Discussing long-term care
with clients and families is painful. People shudder at the thought of wasting
away, losing independence, and enduring lack of privacy and dignity.
Traditional nursing homes [and assisted living facilities, too] are designed
with the “asylum model” for the benefit of workers who must “control” the chaos
and profit motive. Long hallways lined with older people in wheelchairs,
scheduled meals, conformity, lack of control, urine smells, and lack of choice
are the hallmarks of this model. A fellow gerontologist identified this model
as “learned helplessness.” It is no wonder that people express horror at the
thought of nursing home admission.
Grown
children and spouses avoid nursing homes at the expense of their own health.
Caregiver burnout is a major threat to the health of families caring for loved
ones, especially when the patient needs 24/7 skilled care. “But I promised dad
I would never put him in a nursing home!” Grown children and spouses do not
“put” people in nursing homes. They usually are admitted after a triggering
event and the medical team recommends placement. Going home at that point is
unsafe. Most people do not have the funds to hire private nurses and doctors
24/7 and that is why sick patients need nursing home care.
People
want choices, dignity, and independence. The exemplary model of care is the
Green House model, begun as the Eden Alternative, a model that embraces
autonomy and living life to the fullest. Their person-centered approach is what
I recommend to all clients. No nurses. No medicine carts in the halls. No long
hallways with lined-up wheelchairs. No urine smells. Residents go to bed when
they want to. They get up when they want to. They eat meals when they want to. Or
they can shut their door and be alone. The Green House model consists of
resident-centered small cottages with a dozen residents in private suites, a
common kitchen, and comfortable communal areas for socialization. Some of the
Green Houses were asylum models in the past and have been retrofitted and
redesigned with Green House principles. The greatest hurdles are policy and
funding.
Below
are resources about the Green House model and two articles related to nursing
home reform policy. Please write to your state senators and demand nursing home
reform. Make this a priority. AgeDoc
Learn about the Green House
Project: http://www.programsforelderly.com/nursing-greenhouse.php
Marselas, K. (2022, March 4).
LTC small homes could become big venture, but policy, funding must catch up.
Retrieved from McKnights Long-term Care News.
https://www.mcknights.com/news/ltc-small-homes-could-become-big-venture/
Stulick, A. (13 March 2022).
No innovation without compensation: SNFs need federal support to realize
Biden’s private room plans. Retrieved from Skilled Nursing News.
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