into place. I make an underlying assumption: that we will continue to need places where elders live, beyond their own homes. This may not be a bad thing. For many people living in their own home means being isolated, lonely, and fearful, eating microwaved frozen dinners and watching endless hours of television. Is it possible that one reason people cling to their independence is that the alternatives are so unappealing? What if instead there were communities where the spirit was nourished, along with the body tended? Many assume that any significant change in eldercare is unaffordable. But as we will see, living well doesn’t have to cost more. The places I visited served all classes of people, from those who were formerly homeless to those who were wealthy. Most places had a high proportion of residents who were on Medicaid. Fundamentally, the envisioned change is one of the heart, and the investment that is required is not so much financial as attitudinal. Culture-change leaders address critical and costly problems such as high staff turnover and resident neglect. Exceptional homes also tend to have long waiting lists rather than empty rooms. By reducing expenses and increasing revenue, these homes do not typically cost more to operate. That said, a foundational goal of any long-term care system should be a living wage and health insurance for all employees. Those who care for our most vulnerable loved ones deserve at least this much. We—as taxpayers and as families—already pay an incredibly...