The Denver Post ran a story that is, at least at first glance, encouraging. Titled, "Rebirth in care of the elderly," the story centers on the changes in attitude of administrators and staffers in nursing homes. Patient-centered is the key word, here. There is more awareness, thankfully, that good care centers aren't in business for the convenience of the staff. They are there for the residents.
Awhile back, I reviewed on this site Beth Baker's wonderful book Old Age in a New Age. Baker's book is a great primer on the Pioneer Network and other powerful groups in the nursing home world that have proven repeatedly that the old nursing home model, which was set up like a military barracks (or even a prison) for the sake of perceived efficiency, is a disaster, and hopefully a dying breed.
Good nursing centers these days have several meal options available at different times of the day. I can't help but think of my mother, who was okay with a light breakfast, but couldn't eat most of the huge breakfasts served. Then, they'd serve a huge noon meal, just like these people were out working on the farm all day. In the evening, they'd serve a lighter meal, which she generally enjoyed.
We were lucky in that my parents were in an excellent home, for the time. We also knew the staff well (I visited someone there nearly every day for 15 years). The staff tried very hard to help my mother get good things to eat, and I brought her favorite foods on a regular basis. Just as she was reaching her death, the home was going through the process of setting up the kitchen for many meals a day, where patients could order what sounded good to them - a light snack or full meal. This came too late for Mom, but was wonderful to see.
This home has now been totally remodeled, with more private rooms. Even the shared rooms are so much like private rooms that those who lived there during my parents' era wouldn't recognize them. They have a great new administrator (the old one was good, too, but this new fellow is really into the patient-centered dream). He's working hard at it and it shows.
Some of the examples in Baker's book are absolutely dream-like. The Green House project sets up small home communities, where people are served by what we could call a house mother. It's an amazing plan that pushes the boundaries of what people consider nursing homes.
Will all homes be like the one described in the Denver Post article, or the best of the best homes highlighted in Baker's book? No. Unfortunately, we still have some terrible homes. But most are feeling pressure to keep improving.
Staffing is one of the biggest issue when it comes to making a home better. Acceptable pay for those who care for our elders is a key factor in reform, sinice quality people are what we need to make these changes. It's all expensive.
However, better food and more choices means less waste and fewer pricey supplements; healthier residents, because of better nourishment and exercise, mean fewer drugs and doctor calls; meaningful activities help depression and improve cognitive function. All of these are advantages that may help balance the financial scale, if people are willing to look for ways to provide a better quality of life for those who need care.
The wave of aging boomers coming at them is going to press nursing homes to offer more home-like treatment, activities that really mean something, swimming pools, saunas, good food, coffee bars - you name it. Will it happen all at once? No. But change is in the wind.
Published On: November 21, 2008