During her one-month stay in Garden Spot Village's new skilled nursing unit, Marie Folkeson made herself at home.
So at home that when she was well enough, she didn't want to leave.
In the New Holland retirement community's nursing unit, Wednesday night cookouts and Flag Day parades have replaced the imposing nurses' station and clanking medicine carts.
"They try to do everything they can to please us," says Folkeson, 77, who had a private bathroom and ate whatever she wanted for breakfast.
"It's just like you were home."
That is by design.
GSV residents now receive nursing care in four "households," small, homelike settings that offer specialized treatment — and personal attention.
"People don't want to live in an institution," chief executive officer Steve Lindsey says. "They want to live at home."
Several Lancaster County retirement communities are adopting the household model, one approach to a growing nationwide movement to make skilled nursing units more like homes than hospital wards.
But the movement, often called "culture change," goes beyond spruced-up buildings and cozier living areas.
Households deliver a fresh, flexible approach to nursing care, encouraging interaction and leaving decisions from celebrating holidays to arranging furniture up to residents.
Local administrators expect their assisted living sections to eventually adopt the resident-centered philosophy.
"Clearly, I think, this is the wave of the future," Lindsey says. "We're providing life instead of just care."
A NEW WAY OF THINKING
Skilled nursing units took off in the 1960s, with the advent of Medicare and Medicaid, says Ron Barth, president and CEO of PANPHA, an organization that represents Pennsylvania's nonprofit elder-care providers.
Early units had an institutional feel, he says, much like a hospital ward.
"For people who need long-term care ... it was depressing," Barth says. "Frankly it was almost depressing for the workers."
Daily schedules in traditional skilled nursing units were based on staff convenience, Lindsey says. For example, wake-up calls might begin at 5:30 a.m. to make sure residents were ready by the scheduled breakfast time.
Culture change took root in Pennsylvania about 10 years ago, Barth says. There are many slightly different approaches to the philosophy, with names like the Eden Alternative, Wellspring and Greenhouses.
Culture change by any name is simply the creation of a home inside a nursing facility, says LaVrene Norton, executive leader of Milwaukee-based Action Pact Inc., consultants who help design and set up households.
"It changes the culture from an institutional environment to one that is centered on the resident," says Norton, who is working with three county communities.
Action Pact's typical 16-resident household model calls for private rooms — ideally with baths — along with shared living, dining, kitchen and outdoor spaces, she says.
Household staff receives extensive training in resident-directed care. Employees, too, have increased autonomy and decision-making power.
Nelson Kling, president of the Mennonite Home, Lancaster, says contemporary consumers expect innovative approaches to nursing care.
"(Baby) boomers are going to be walking in (traditional nursing units) and saying, 'Are you kidding me?' " he says.
"They're not going into these long halls with semiprivate rooms."
NO PLACE LIKE HOME
GSV opened the last of its four 16-resident households last spring.
National magazines have featured the households, Lindsey says. People from retirement communities across the country have toured them for ideas.
The homelike touches begin at the household entrance, a proper front door with a doorbell and coat racks.
"It's a reminder to all of us that ... we're entering a home of the 16 people who live here," Lindsey says.
While the households may feel like home, residents still receive high-quality care for a variety of conditions, he says. Medicare typically covers their stay.
Common TV rooms and porches encourage interaction with other residents and staff.
But just like at home, the kitchen is the center of family life.
"Homemaker" Cindy Dellinger makes everything from omelets to French toast with fresh fruit whenever the residents are ready for breakfast.
"It's whatever they want, when they want it," says Dellinger, a staff member whose duties include menu and activity planning.
Residents in wheelchairs can sit at lowered counters, chatting with Dellinger — often called "Mom" — as she works.
They decide how to arrange the dining tables and even have free rein to raid the refrigerator.
"It's not us dictating how it's going to be," Lindsey says. "It's them telling us how they want to live."
BUILDING ON A TREND
This fall, the Mennonite Home will begin major renovations to an existing building. Kling hope to move residents into its first households early next year.
Renovations include balconies, softer rooflines, spa areas, new kitchens and modified entrances with doorbells.
"What we're trying to do is to give all our care areas ... a residential feel," says Kling, who expects to eventually open at least eight households.
At Manheim's Pleasant View Retirement Community, market research shows that people prefer a homelike care environment, president Ron Waack says.
They also want to make their own decisions.
"There's no reason why they couldn't," Waack says. "There's more room for flexibility (with households)."
Pleasant View plans to open its households in an entirely new nursing facility around 2010, he says.
So why are households the wave of the future?
Action Pact's Norton puts it this way: "Because you and I are going to get old, too.
"Do you want to live in an institution?"
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