Welcome to the future of nursing homes

By WARREN WOLFE, Star Tribune
February 24, 2009

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Arnold Gardner will start his day in a new place today, a "neighborhood'' where bright sunlight streams down wide hallways. A specially trained aide will be on hand to help him dress, to cook his breakfast to order, do his laundry and lead a meeting where he and his neighbors choose rituals such as mealtimes and bedtimes.

It's as close to the nursing home of the future as you can find in Minnesota.
Gone are the uniform wake-up times and bedtimes, the set meal hours and even rigidly-defined roles for the staff.

Gardner is a resident of the new Sholom Home East, one of two nursing homes opening this week in the Twin Cities that represent the vanguard of "resident-centered care.'' It's an approach that marries building design, staff training and technology to support a philosophy that older people will live healthier, more rewarding lives when they retain a much control as possible over their own lives.

The newest example opened Tuesday in St. Paul. At 7:30 a.m., Gardner and 68 fellow residents of Sholom Home East near the State Fairgrounds began boarding buses, moving six miles south to a new $59 million campus off W. 7th Street overlooking the Mississippi River.

The next one starts today at 10 a.m. in Oak Park Heights. Mavis Riegel, 93 -- the first resident nine years ago of a senior apartment at Boutwells Landing -- will be rolled in her wheelchair across a red carpet to become the first resident of a new $30 million nursing home on the expanding campus operated by Presbyterian Homes and Services.

Both nursing homes have opened at a time when tight finances and stiff competition have forced 62 Minnesota nursing homes to close since 2000. A 63rd -- in Two Harbors, Minn., -- announced last week that it will close, too.

"There is so much difficulty in the [nursing home] industry," said Gayle Kvenvold, CEO of the nursing home trade group Aging Services of Minnesota.

"These two new homes really show that it's possible to shift from the old medical approach to a much more dignified, empowering, person-centered approach to nursing home care."

While different, the two homes share many features that have come to mark the "culture change movement" taking root in most states.

Resident life will revolve around "neighborhoods'' -- clusters of 10 rooms at Sholom and 12 to 14 at Boutwells. Aides will serve only one neighborhood, so staff and residents will get to know each other as friends.

Call lights still remain outside the rooms because government rules require them. But there will be no more loudspeaker announcements or ringing bells; aides and nurses will answer pagers, and will be able to talk with residents or co-workers from anywhere in the building. Records now are kept electronically.

Each home is part of a broader "campus" that offers a range of housing -- from independent-living apartments to end-of-life care -- and incorporates on-site amenities such as banks, beauty salons, auditoriums for public events, meeting rooms for community groups, adult day care, child day care, a doctor's office, dental and foot care, fitness centers, chapels, libraries, personal computers and Wi-Fi connections.

There are differences. Sholom provides kosher meals and has guest rooms for visitors. Boutwells has luxury nursing home suites, including two in which a well spouse could live with a nursing home resident.

"The nursing home of the future? Well, it's close, but that's an evolving target," said Barb Ruppe, administrator of Sholom East. "We've built so we can keep evolving as new ideas, new training and new technology come on line."

Donations and training

Two key factors separate the homes from most others: donated money and a commitment to continuous staff training.

"We couldn't have a building this beautiful and this functional without very, very generous help from the community," said Bruce Kahn, CEO of Sholom Community Alliance, which operates various levels of senior housing in the Twin Cities.

Of the $59 million cost of the Rossy and Richard Shaller Family Sholom East Campus, organizers raised about $38 million from donations. The complex includes the 92-bed nursing home, a 66-bed assisted living facility that opens March 1 and a 45-unit subsidizied apartment building that opened in May.

At Boutwells Landing, the 108-bed nursing home's $30 million cost included about $10 million in donations.

"You can't build a state-of-the-art nursing home based on the payments you get from government programs," which finance the care for about two-thirds of nursing home residents, said Dan Lindh, CEO of Presbyterian Homes. "Until we change the way we finance long-term care, we'll have to depend on the vision and generosity of benefactors."

At Sholom East, aides and nurses have been practicing living in neighborhoods for more than a year, administrator Ruppe said.

Boutwells has taken a different approach. Financed in part with $5.5 million in state grants, Presbyterian Homes and Minneapolis Community & Technical College have developed a three-year training program for certified nursing aides that could be adopted by other facilities around the country.

"When we advertised for staff, we had 721 applications," said administrator Laura Cognetta. "The training shows how much we value staff, and their response shows how much they want to change the way we care for our moms and dads."

Said CEO Lindh, "What's really gratifying is to literally create a new place with new concepts from the ground up. We're building on what others have done and we're pushing the envelope just a little bit farther."

'I'm gonna like it here'

At Sholom, Gardner was settling into his new room, testing out his new bed and chair, and gazing fondly at his view of J.R. Mac's Grill and Pub, where he and his late wife used to eat.
"Can't tell for sure until I taste the food," Gardner, a retired salesman, cracked with one of scores of volunteers roaming the home helping residents get settled. "But my guess, I'm gonna like it here."

Warren Wolfe • 612-673-7253