Warning: After this article was first published, I had some really unhappy readers, so be warned. You can read my reflections on that anger here. No one, not a single person ever wants to end up in a nursing home.  There are two reasons for this, one good the other disgraceful. The Good Reason The good reason is that individuals end up in nursing homes because they need significant regular (continuous) nursing care; often meaning they are in their last few weeks, months or years of life and there is no practical way for them to receive the life preserving care they need at home or in a lower level of senior housing.  In short their bodies are failing them.   The Disgraceful Reason The disgraceful reason is that most nursing homes suck.  In truth, the way most nursing homes operate day-to-day, week-to-week and year-to-year is to get through a checklist of tasks:

  • Give baths
  • Feed residents
  • Pass medication
  • Provide a  required activities program
  • Do lots and lots of documentation

Because the government pays for most nursing home care, the only way to make money, or more money, is to reduce costs, which means cutting everything that can be cut. The government, in its all-knowing wisdom, has compounded the problem under the theory that the more regulations, the better protected residents are.  A nice theory except that we have more regulations today than we have ever had, and for all the regulations, there are still a significant number of really terrible nursing homes and a ton of barely decent homes.  Not to mention more regulations means more task-oriented check boxes.  

A Better Way

I recently spent an hour or so talking with Karen Stobbe the Director of Education and Outreach for The Pioneer Network, an organization that is committed to a better way of serving senior living residents. Pioneer Network is all about creating senior living environments that actually makes residents the most important thing.  These communities look something like this:

  • Senior communities, including nursing homes, operate more like a home than an institution (an interesting paradox, with many assisted living communities moving to more of a medical model)
  • Resident choice always comes first, which makes the documentation checklists problematic, but not an impossible barrier.  This means things like allowing residents to decide when to get up, when to go to bed, when to take baths and when to participate in activities.
  • Direct staff members are empowered to say yes to residents, to make decisions and know they will be backed up by leadership as long as it is about saying yes to residents.
  • Activities are designed to not just entertain but to empower.
  • Caring for residents becomes a team effort that involves everyone from the aides to the executive director.  The idea is that no one ever walks by trash on the floor, a care aide struggling to help a resident or a table server struggling with a stack of dirty dishes.
  • Best of all, taking a person centered approach to caring for residents often results in lower costs and longer stays.

No Buzzwords

What Pioneer Network does is not just buzz words like “Culture Change” and “Person Centered Care” for use in marketing or self-delusion.  Rather it is a whole way of thinking of providing senior care.  It  is a way of seeing seniors and the care of seniors from an entirely different perspective.   If you are serious about giving each of your assisted living or nursing home residents the best day everyday, Pioneer Network should be important to you.   If you want to jump in with both feet, their annual conference takes place August 11 – 15 in Bellevue, Washington.  If you are looking to dip your toes in, there are tons of resources on the Pioneer website.   Steve Moran