Facing Challenges for Enlightened Care in an Urban Environment

Facing Challenges for Enlightened Care in an Urban Environment

A lot of attention is paid these days to what lies in the future for older adults when they become frail and in need of some level of ongoing services and care.

While some of this has been prompted by the aging of the Baby Boom generation, most has been fueled by a genuine effort to reform long-term care and to step away from the long-established institutional model of care represented by the traditional nursing home.

If you’ve been paying attention, you might have heard words such as “person-centered care,” “culture change” and “Green Houses.”

The Wall Street Journal recently did a front page article about the Green House concept, and a few days ago, the U.S. Senate’s Special Commission on Aging held a hearing about all these things.  The senators called their session, “Bringing Older Citizens Back into the Heart of Society.”

Green Houses are a noble effort to bring something very akin to the mental retardation group home model into the world of senior care in order to replace or recast the nursing home as we know it today with something “new and improved.”  More than 20 years ago, when I was commissioner of New York State’s developmental disabilities care system, we were pioneers in the group home movement as we set out to replace large-scale, old “state schools,” or developmental centers, some with notorious names like Willowbrook, with small community residences.

In those days, group homes were something brand new and not the standard of care they are today, but it didn’t take long to appreciate the advantages small congregate living brought to a population once consigned to large-scale institutions.

Not dissimilarly, those promoting Green Houses, with their roots in rural and suburban America where open land is still available and old nursing homes sometimes sit on several acres of land, set about to right much of what is wrong with the old large-scale living environment of the traditional nursing home model.

In urban environments, however, such as right here in New York, the challenges of trying to break with the old nursing home concept are even greater.  At Village Care of New York, where we are engaged in an effort to reform and reconfigure a long-term care system dominated by a traditional nursing home, we are trying to move beyond congregate living both conceptually and because of the realities or urban development.

Talk about realities.  There are more than 42,000 persons residing in nursing homes in New York City.  Would that we could build nice little 10-person Green Houses for all of them, but have you priced real estate in Manhattan, for example, of late where our not-for-profit organization is headquartered and where our Village Nursing Home has reliably served our community for more than 30 years?

We needed to come up with a better plan.

At Village Care, we are well on our way to transforming the concept of long-term care in the communities we serve by closing our 200-bed nursing home and replacing it with a variety of options that are designed to keep people in their homes whenever possible and to offer assisted living, a far less restrictive setting than the nursing home.

We are also building a new state-of-the-art, 105-bed residential facility, but it will focus primarily on short-stay rehabilitation, getting people in and out and back home as quickly as possible.  There will be a relative handful of beds set aside for persons with complex clinical care needs who require 24-hour nursing care.  For these residents, we’ve adopted many of the group home sensibilities, dispensing with nursing stations and creating small “neighborhoods,” for example.

Five years from now, we’ll be serving hundreds more each year, mostly through more enlightened offerings such as PACE (Program for All-inclusive Care for the Elderly) and New York’s Long-Term Home Health Care Program, both of which are designed to keep nursing home-eligible individuals in their own homes, and Medicaid’s Assisted Living Program.

We’ve not done this in a vacuum – we’ve worked together with the state’s Department of Health and with the Legislature in putting together our reform plan.  Most importantly, our work force has been a full partner, including SEIU1199, which has worked closely with us in reconfiguring our staffing and individual job responsibilities.  And, significantly, we’ve sought advice from community residents.

It has been a long, deliberative process that, in the end, will result in a vast improvement in the quality of life for those in our community who need long-term care services.