The business of caring for the elderly

Filed under: Focus |

Nursing homes are evolving. Patient profiles are changing – nursing home residents are dependent and increasingly infirm, requiring the skilled level of care germane to hospitals. The traditional culture of long-term facilities is changing to reflect the desires of the residents. Nursing homes are switching from a systematic structure to an all-inclusive and spontaneous concept, inviting individual choice and freedom.

The Eden Alternative, which defines nursing home care in terms of the resident/patient as opposed to the institution, is the new buzz phrase among nursing home administrators, and many are adopting it as a way to embrace the aging population.

Liberty Heights at Northgate is a tiered retirement community offering a continuum of services, including independent apartments, assisted living facilities and a 42-bed skilled nursing facility. Dean LaChance is the administrator of Liberty Manor, the skilled nursing facility. He said a physician, who believed the daily routines of the nursing home environment bred loneliness, depression and boredom among residents, developed the Eden Alternative concept. “Organizations in the past set up systems to address their systematic needs,” LaChance said. “Under the Eden Alternative, nursing homes are moving to the rhythms of the individuals. It’s about the people and their choices.”

For example, uniform meal times benefited the institutions, he said. Breakfast meals required residents to rise and shine at a specific hour, so the nursing staff could serve everyone at the same time. Liberty Manor changed that course when LaChance instituted a morning omelet bar, where residents partake at their leisure. “Residents can get up when they want; there are no more pressures or staff crunch times,” he said.

LaChance confirmed that people residing in the nursing home today have different profiles than former residents. Assisted-living facilities provide alternatives to people who are mobile and healthy but need help with personal care, medications, etc. They enjoy the freedom of independent living knowing that caregivers are close by.

Liberty Manor residents need skilled care because of extended illnesses or recent strokes. Some residents have mild forms of dementia and others are terminally ill. Liberty Manor contracts with a local hospice provider to aid the terminally ill. A few residents are short term, recovering from an illness or broken bone.

Regardless of their state of health, long-term care residents need activities and choice. The Eden Alternative concept encourages spontaneity with activities – engaging the residents in various ways that are not regimented, LaChance said.

Pet visitation is welcome, and a few staff members tote their dogs to work every day to the delight of many residents. “It’s all about providing a quality, home-like setting and giving a voice and a choice to residents,” he said.

La Chance ensures quality of care by staffing at higher-than-usual levels, paying a good wage, utilizing weekly, multi-disciplinary standard-of-care meetings and meeting monthly with the medical director to focus on problem areas or general facility care issues. Liberty Manor is a Medicare and private pay facility, and the majority of rooms in the nursing home area are private.

Many nursing homes, however, rely on Medicaid funding, and some are struggling to survive as government support dwindles.

Jana McDonald is the administrator of the 48-bed Garden of the Gods Care Center. She said Tabor and Amendment 23 restrictions have zapped government funding to nursing homes. “According to the Colorado Health Care Association, if nothing is changed with regard to Tabor and Amendment 23 this next year, the state will be refunding taxes in the amount of $350 million during 2005 and 2006 and cutting services by $250 million, and $30 million of those services include Medicaid funding for nursing homes,” she said.

“There will be no Medicaid beds, and many nursing homes will be forced to close. Meanwhile, the government wants more and more (regulations) and we are doing it with less and less.”

One federally sponsored program – the Nursing Home Quality Initiative – launched in 2002 by the Centers for Medicare and Medicaid Services, an agency of the U.S. Department of Health and Human Services, attempts to improve quality of nursing home care throughout the country. The Nursing Home Quality Initiative is coordinated in Colorado through the Colorado Foundation for Medical Care.

Angie Barrett is a physical therapist and a consultant with the Colorado Foundation for Medical Care. She said the statewide program, initiated in March 2003, addresses three nursing home problem areas: pain, infections and pressure ulcers. Representatives from the foundation provide assistance in nursing homes to identify and improve the problem areas. “We tailor our program to each facility,” Barrett said. “Nursing homes have welcomed the assistance, and it’s been a positive and successful program for the facilities.”

Thirty-two of the 222 nursing homes in Colorado are participating in the program, and nine are in Colorado Springs. The Garden of the Gods Care Center is one of them. McDonald said they have concentrated on efforts to improve pain and pressure ulcers through the quality initiative. “The initiative has brought the issues, like pain and skin care, to the forefront,” McDonald said. “And we’ve added holistic practices, such as massage and aromatherapy, to assist with pain management and encourage more activity among residents.”

The nursing home, which is 75 percent Medicaid funded, also is participating in the initiative’s culture change program, which aligns with the Eden Alternative. “We are redecorating the rooms and giving residents choices above and beyond federal and state guidelines,” McDonald said. “We are looking toward a social model instead of a medical model.”

Dot Falasco is the minimum data sets coordinator for Sunnyrest Health Care Facility Inc., a 107-bed skilled facility participating in the pain management and infection control programs provided under the statewide quality initiative program. “If pain is not controlled, residents become socially isolated,” Falasco said.

In response to the quality initiative program, the nursing home is conducting quarterly pain assessments that address medication changes, therapies and holistic practices. They involved the residents’ council, too, asking them to assist in recognizing the signs of pain in fellow residents.

Cultural changes within nursing homes could be a draw to aging Baby Boomers who swear they will remain independent until death. Because of the boomers’ attitudes and greater options, LaChance is not certain the nursing home industry can expect future growth, despite the aging population. “There are more home and community-based services today, the consumer is more sophisticated and people are choosing to remain in their homes,” he said. “And people, instead of fighting diseases at age 90, are opting to live comfortably through the disease.”

LaChance discussed the industry’s challenges. The regulatory environment is “horrendous,” he said. “I am not opposed to regulations, but the government’s reaction to poor performers brings about regulations that are burdensome to the group as a whole. And Reimbursement and Medicaid certification issues are key issues.”

A nursing shortage also affects long-term care facilities. “Staffing is a huge challenge,” LaChance said. “Everyone wants the best of the best, and it’s tough to get qualified nurses and aides.”

Regardless of the challenges, LaChance said it is a sure bet that the future of nursing homes is about empowering the residents toward individual choice.