Sunday, October 3, 2004


Very interesting column in the Oregonian's commentarty section this morning. It's by Lenore Skenazy who writes for the New York Daily News.

She writes about William Thomas' book What are Old Poeple For? He proposes an alternative to nursing homes. He calls them Green Houses. Small groups (eight to ten) with a couple of staff. As much as possible the residents do the cooking and cleaning and everyone sits down to meals together. Sort of a do it yourself family. Thomas is running a pilot program in Tupelo Mississipi. The first 13 are up and running. Apparently the costs are comparable to the institution they replaced and the results sound inpressive.

Four of the seven residents who were using wheelchairs when they moved in are up and walking on their own. Eight out of the ten have some level of Alzheimers but are doing better. One lady even makes her cornbread recipe once a week. Each resident has their own room and all the room open on a yard. I suspect that the buildings are built on a courtyard design with the rooms facing inwards.

Thomas is quoted as saying "the first thing we had to do was run out to the store for sunhats." Some of these folks hadn't been out for years.

We do have a lot of Adult foster care in our area but the results sound pretty hit and miss. A close friend of my mom's is on her second try. Apparently the first home was not very clean and it smelled. Also her medications weren't tracked the way they should have been and she is a diabetic. A one size fits all diet plan is not good in this case. What can you expect when the people who are supposedly running the place never come around to check on the help?

I like the idea of what Thomas calls a "convivium." Of course the people running such a network might actually have to pay attention to the people they're collecting money from instead of just looking at the balance sheet.

Now if we could just move this idea to the schools. I was lucky and went to a small high school. I can't imagine going to a school with more students than many small towns. Yes, I know it's more efficient for equipment and staff, but Lord, there must be some alternative to what we've got.


mlraminiak said...

Having a mom who is IN Assisted Living, and having worked at an Assisted Living facility, I can say that the system is slightly out of whack, but basically decent.  Don't know if you know the technical difference between a nursing facility and assisted living.  "Nursing homes" are for people who need some level of nursing care around the clock.  Usually very old or very sick.  Our residents at Rose Valley often went to nursing homes for their last few months before they died.  So to say you are replacing "Nursing homes" with what was discribed in the article would be impossible.  The residents there are too sick to participate.  Sounds like a good alternative to Assisted Living, though.  I would have liked to see my mom, and some of the residents at Rose Valley, be more invested in their own care.  Lisa  :-]  

donah42 said...

I think this sounds like a great idea, if done by people who really care for other people. It bothers me how "disposable" the elderly are considered to be these days. I used to volunteer at a nursing home and I cried every Sunday when I got home. So many people who rarely got a visitor... I understand that families are scattered and that most people feel they have to work & can't care for an elderly family member. I would hope, that should my parents ever be in this situation, that I would be able to find a way to keep them with me, much the same way that I left a full-time job in order to care for my child. I think it's as important as that.
Thanks for sharing this story.

mlraminiak said...

Comment on Amy's comment...Having the old folks with you SOUNDS nice, but it assumes the old folks WANT to live with you, which my Mom decidedly did NOT.  Had to give her the freedom of choice, and she chose Assisted Living.  Part of the problem with the "greatest generation" is, they are so independent, they are determined not to be a "burden" to their children.  Which is one of the reasons, I think, that Assisted Living is finding such a big market...  Lisa  :-]

skalthia said...

These are the regs in Virginia.  Other states vary.  Nursing homes are federally funded and therefore are inspected and licensed by the feds. (Although the state is tasked with inspection in most states). Assisted Livings are not federally funded, and are licensed by states Social Services Department.  The state inspects Assisted Living homes and issues their licensure.

The biggest AL provider, Sunrise Senior Living, started in Oakton VA. Paul & Terry Klassaunn purchased an abandoned nursing home and renovated it in the late 80's to begin THE largest provider of senior services today. They are in several other countries, and grow daily.  Their philosphy is to help people live, not keep people alive. Although, as a nurse for SSL, I do help to keep my residents alive every day.

It is a wonderful option for seniors who can no longer live on their own, but do not need the intervention of a nurse on a daily basis.  The homes I have seen and worked in are friendly family atmospheres with an emphasis on makeing today a great day, and this moment the best it can be for all our seniors.  The activities that are offered in SSL homes outnumber the local nursing homes 10 to 1.  

skalthia said...

The differences between a nursing home and assited living are many.  Nursing homes accept Medicare and Medicaid payment, they provide in house therapies, and have to have a skilled need, which means a nurse has to take care of that need. They can manage vents, post op, drains, IV's, just about anything a hospital can do, except ICU care.

Assisted Living on the other hand is private pay (or locally funded), and the residents can not have a skilled need. Which means, they cannot have, a ventilator, a level 2 or higher wound, IV therapies, daily injections (except Diabetes medication), a condition which requires daily assessment or intervention by a nurse.  (The caveat to that is, if the need can be met by Visiting Nurses, then the resident can stay or enter Assisted Living. So, for instance the wound care could be covered by Visiting Nurse and the resident can stay in the assisted living).

krobbie67 said...

My mom is a nursing home administrator. When ever she makes me mad, I threaten her with spending her old age in one. Works like a charm. That new group home format sounds wonderful. :-) ---Robbie