Stateline.org, the premier government policy and news reporting web site (where I happened to get my start as a young journalist), just published an in-depth profile of the Green House® Project movement.
Stateline specializes in picking-up on emerging trends that are poised to have a big impact on the nation. In regards to the culture change movement, Stateline reporter Chris Vestal has this to say:
…the culture change movement isn’t just about new architecture. It’s about states adopting a new attitude toward regulation so that facilities can create more home-like settings and give elders more privacy and control over their environment.
Vestal visited The Leonard Florence Center for Living in Chelsea, Mass., to provide an excellent example of how collaborations between the nursing home industry, government regulators and culture change advocates is revolutionizing the delivery of long term care:
CHELSEA, Mass. — The Leonard Florence Center for Living in this working-class neighborhood on the outskirts of Boston is technically a nursing facility — a place most people hope they can avoid. But for Rhoda Klein, age 79, this five-story urban complex feels like home.
There’s a calm and comfortable atmosphere in Klein’s apartment, which she’s decorated with her own dresser, chair and other furnishings she brought from her house in Florida. Outside Klein’s door is a common area with an open kitchen, a fireplace and a long dining room table where other residents in her suite often hang out to talk or eat. The residents interact with their caregivers, assigned four at a time to the suite, with the ease of old friends. There aren’t many rules or schedules to follow. “I decide every morning what I want to do that day,” Klein says. “I can share group meals if I want to. Or play bingo and just have a snack. If I get hungry later, someone will make me a meal.”
Klein’s nursing home lifestyle is also notable for what it isn’t. There’s no long gray linoleum corridors with doors that open onto shared rooms with nothing but a curtain between the beds. No beeping monitors or carts full of soiled linens and no patients in wheelchairs parked in the hallways. Few rules govern when, what and where residents can eat.
Vestal also delves into the origins of institutional nursing homes:
The reason nursing homes have traditionally had an institutional feel to them is that most were designed in the mode of hospitals. That mentality extended to the physical space, leading to a standard two-wing design with a nurse’s station in the middle — a floor plan known in the industry as the “double-loaded corridor.” It also extended to the state regulations and rules governing everyday life in nursing homes. These tended to favor considerations for safety and medical care over concern for residents’ quality of life. Little or no attention was paid to making residents comfortable or fostering relationships between the staff and residents.
As a result, frail elders in nursing homes have suffered from the “three plagues of boredom, helplessness and loneliness,” says Dr. Bill Thomas, a geriatric physician and a leader in the culture change movement. A self-described nursing home “abolitionist,” Thomas would like to see old-style nursing homes eliminated altogether.
At a minimum, Thomas says state policymakers should put a moratorium on any new construction of institutional-style nursing homes. “Every single time a state green-lights an old-fashioned nursing home, they’re condemning its residents to inferior care for the next 30 or 40 years until that building wears out,” he says. “That’s not a good investment.”
In their place, Thomas wants to see more small cottages or apartments like the one Klein lives in at the Leonard Florence Center — designed for 10 to 12 residents with skilled health care workers who give individual attention to each person. Thomas’ design has been replicated in 50 such facilities in 13 states, built with the support of the Robert Wood Johnson Foundation and NCB Capital Impact, a nonprofit community development organization. Dozens of other small nursing facilities have been built across the country with the same goals in mind, gaining support from private donations, and in some cases, direct state and federal grants.