Making it more like home
Making it more like home

CLINTON — Bourbon Street lives up to its name.

In the wing, one of four at Grace Living Center in Clinton, residents — they're all male in this "neighborhood” — watch football and pay-per-view wrestling. They play video games, have cookouts and gibe one another. Their late-night poker games are frequent.

"We just do a lot of guy stuff,” said Bourbon Street resident Patrick Emmerson, 36, who has been at the Clinton home for seven years.

Twenty years after Congress passed legislation to "de-institutionalize” nursing homes, the effort is beginning to show results in Oklahoma and nationwide.

Known variously as Eden Alternative, Green House, Pioneer Network, culture change or person-centered care, the movement aims to make nursing homes less like the hospitals they developed out of and more like the homes from which their residents come when they need round-the-clock care.

The 70-resident Clinton home is among the leaders in adopting the changes.

It has themed neighborhoods and flexible wake-up and meal times. Its bathrooms have been made to resemble a spa. Its nurses are cross-trained "universal caregivers” who clean residents' rooms and stay on one wing rather than rotating throughout the building.

Although the home began in 1994 with its first neighborhood, Redbud, changes accelerated and remade the home about four years ago. Now, the home revolves around its "learning circles” where ideas and grievances are discussed, and around residents' wishes. Each neighborhood has a distinct personality.

"The chain of command sort of flips. ... I had to let go,” said Janis Raab, administrator of the Clinton home.

Raab, who has been with the home on and off for 25 years, wants it to be the type of place in which she would like to spend her golden years. She thinks residents there live longer because they have more purpose in their lives.

"I would not go back,” she said of returning to the way the home was before.

Raab said nurse aide turnover, which averages more than 200 percent a year in many homes, is less than 85 percent at her home. Staff are placed in the neighborhood in which they feel most comfortable.

"The girls are kind of part of our family. I couldn't make it without them,” Redbud resident Veneta Orgain, 83, said of her nurses.

The red scrub-clad nurses stay in the wing and know its occupants well.

"The continuity (of care) is a lot better. We can tell when they're not feeling good,” said Anna Whiteskunk, a licensed practical nurse who has been at the Clinton home four years.

Orgain's granddaughter, Sherry Bieberich, brings her family and pets to visit.

"It's really just a relaxed atmosphere,” she said.

Some changes state Health Department officials have seen are small, such as allowing residents to bring their own beds or choose room colors, while others are large, such as having residents hire and fire staff and sleep and eat on their own timetables.

Nurse aides also often receive more authority in culture-change homes, planning activities for residents or coordinating schedules with their co-workers.

Dorya Huser, chief of long-term care for the state Health Department, encouraged homes to change and not fear being cited when surveyors visit them.

"The hardest thing about culture change is the fear of change,” she said. "We cannot find anything in the regulations — federal or state — that would prohibit this type of flexible scheduling in facilities,” she said, adding that she would work to change any such laws should she find them.

The hospital model emphasized uniformity and regimentation. People's lives are different, however, and what works for one person doesn't necessarily work for another.

"I think we're all the same in that we do want some choice,” she said.

Once residents adapt to new sleeping, eating and medication schedules, everything again becomes predictable, Huser said.

The Clinton home's shower room now has chocolates, sparkling apple cider, fluffy robes, soothing music and patient-tailored aromas, just like a spa. On Thursday, the room smelled manly — "NFL” scent, coordinator Rebecca Bookout said.

Bookout said the room looked like a hospital before the makeover. She was a nurse aide at the time and was frustrated she couldn't give residents the time and attention they deserved. Now, she pampers them and knows each one's likes and dislikes.

"I feel like I can give them one-on-one time, as much as they need,” she said. "They've worked hard all their lives. They deserve so much.”

A Centers for Medicare and Medicaid contractor, the Oklahoma Foundation for Medical Quality is a force behind person-centered care in the state.

Foundation spokeswoman Melissa Hill said the federal government was working to increase consumer choice, availability of public information and quality of care.

Through the Nursing Home Quality Improvement program in 2005, a total of 58 homes worked "intensively” with the foundation on culture change.

"We work with every home in the state to some degree through education forums, training, providing resources, interventions, etc.,” she wrote in an e-mail. "All 58 homes have adopted principles of culture change to some degree.”

Giving residents more control over their lives and creating more homelike environments leads to better clinical outcomes such as eating more, less depression and fewer pressure ulcers, Hill wrote.

"Homes are changing staffing models to designated caregiver rather than rotating around the home to build social/emotional bonds,” she wrote.

Raab said she didn't know what culture change has cost the Clinton home, but staff levels have remained consistent. The struggle is to let them know it's OK to cook an omelet at 11 a.m. or let a resident take a pill after waking up rather than waking them to take it.

These types of conveniences make a place more like home.

"When you leave your home, you don't want that to change. You want that to continue,” Raab said.

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