National movement focuses on choice, independence for elderly
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At a recent training session for elder-care workers, Patricia Hillebrand asked the class of 15, all but one of them women, to imagine the anxiety of a person with Alzheimer's disease.
"Remember the first time you were going to call a guy and ask him out?"
Around the room of the Holiday Inn Express in Robinson, smiles acknowledged the fluttering fear and anxiety.
"Imagine what it would be like to feel that way all the time," she said. Then she initiated a role-playing session designed to inspire trainees to walk in their clients' shoes.
Ms. Hillebrand is a training specialist for Paraprofessional Healthcare Institute, a national organization that advocates a shift away from traditional institutionalized elder care. PHI recently received state grants totaling $500,000 to run a pilot program that Joe Angelelli, PHI director for Pennsylvania, describes as "training the trainer toward culture change."
Culture change is the term for a national movement that calls for a reversal of the traditional nursing home model -- re-education of care workers and a break-down of institutional housing. Increasingly, care is being taken to people where they live or in newly built enclaves designed to foster independence.
Foundations are spending millions to advance the idea. The Robert Wood Johnson Foundation has granted about $13 million. Ann Christiano, a spokeswoman for the foundation, said most of the money has been in support of the "Green House" model -- housing enclaves in which people who choose to be together can live individually but with communal spaces and support staff on site.
"People don't want to be in nursing homes," Mr. Angelelli said. "It's where they get sent. And the care they get is done by people who don't get the pay or support they need."
The grants from the Pennsylvania Department on Aging and the Department of Labor and Industry started a statewide re-education process for workers. It is heavy on role playing, such as walking across a room with eyes covered to give a worker an idea of the challenges blind people face.
Most of the trainees are employers of people who do lifting, feeding, bathing and other elder-care support services. The state grants pay for their training and for the training that they take back to their employees.
Tiffany Richter, a master's student in social work at the University of Pittsburgh, said that when she saw the role playing, "I got excited. I have never seen role play like this."
Nancy Mercer, a home companion service worker for From the Heart in Trafford, said an aspect of the training she appreciated was "practicing how to feed someone and encouraging nutrition, not just slapping a meal in front of them and walking out of the room."
Mr. Angelelli said the goal of the training is to build a more stable workforce and help workers bond with their clients so that the work will be more rewarding.
Much of the industry's cost is in turnover. The rate ranges from 25 percent to 75 percent, he said. The lost time and retraining cost of losing a worker averages about $3,000, he said.
Language in the new federal health-care bill supports PHI's training model and is based on recommendations from an Institute of Medicine report that PHI helped shape, Mr. Angelelli said. The Institute of Medicine is the health arm of the National Academy of Sciences and is an independent, nonprofit organization.
The culture change movement came out of the Omnibus Budget Reconciliation Act of 1987, which was in part a reaction to abuse scandals that rocked the nursing home industry, said Susan Feeney, a vice president of the American Health Care Association. She said the mission now goes beyond "person-centered" and seeks to have the elderly shape their own care.
Last year, amid massive budget cuts, one expansion of funding went to Medical Assistance to serve 2,000 people at home in the PDA Waiver program. These clients would have been eligible for government-funded nursing-home care, but similar care in their own homes cost the state less. The waiver program now serves more than 15,000 clients.
"Even institutions are starting to realize that this is what people want, and from the market standpoint, it will all come down to this: What do people want to pay for?" Mr. Angelelli said. "In Pittsburgh, we have a great opportunity because so many of our elderly population are already in neighborhoods where they could organize their own" villages.
"I don't know of anyone who has balked at culture change," said Ms. Feeney, adding that nursing care for a more independent client has to balance the client's lifestyle desires with his medical needs.
Culture change adherents acknowledge that "there will always be a need for nursing homes," said Mr. Angelelli, but the movement can reshape how they are managed and run.
Even if a place looks institutional, care can be client-driven, said Lauren Shaham, spokeswoman for the American Association of Homes and Services for the Aging. The association represents nonprofit providers, from adult day care to continuing care. "Every nursing home in America should be aware of the movement, but very few consumers are."
She said the "intentional village" model, a form of co-housing, is gaining ground among elders who have various needs and abilities. The model promotes the residents' care of each other, which ultimately would save the government money, Mr. Angelelli said.
Locally, he said, a culture change leader is Presbyterian Senior Care, which operates several sites in Oakmont.
Woodside Place of Oakmont, a center for Alzheimer's patients that opened in 1991, was a prototype before anyone was using the term culture change, said Paul Winkler, president and CEO at Presbyterian Senior Care. Its campus is home to a retirement community, assisted-living community and nursing home. After the success of the changes at Woodside, Presbyterian expanded the concept to the whole campus.
"There is not one model for culture change," said Mr. Winkler, but the driving concept of resident-centered care is "a complete flip" of the traditional medical model that has "a big nurses' station, a command-and-control kind of environment that was convenient for the staff. We flip that and say, what is better for the resident's dignity and quality of life?"
That includes giving clients the authority to, say, choose a paint color instead of an administrative decision to paint everything eggshell white, he said. Instead of a cafeteria with tray lines and automatic portions, there are steam tables and soup aromas and staff mingling with residents, he said. "We have different venues for dining so people can eat in small groups.
"That change was huge," he said. "There was less waste because people could choose what they wanted to eat, and they were eating more of the good food. Use of supplements went down, and people's weight improved. Outcomes were better."
It started with Woodside Place, he said, "and we thought 'If this is better for people with dementia, why isn't it better for everybody?' "
First Published May 23, 2010 12:00 am