I've read about the "Green House Project." I've seen homes that proudly carry the moniker "Eden Alternative." I've witnessed tremendous progress, physically and culturally, in many of our local nursing homes. But I've never had the foundation to defend my dream of patient centered, dignified lifestyles for our elders until I read Beth Bakers "Old Age in a New Age: The Promise of Transformative Nursing Homes."
This book should be read by every nursing home employee, from certified nursing assistants to administrators, and every government regulator and Medicaid employee. I'd also love to see everyone who is considering a nursing home for an elder have a copy of this book. If more people were informed about what is possible, there would be such a demand for improved services that there would be no way the masses could be ignored.
Baker has issues with the way aging is viewed in this country. She writes, "Nursing homes are a predictable outgrowth of a U.S. culture that views old age as a disease to be prevented or conquered, rather than a life stage to be honored."
Baker's book is all about cultural change. It's about moving from the perceived "efficiency" of most nursing home models to a patient centered model. She tracks the culture change pioneers in the nursing home field and visits their facilities to see how the elders respond.
What she sees is that when an elder is given choices; when an elder is treated like an individual; when an elder is tended to lovingly by staff that is respected by peers and supervisors alike - and the same caregivers are consistently there for the elder - then the elder thrives. People who had once quit communicating or were considered to exhibit "difficult behaviors" tend to become engaged in their new, patient-centered environment and exhibit more friendly personalities. Many examples given by Baker are total transformations for people thought to be unreachable. They were "reached" simply by giving them choices and treating them as honored individuals.
Much of this progressive thought process has been spreading across the nation in the last decade. Too late for my folks, but several years ago, the nursing home where my parents spent many years went to a flexible meal plan. If my mom could have eaten the frequent light meals offered at any time of day - the plan they now offer - she likely would have been able to eat more. She would have lost less weight, stayed healthier and maybe even fallen less often.
Unfortunately, though the home was excellent, they were still stuck in the three-meals-a-day plan, with a huge heaping of meat and potatoes at noon. Mom would feel sick at the sight of the heavy meal and completely lose her appetite. I kept her supplied with fruit and vegetables she loved, and cold shrimp and sauce (she had a cooler) and other goodies. But still, I couldn't be there for every moment she wanted something light to eat. With new meal plans now being adopted by facilities today, this would have not been an issue. She could have eaten lightly several times a day, and she would have enjoyed food far a longer period of time.
Doesn't this type of food plan cost more? That's the first question people ask. The answer I've gotten, coming from Baker's book as well as administrators I've visited with, is a resounding "no." There is less waste when there is more choice, and people eat better, so fewer supplements are needed. Many homes find food costs go down.
Baker writes about ground up physical renovations such as building homes per the Green House plan, where groups of ten people, each with his or her own bedroom, live together in a modified house. They are watched over by a specially trained CNA. Baker writes about other homes in the Pioneer Network that are working under their own plans.
Not every facility can completely rebuild their physical plant, but changes can be made to make even older facilities less institution-like. Most changes are attitude changes. Cultural changes. As always, it's the people that count. And that means the people who work at the facility, starting with the most important employees - the lower paid and often less respected CNAs. A true culture change puts all employees into the mindset that they work together for the good of the elder and they each respect the other for the job they do. The staff is happier, therefore there is less staff turnover, and once again, the homes save money.
The key to a good employee is how he or she views the elders they care for. Do they look at them as individuals that, if understood and worked with can still have a satisfying life, or as just another resident to warehouse until he or she dies? This is where the most fundamental change must occur. Giving choices - truly believing that elders are in another life phase, as opposed to just sending them out to pasture - this is where the culture change must start.
Floor plans, food plans, costs and regulations are all addressed in "Old Age in a New Age." What Baker leaves me with is a sense of excitement. She helps me have faith that nursing homes can and will be totally transformed. She leaves me with the hope that the sheer numbers of boomers, rather than being a frightening thing, may push change so that our elders (and older boomers) are able to experience a quality life, even when their bodies and minds make it impossible to live an independent life.
Baker gives examples of changes made that save money while providing better care; changes that stay within the Medicaid budget, so it's not just more of the same - the people with money get good care, and those without get ignored (or worse). These changes would take place in such a manner that every elder gets the kind of care and living conditions he or she deserves, no matter what financial circumstances they come from.
I pray that Beth Baker's "Old Age in a New Age" has as lasting effect on our culture as the hospice movement has had. Our elder years are part of our life cycle and people in that part of the life cycle deserve humane care that includes making choices in their everyday life.
Old Age in a New Age, by Beth Baker is published by Vanderbilt University Press (2007).
Published On: December 20, 2007