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Home sweet Retirement Home

"Person-centered" facilities offer more choices, freedom for residents

Dennis Fiely - The Columbus Dispatch
03/04/2007

The management at Westminster-Thurber Community runs a loose ship. "Rules? What are they?" Erma Huber asked.  Huber, 86, is among the residents of the Neil Avenue retirement home who care for pets in their rooms and eat, sleep and bathe when they wish.  Giving people what they want is the crux of "person-centered" care: providing the physical and psychological comforts of home in housing for senior citizens.

"Our industry has been too paternal," said Steve LeMoine, executive director of Westminster-Thurber. "The 'We know what's best for you' attitude takes away human dignity."

William Longenette, another resident, frequently wheels his chair down the hallway for a midnight raid on the refrigerator.

The kitchen is always open.

So nobody stops the hungry, 63-year-old night owl, who recently had hip-replacement surgery.

Elsewhere, nurse Anna Quirk prepares food off the menu for 66-year-old Larry Hayes, who has diabetes.

One of his favorite meals: pickled eggs with onions and hot peppers.

"It may not be on his strict diet," Quirk said, "but that's what he likes."

The person-centered movement, which began in the late 1990s, picked up steam two years ago when 500 advocates from 49 states met at a national conference funded by the Centers for Medicare and Medicaid Services.

After the meeting, called the St. Louis Accord, Ohio joined 27 other states in forming or solidifying coalitions for "revolutionary" change in the delivery of elder care.

The Ohio Person-Centered Care Coalition includes trade associations, state agencies, vendors and more than 30 housing providers that reject the traditional hospital model of rigid schedules and clinical settings.

The group will meet this month in Columbus.

"We are not trying to create homelike situations; we are trying to create home," said Bonnie Kantor, who recently left Ohio State University as director of geriatrics and gerontology to head the Pioneer Network, a Chicago collection of nursing home policy experts.

The concept puts the institutionalized elderly -- even those with dementia -- in charge of their lives.

"It's all about allowing older adults to make choices based on their desires," said Matt Wayne, chief medical officer of Eliza Jennings Senior Care Network in northeastern Ohio.

"Many residents are more interested in the quality of time they have left than living longer."

Person-centered care also aims to correct negative public perceptions of nursing homes and position senior housing for the demanding baby-boomer market.

"If nursing homes are going to remain a core part of the long-term-care system, they have to be responsive to the consumer," Kantor said. "It's hard for me to imagine organizations that don't promote it remaining solvent."

Westminster-Thurber started transforming itself seven years ago with the Eden Alternative, an early national model.

It is one of 14 Ohio homes registered with a nonprofit Texas organization that provides training and assistance.

Common areas for 350 residents have been remodeled and redecorated. Restrictions on movement and behavior have been relaxed. Large units have been reconfigured into smaller "neighborhoods," each with its own staff as well as dining and activity rooms.

"Our journey hasn't been smooth," LeMoine said. "It's hard to change routines and the way people do business."

Some staff members have quit.

Those who stayed see the inconveniences as offset by closer relationships with residents and a greater role in decisions.

"It's different, but it's better," said Caprina Braxton, a nursing assistant. "We are trying to satisfy residents, not ourselves. And my supervisor is not over me telling me to do this and do that."

Longenette has lived in two other facilities.

"The other places locked everything up at 9 p.m.," he said. "Here, I can come and go as I please."

In a cooler under the sink in his room, Longenette stocks beer for poker games played in the dining room or on a patio.

"Why not?" he said. "This is my home right now."

Smoking is allowed outside and in a basement room.

"How can we take that away from them?" LeMoine said. "We are not about restricting what they want to do."

After joining the Ohio coalition last year, Traditions at Stygler Road in Gahanna broke its 100-bed building into neighborhoods of 25 beds each -- so residents and staff members could get to know each other better.

Recent policy shifts include open dining and undisturbed sleep.

"The first thing we noticed was that people were eating better and falling less because they weren't as tired," Administrator Joanne Whiteman said.

Traditions has liberalized special diets and embraced a universal work force, matching one group of multi-tasking staff members with one group of residents.

"I've seen our aides singing with residents and mopping the floors at the same time," Whiteman said.

Person-centered care has also redefined offerings as vital to well-being.

"Everybody is trying to find more to do than bingo," said Beth Sanders, founder of LifeBio.com in Marysville -- an online program for senior citizens to write and publish autobiographies.

Trillium Place, with independent and assisted-living apartments on the Northwest Side, recently launched humor and walking clubs.

"Social interaction is a more important predictor of longevity than age or medical factors," said Dr. Kevin O'Neil, medical director for Brookdale Senior Living, a parent company.

Dublin Retirement Village for independent seniors is among an increasing number of homes relying on brain-fitness programs to ward off dementia.

Person-centered care doesn't require large investments in remodeling and new construction, according to advocates.

"Personal transformation takes no money," said Carol Ende, spokeswoman for Eden Alternative in Texas.

Relaxed restrictions, however, have raised concerns about lawsuits and licensing.

"Nothing in our regulatory system interferes with our ability to do this," Kantor said. "We are asking folks to take risks. There may be an extra fall, but that's OK.

"When you create a pristine environment that protects everyone and doesn't let people grow and learn, that is not home."

Despite his partial paralysis because of a stroke, "70-something" resident James Swanigan relishes the opportunity to control his life at Westminster-Thurber.

"I have all the freedom I need," he said. "I can stay up as long as I want; the aides won't put me to bed. The one thing I hate about it: There ain't no woman in my room with me."



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