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Aging: Small Is Beautiful
By
Claudia Kalb and Vanessa Juarez, Newsweek
August
1, 2005
Dorothy Green had always been an independent woman. A
Cadillac-driving, mink-coat-wearing, Tiparillo-smoking woman. So it was
especially hard on her family members when they realized that their
spitfire matriarch, now 85 and suffering from dementia, could no longer
care for herself.
Last year Green's family moved her into a 60-bed assisted-living facility
in San Luis Obispo, Calif. Green was well cared for, but she didn't like
the rigid schedule. And living with dozens of other people made her
agitated. "She would cry a lot," says her granddaughter and
staff nurse, Teri Weitkum.
All that changed last fall, when Green moved 30 miles
away into a luxury suburban home called Vista View. The stand-alone house
is a long-term-care facility for people with Alzheimer's and other forms
of dementia, but it feels like home. There are spacious bedrooms,
wall-to-wall carpeting and a garden, where residents grow tomatoes and
squash.
In the mornings, Green pads around in her slippers. One recent summer day,
she and her three housemates gathered for beef stew served on china plates
with designer cutlery. "They treat me like I'm a somebody," says
Green.
It seems so obvious: let people age the way they have
lived. Today, finally, it's beginning to happen.
From upscale residences in
California
to family-size nursing homes in
Mississippi
, living facilities for the elderly are undergoing an architectural and
cultural makeover: big, sterile institutions are out, small, homey
environments in.
The need has never been greater. Today 35 million Americans are over the
age of 65-by 2030, that number is expected to double. As baby boomers
age into sixtysomethings, the demand for civilized living will only
intensify. "We have to completely transform the system," says
Rose Marie Fagan of the Pioneer Network, an umbrella group for innovative
aging programs.
Nursing homes are at the top of the list. Many of the
nation's 17,000 institutions are decades old and operate on an impersonal
hospital model-lackluster corridors, shared bedrooms, strict sleeping
hours.
Enter Dr. Bill Thomas, a 45-year-old geriatrician at
SUNY
Upstate
Medical
Center
, who's on a mission to revolutionize long-term care. In the 1990s, Thomas
launched the "Eden Alternative," which called for humanizing big
facilities by removing nurses' stations, adding plants and pets, and
focusing on the staff-elder relationship.
Eden
was just the beginning. Today his baby is the National Green House
Project, a radical shift away from large institutions to homes with no
more than 10 residents each.
The advantages: cozy living, privacy (individual bedrooms and baths) and
time for caregivers to get to know residents-not just their medical
needs, but their life stories, too.
The project's birthplace is
Tupelo
,
Miss.
, where Steve McAlilly, CEO of Mississippi Methodist Senior Services (MMSS),
is making Thomas's vision a reality. Several years ago MMSS was going to
replace a worn-out 140-bed nursing home called
Cedars
Health
Center
with a big new facility. Then McAlilly learned about the Green House
Project.
"Intuitively," says McAlilly, "it made sense." In
2003, MMSS opened the first four Green Houses in the nation. Two more
launched in June and four are expected to open by mid-September. The
6,000-square-foot single-story houses, which cost the same to live in as
Cedars, have a driveway, a doorbell and a yard. Residents get to select,
and even help cook, their own meals.
In
Mississippi
, says Jude Rabig, the project's executive director, that means plenty of
okra and fried chicken. Mildred McDonald, 85, says mealtime reminds her of
her childhood, when she and her seven siblings ate around a long table.
"It's like family," she says.
Today dozens of other Green Houses-from
New York
to
Hawaii
-are in the planning stages or have recently broken ground.
As the home-living concept spreads, questions arise:
Is the medical care adequate? Is quality of life improved?
Daniel Carsel, founder of Alta Vista Living, which owns Vista View, says
he was prepared to witness the rough transition that people with
Alzheimer's typically experience when they move. Instead, he says, many
residents were settled within a day. "We were reducing medications,
people were eating more," he says.
Alta Vista operates a second house in
California
and plans to open a third this August. Rosalie Kane, a long-term-care
expert at the
University
of
Minnesota
's
School
of
Public Health
, has studied the
Tupelo
houses for two years. Compared with traditional nursing homes, she says,
residents are more satisfied and in better physical shape.
And in an industry with a massive work-force-retention problem, caregivers
feel more empowered and relish the personal contact with residents. The
result: they're more likely to stay on the job.
Long-term-care facilities never come cheap. The
average monthly price tag in a nursing home is more than $5,000.
The Tupelo Green Houses, which are licensed as nursing homes, ring in at
$4,350; Medicaid covers the cost for most residents.
At Alta Vista Living, shared rooms are $4,500 per month, private ones,
$5,500. But because the houses operate as assisted-living
facilities-residents need help with daily living, but not skilled
nursing care-government insurance doesn't pick up the tab.
Jill Hreben, CFO of Otterbein Homes, which manages six retirement
communities in
Ohio
, admits that she was skeptical about the business model at first.
But after visiting
Tupelo
, Hreben concluded that the project's simple organization-no hierarchy,
no separate departments for food, laundry, maintenance-would ultimately
reduce costs. Otterbein is now planning to convert its own nursing homes
into Green Houses. "I think the dollars are going to work," says
Hreben.
The lifestyle does, says McDonald's granddaughter Sherry Wood. McDonald,
who has dementia and congestive heart failure, feels right at home in the
Green House she moved into this spring. "She has a smile on her
face," says Wood. "She's happy." The ultimate vision for
the future.
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