By 2050, one in five people in the United States will be age 65 and older, and 12 million of them will need long-term care. But the old paradigm for institutionalized care in the nursing home setting doesn’t fit the preferences and expectations of the baby boomers and Gen-Xers entering their golden years. Greenhouses are a wave of the future.
In general, consumers have a negative impression of nursing homes as clinical, rigid and unappealing places to live out their final years. Changing the nursing home culture to become better attuned to consumer desires requires first an understanding of what consumers want.
A recent study of the preferences of older Americans points to a truth that the old-style nursing home culture, with its focus on efficiency and the clinical aspects of care, doesn’t fit the bill. The study, which looked at differences in long-term care for younger disabled populations and older populations, found that older people want the same things their younger counterparts desire: control, individuality and continuity of meaningful personal life.
Older people want to live in a home-like setting where they have autonomy over the daily routine–like meal times, bed times, and what activities to pursue. They want to choose when to take a shower or bath, and to decide whether to take a walk or read a book. They would prefer to stay at home rather than live in an institutionalized setting that focuses on care rather than daily life. They want to be surrounded by their own personal items, and they would rather that the person providing their care be a consistent presence who knows their preferences.
To meet these preferences will require a cultural transformation, a change in the perception of nursing homes from a place that is clinician-centered to one that is patient-centered. Nursing homes are now places that deliver long-term care, but they need to become places where people live and can also get good care.
The patient-centered model has already been adopted by pioneers in nursing home care, beginning with geriatrician William H. (Bill) Thomas’s Green Houses. This model groups a number of small homes or units, each housing six to 10 residents, on a campus. While each resident has a private room and bath, they are free to come together for meals and recreation in a family-style living room, dining room and kitchen configuration.
The Robert Wood Johnson Foundation is currently supporting a five-year plan to develop Green House projects throughout the United States, and has 24 sites in operation or development. Greenhouses are self contained residential homes for 7-10 persons.
Other innovative nursing home management organizations are working within traditional architectural configurations to transform resident routines and programs to a more patient-centered approach. Not only are patients reporting better satisfaction, but staff is more satisfied with their work and retention rates are higher where cultural transformation has been achieved.
Challenges to nursing home cultural change remain; financial disincentives make change difficult, and some state regulatory mandates must be changed. Giving aging Americans what they want can be done – to provide care in a manner and environment that enhances patient quality of life.