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Bill is a visionary leader in the online Changing Aging movement and a world-renowned authority on geriatric medicine and eldercare. Bill is founder of two movements to reshape long-term care globally – The Eden Alternative and Green House Project.

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  1. Al Power
    Al Power at | | Reply

    I think there’s a much bigger issue at stake here. While both The Eden Alternative and The Green House Project have led a revolution in elder care, “elder care” itself is a concept that needs to be more radically reinvented than what most current culture change practitioners have accomplished.
    I say this, not because of the (very legitimate) financial arguments, or even the (also very legitimate) moral arguments, but rather due to a simple matter of demographics: if we do not do away with the notion that the solution to aging is simply “better long-term care”, then we are in for a lot of trouble. The reason is that our system of pulling elders out of communities and moving them to separate campuses–whether skilled, assisted or independent living–is unsustainable with our shifting demographic (in 2050 there will be only 4 working-age people in America for every elder).
    This system creates a need for more infrastructure and more of a workforce to “provide services”. Thus, aging becomes a commodity that is heavily monetized, and elders are systematically disempowered and marginalized, albeit in a kind, paternalistic way.
    I believe we need to create better ways for elders to succeed in our communities and create a social structure that enables those elders to continue to have important roles in those communities (including those living with dementia). What our culture change movement has not done effectively is to move beyond the paradigm of older adults “needing services”, so we are locked in this mindset of how to provide better care within a broken societal system. Providing opportunities to give and receive care in a nursing home is not enough; we need to go much farther.
    Granted, there will always be people who need skilled care in a congregate living setting. For this group, the community-integrated Green House, in my mind, remains the best prototype, but I think the power of social capital and the gifts elders can return to society have yet to be fully explored and unleashed.
    So…what’s the modern nursing home to do? I vote for continuing to work to create a new elderhood for our current communities through Eden and the Green House, but also realigning our strategic plans to move beyond simply being purveyors of skilled care and other services, toward being more truly integrated with our communities as vehicle for changing aging. Bring people into your organization with cafes, education offerings and community outreach projects, and move people out through expanded community connections. The sooner we start to blur the lines, the better positioned we are for the future in which simply being an SNF will not be a viable business.
    I’m rambling a bit, but one thing is certain: we will never have more money or more staff; and we will likely have less of both. The time for a serious paradigm shift is upon us.

    1. Meredith Ann Rutter
      Meredith Ann Rutter at | | Reply

      Al Power makes a great point, and one that drove me back into Bill Thomas’s book “What Are Old People For?” – the chapter “Eldertopia,” pp. 299-314. He suggested some excellent ways to start bringing elders [sometimes back] into current communities. I hope people will add that chapter into their thinking on this topic.

  2. Paul Riccio
    Paul Riccio at | | Reply

    If everything in the above written article is accurate (and I certainly believe it to be so – the gentleman did a fantastic job of saying what many know to be true), then there is only one way to convert both…

    Perhaps culture change’s biggest roadblock is the misconception that it’s not profitable. That it does not fulfill the profit line as well as another method. However, Eden Alternative and culture change, done well, wisely, and thoroughly, will ultimately make an organization the provider of choice within their community.

    When for-profits are losing that valuable Med A admission because an elder wants to go someplace that feels like home, where they feel valued and cared for, then they will start to invest in culture change. When non-profits start filling all their census and beating the for-profits because they treat the elders (and their staff) with dignity and respect in a home setting, the long-term care industry in the area as a whole will at the least take notice of culture change. Some will not chase it – but many more will.

    The culture change movement should become more aggressive and active – yes – but it needs to do so in a way that shows this is a win-win-win situation. The Elders win, our industry and culture change wins, and the facilities ultimately win because they become the provider of choice.

  3. Mark Anderson
    Mark Anderson at | | Reply

    Then there are the state agencies that want facilities to be sterile places where substantial compliance means no mistakes, no variances and no cultural flexibility. I don’t see CMS becoming kinder and friendlier and that is the real bottom line we’re living with. Culture change is the right path but it seems like I have to disguise it when the state agency visits!

  4. amanda griffin
    amanda griffin at | | Reply

    I give tours all the time to companies who “want to see it work”. Send them my way. I would be happy to show them the way.

  5. Kayce Gentry
    Kayce Gentry at | | Reply

    Absolutely. I have been trying to bring Eden to my facility’s nursing home for 5 years – and there is nothing to show them the benefit. Having a touchy-feely-look at the bottom line facility in our state would be SOOO helpful. Right now it’s like the blind men examining the elephant. Let’s figure out a way to show what the big picture is.

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