Reality TV, LTC style

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A Wisconsin nursing home is the feature of a PBS documentary that aims to show the good with the bad.

Camera crews are at the ready. There's drama. There's reality. And there are definite standout stars.

Is this the latest reality show in the making? Sort of. There are no staged scenes, no game-show like contestants and certainly no $1 million dollar prizes at the conclusion. This is a PBS production documenting the day in the life of residents, staff and administrators at Wisconsin's oldest nursing home, Saint John's on the Lake in Milwaukee, over a year's time.

Saint John's, which comprises 52 skilled-nursing rooms, 20 assisted living units and 130 independent living apartments, was chosen by filmmakers Brad Lichtenstein and Lisa Gildehaus because the facility is in the midst of an enormous cultural change from a medical institutional model of care to a social model of care.

"We wanted to profile a facility trying to make a change," said Lichtenstein, of 371 Productions, Milwaukee. "It's a fascinating rollercoaster ride. We wanted to see them strive and succeed but also see where they fail."

John George, the administrator of Saint John's on the Lake, noted: "No one ever says, 'When I get old, I want to go live in a nursing home.' We want to change that."

So administrators and staff at the 138-year-old organization set out to identify what needs to happen to change how America perceives aging and long-term care. This self-evaluation led to a "journey" toward a cultural change that would address the key reasons why people are resistant to moving into a nursing home or moving along a range of care, George said.

"The idea of loss is the number one reason for this resistance," he said. Nursing home residents traditionally lose choices:  When and what to eat is dictated, when and how to bathe is predetermined and staff even decides what time to go to sleep.

A medical model traditionally emphasizes a person's limitations with regard to medical conditions. A social model recognizes a person's strengths and getting to know the person's preferences and dislikes, George explained.

Some of the changes so far in Saint John's journey, which is nowhere near complete: No more staff uniforms and breakfast is served by a "homemaker" (a combination food services worker and housekeeping employee), from 7 to 9:30 in the morning.

'Dismantling fear of aging'

"Almost Home" is a portrait of a microcosm of society, said Lichtenstein, with about 10 months of filming down and a few more to go. The film is expected to air on PBS stations nationwide in the fall of 2005.

"We want to show elders in a true, humanizing light, dismantling our fear of aging" said Lichtenstein.

Showing the true side of nursing home life means showing the good with the bad, however, an idea George said he initially wasn't comfortable with.

"I was a bit concerned about the film crew recording some of the more rough issues of life in a nursing home," noted George, who reserves the right to ask that cameras be turned off at any time.

Ultimately, George said, he was reassured by the reality that life for the elderly in a nursing home is not all social events and happy experiences; if the film is to give an accurate representation of elderly life, the less pleasant side of nursing home life also must be filmed, he said.

"We agreed to participate in this projec