Placing an elderly loved one in a long-term care facility—well known for their less-than-stellar reputations—can be as unavoidable as the feelings of guilt and regret that accompany the decision. But, when your elderly loved one's health deteriorates to the point that you can no longer provide day-to-day care for them, a nursing home or assisted living facility may be the only option.
Happily, radical changes in the industry may eventually transform long-term care from the only option for seniors with advanced medical needs —into the best option.
As we look at the revolution taking place in this vital source of elder care, we'll follow the story of an elder living in one of these facilities.
*Names have been changed to protect privacy.
Kate lay in her bed, completely still, her thin, silvery hair fanned out on her pillow. Her gaze is fixed on the ceiling and, if not for the gentle rise and fall of her chest, a casual observer might mistake her for being dead.
It's been months since Kate has moved on her own, she hasn't spoken for almost as long, several bed sores have begun to spring up on her prone form…
This is the nightmarish vision that people see when they think of life in a long-term care facility, such as a nursing home, or assisted living center.
The decision of whether or not to put an elderly loved one in long-term care is one that caregivers face with guilt and seniors face with dread. And, up until recently, their fears weren't unfounded.
"The field of long-term care hasn't seen a lot of change since the 1960s. For half a century, we've been in the grip of a system that has been very conventionally operated…The conventional nursing home was never designed with elders and their family in mind; it was designed with the staff in mind."
William Thomas, M.D., author of The Tribes of Eden, and co-founder of the Eden Alternative and Green House Project, feels that it's time to re-think how we approach caring for elders who need long-term assistance.
This new approach is one that aims to tackle one of the most persistent complaints among people in long-term care facilities: the lack of dignity.
Robert Bua, president of Genworth Financial's caregiving division, says, "The main flaw [of nursing home care] is basically the loss of dignity and privacy." He says that nursing homes in particular have recently begun to focus on infusing more dignity into their care delivery system by caring for the whole person—not just their medical ailments.
Going outside the box to deliver dignified care
Sara, a nurse, had been looking after Kate ever since she entered the nursing home several years ago. Before Alzheimer's had stolen Kate's ability to speak, she would go on and on for hours about a pet bird she'd had growing up. Mr. Crackers had been a beautiful, pure white cockatiel that would repeat anything Kate said to him.
The nursing home decided to begin bringing animals and plants in to the facility to interact with the residents. Sara was introduced to a blue macaw named Berry. When Berry needed a place to stay the night, Sara offered up Kate's room—it was private, and Sara knew how much Kate loved birds…
Amanda Smith, M.D., Medical director at the USF Health Byrd Alzheimer's Institute says that long-term care programs focused on providing care with dignity are those that, "respect who they've been in their lives, and allow them to feel that they have autonomy despite needing supervision."
Though most experts agree that a person-centered approach to care is essential to helping a senior maintain their dignity, this can translate into many different methods of care delivery.
In Europe, for example, there are facilities called ‘dementia towns.' One of the more extreme re-interpretations of the long-term care model these are literally entire neighborhoods constructed for people with dementia. The residents in these towns are watched over by professional caregivers disguised as shop owners, maintenance workers, and hairdressers.
The most recently built dementia towns are designed to look like they were just plucked from the 1950's.
According to Smith, this retro design strategy likely came about because many people with Alzheimer's and other forms of dementia, while they may have trouble creating new memories, often retain memories from their past.
Man's best friend
Sometimes, putting people first means doing some unconventional things; like allowing plants, animals, and children into nursing homes to help deliver care to the elderly. Nursing homes in several different countries, including the U.S., have chosen to adopt this philosophy, called The Eden Alternative.
According to CEO, Chris Perna, Eden Alternative emphasizes relationship building between nursing home staff and their residents. "We focus on putting relationships first and letting the care flow out of that."
The Green House Movement, a smaller-scale application of the Eden Alternative, shrinks the nursing home model down until it becomes house-sized, fostering person-centered care in a more intimate setting.
Finally, the Village Movement fosters individualized care by providing services that allow elderly people to continue living in their homes. People who live in Villages are offered benefits ranging from transportation to discounts on home repair services. Volunteers will even come and shovel a senior's driveway and sidewalk, or to spend time with them.
Robin Kahn, marketing director for Beacon Hill Village, has seen the impact of the community aspect of the Village Movement. "Everybody cares about each other, it's an animated environment," she says.
But, delivering person-centered care takes money, and, nursing home budgets, in Bua's words, are often "extremely tight."
Many long-term care facilities need to have a certain number of senior residents to stay afloat financially. This leads to pricing structures that incentivize people to share rooms with strangers, taking away their privacy and, often, their dignity along with it.
Indeed, none of the aforementioned initiatives are cheap, but Thomas says that there is a way to deliver personalized care and remain in the black. According to him, the investment that long-term care providers make to acquire new resources and improve their staff can be recouped by eliminating unnecessary middle management. That way, the cost of delivering higher-quality care won't be passed along to the elderly, who can ill-afford it.
Looking towards a brighter future
Sara noticed the change as soon as she brought Berry into Kate's room. The elder's gaze shifted from the ceiling tiles to the doorway where Berry was squawking shrilly. When Sara placed the bird's post next to the window on the other side of Kate's bed, the woman shifted slightly so that she could keep hers eyes on Berry.
Over the next few weeks, Sara would come in and move Berry around Kate's room. Each time the macaw moved, Kate moved too. Soon, her bed sores began to heal and, though she still couldn't speak, Sara knew by the look in her eyes that Kate had found a small measure of peace.
From Villages, to dementia towns, to Green Houses, to the Eden Alternative, the focus of long-term care is evolving from a model based primarily on efficiency, to one based on providing person-centered care.
These new approaches are proving that a person-centered approach can be both profitable and provide seniors with high-quality care.
Research on Eden Alternative homes and Green Houses for example, has shown that a person-focused care model can lead to higher occupancy rates and lower monthly resident fees than the national average. These facilities often have lower staff turnover rates, longer staff tenures, and fewer elders with pressure sores.
Dementia towns and Villages are so new that little research has been conducted on them, but Smith says that care models like these, that allow seniors to retain the feeling of freedom and independence, can reduce stress and anxiety for seniors.
Despite these positives, Smith still feels that there is some room for improvement in these models.
She says that a more affordable cost structure and more comprehensive required training for people working in long-term care facilities would further enhance the quality of life for seniors receiving extended care.