September 09, 2013
Nursing homes as human habitats
Jean Dobay, RN, MSN
Things were so much less complicated when I started into the nursing home business in 1973. My father, looking for a business venture, built a 19-bed nursing home on the family farm. My older brother was the administrator and night shift aide. My mother was the cook, and my father was the maintenance man. I was the director of nursing and day shift aide. I used my two years of acute care knowledge to set up the nursing home with medical charts and medication kardexes.
Otherwise, we decided to treat the nursing home as our home. The elders got up in the morning when they wanted, shuffled to the kitchen in bathrobe and slippers, and ordered breakfast from the cook, my mother. The women of the home would spend their days peeling potatoes, making desserts, or snapping beans for the next meal. The men could be found in the gardens harvesting the vegetables for all to enjoy at the table. Our family joined the elders for meals, holidays, and any and every event. My then 2-year-old son spent his days with the elders, and our pets were part of the home. We were one big happy family. There were no state or federal regulations back then to tell us that we were doing something wrong. We just cared for the elders in a way that made sense in a way that seemed like the right thing to do.
In 1975, the nursing home regulations came into play and continued to become more and more stringent until the nursing home industry was the most heavily regulated industry in the United States. Suddenly, nursing homes looked and ran more like a hospital, elders came to us sicker and sicker, and the medical model became the accepted practice. Our nursing homes became sterile, institutional, and regimented. Reimbursement became more complicated and the focus went from caring for our elders to meeting state and federal regulations while still jumping through all the hoops to be reimbursed. The “Mom and Pop” homes could no longer survive in the industry and sold out to the mega chains. Caring for the elders became an industry where only the business savvy could survive.
It was in the mid-1990s that I first heard about culture change, a guy named Dr. Bill Thomas, and the Eden Alternative. My first thought was, “you can't teach me anything. I've already run a nursing home that way and the regulatory agencies won't let us do that anymore.” But in 2007, I attended Certified Eden Associate training. The doors began to open slowly to the idea that we can go back to the way it was. I learned that caring for our elders is very different than treating their illness. I learned that our elders in nursing homes are suffering and dying from the plagues of loneliness, helpless, and boredom. I learned that the medical model may work in a hospital, but it is killing our elders in the nursing home. If we care for a person's medical problems, but do not care for their human spirit, they will die.
discovered that caring for the human spirit is far more important than treating their medical ailment. He discovered that creating a human habitat in a nursing home where plants, animals, and children surround elders is vital to caring for the human spirit. Nursing homes should not mimic their sister hospitals, but be the “citadel of caring” where an elder can continue to grow: A garden of compassion and caring.
Making the decision to place a loved one in a nursing home is a difficult but sometimes necessary decision. I know; I have had to make that decision for my own mother. Now she lives in the home that she and her husband started. She frequents the kitchen to remind them that that was once her domain. Maintaining her identity and quality of life is critical to both of us. That is why I chose a registered Eden Alternative home: A place where the care partners understand the plagues of the human spirit – a garden where she can grow and thrive.
Jean Dobay is the director of transformation and growth at Quality Life Services, Butler, PA. Quality Life Services is a small chain of nursing homes and personal care home located in Western Pennsylvania owned by the descendants of Kenneth Tack, Sr. and Nancy M. Tack.