Did we learn anything from the pandemic? ‘If it doesn’t turn the tide on nursing homes, then shame on us.’

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This article is reprinted with permission NextAvenue.org,

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In October, 150 people stood in the rain to celebrate the foundation of an innovative elderly housing project on the rural Key Peninsula in western Washington state. For the first time, older people who are no longer able to stay at home can still live in their community. non profitable Mustard Seed Project Three greenhouse houses are being constructed, two for assisted living and one for memory care. About a third of studio apartments will be for low-income people who are on Medicaid.

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Founded in 2006, the Mustard Seed Project helps ages of people with transportation, home repairs, friendly visits, yard cleaning and information and referrals. “The missing piece was ancillary housing,” says executive director Eric Blegen.

This rural community could be at the forefront of the future of elderly care: creating supportive services to help older people remain independent; With well-trained staff, nurturing close-knit communities instead of large hospital-like institutions, and developing small long-term care homes, all are offered in a way that doesn’t break the bank.

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ReadingNursing home crisis ‘worse than ever’

the beauty of small nursing homes

For more than 20 years, nursing home reform advocates have called for new models to replace traditional, dreaded institutions. This demand increased when the pandemic broke out in nursing homes. By October 10, 2021, More than 138,000 nursing home residents and more than 2,100 staff members have died of COVID-19. had died from, a number widely considered to be low count.

Some small nursing homes, especially the greenhouse model, did much better than others at protecting their residents. A 2020 (Pre-Vaccine) Study in Journal of the American Medical Directors Association Concluded: “Unconventional Green House / Small National Highway” [nursing homes] Better results than conventional National Highways in many areas; Evidence now demonstrates that they have lower COVID-19 and COVID-19 mortality rates than other NHs. As such, they are a particularly promising model as NHs are rebuilt post-COVID. ,

Susan Ryan, senior director of The Green House Project, says, “Interest in the model is at an all-time high. The media has been through the roof. Greenhouses have made this kind of approach to what we were seeing in nursing homes. offered a bright counter-argument.”

She talks about the advantages of the model: Each resident has a private bedroom and bathroom. Small autonomous homes greatly reduce the number of employees who come into contact with residents. Greenhouses use “universal workers” (known as “shahbaz”) who provide direct care, food, and household management through food, laundry, and housekeeping staff cycles. Nursing staff remains the same throughout the week.

“A lot of things about the model carry good COVID data,” Ryan says. “And you can’t underestimate the physical environment and being outside.”

Greenhouses, which typically serve 10 to 12 residents, are typically single-story, with yards and courtyards its residents can use independently.

“We’ve shown that we have a model that performs really well in the worst of times,” Ryan says.

See: There has been a significant drop in the number of people living in nursing homes in the wake of COVID-19

incentive change

The first greenhouse was built in Tupelo, Miss., in 2003. Today there are 360 ​​in 32 states, a small number compared to the 15,000 nursing homes nationwide. Despite ample evidence that greenhouse and other tiny-house models have better clinical outcomes and higher resident, family and employee satisfaction, change has been sluggish.

Too 90% of people want to grow old in their own home — what is the real cost of doing so?

One reason is that 90% of greenhouses are operated by nonprofits, while about two-thirds of nursing homes are for-profit, says John Ponthi, a management consultant for Southern Administrative Services who serves on the Green House Project board. Huh.

For-profit owners assume that only nonprofits that can raise construction capital through philanthropy can afford to build greenhouses, he says.

While Ponthi took pride in running a good quality traditional nursing home, from the first moment he set foot in the greenhouse in Tupelo, he knew this was the future he wanted for long-term care. “I was shocked,” he says. “It’s too good to be true.”

He explains how everyday life is different in a tiny house model. “In a greenhouse you are part of your loved one’s life,” he says. “It doesn’t smell like it shouldn’t — it smells like cornbread. Christmas is Christmas. You can go outside or go to the kitchen and have a Popsicle.”

Perhaps the most important are relationships.

“When you take away everything else, it’s all about this model’s ability to facilitate relationships between elders and caregivers,” Ponti says. “You have a commitment that goes far beyond your work tasks. There’s a relationship out there when it’s real and meaningful and rewarding. That’s the difference, that’s the magic.”

Ponthi’s company developed and provided administrative services to 30 greenhouses on five campuses in Arkansas, with 23 more homes opening as of April. Sixty percent of residents are on Medicaid.

According to Ponthi, although the construction cost is higher than a traditional model, once amortized over 30 years, the cost difference was “negligible”. “Operating costs are also up some 5% to 8% annually, but given the staggering difference in quality of life and all the outcome difference, it is a small one,” he says.

Since Medicaid covers the cost of most nursing home care, the federal government can better use its leverage to force change, Ponthi and others argue. “I will figure out the metrics and pay and take the better providers with better results [payments] away from those who are not,” he says.

People who build greenhouses or provide private rooms, for example, may pay a higher rate than Medicaid, Ponthi says.

The government may also offer low-interest construction financing for the construction of tiny houses, as did the Mustard Seed Project. It received a $7.8 million low-interest construction loan from the U.S. Department of Agriculture’s Rural Development Program and raised $5.6 million through state and county government, foundations, and the community for its greenhouses.

related: ‘Carers are burning with pandemic’: Labor shortage looms large at nursing homes

One barrier to change is the entry of poorly-acting private-equity firms that buy nursing homes and profit from them, often with dire consequences. one discovery Researchers at the University of Pennsylvania and the University of Chicago found a “severe drop in nursing staff, due to a greater drop in nursing staff availability per patient” following private-equity purchases amid the pandemic.

co-founder of Barry Barkan Live Oak Project (part of the national nonprofit Pioneer Network that is working to improve long-term care), agrees that change needs to be encouraged.

“We need to create tax benefits for people who are investing in good care, to invest in redesigning homes,” he says. “We need a system of regulation that is supporting positive innovation and is really hard on the bad actors.”

The future of fewer, better nursing homes?

According to Robin Stone, senior vice president of research at LeadingEdge (a trade group representing nonprofit aging service providers and others), the broader question is: “How does the nursing home fit into all the other options out there in the 21st century? And with the help of home and community-based services, how many can live in their homes with family support, some formal care, and some technology?”

She notes that finding high-quality elder care across the entire spectrum is very complicated. That’s all well and good for tiny homes, but “What do you do with all the existing stock? Are you going to demolish old buildings and build tiny houses on expensive land? You really don’t have enough money to do this in urban areas.” I don’t have a place.”

One option is to create “neighborhoods” with homely environments within larger buildings.

“The most important thing in a nursing home is trained staff who know what they are doing and know how to implement evidence-based practices around mobility, to prevent decubituity. [pressure sores], around managing the pain,” Stone says. “That’s the challenge.”

With older people being able to increase the amount of time they stay at home, moving to fewer, better nursing homes could be the answer, says Ponthi.

go from here to there

The Live Oak Project, which has been in the trenches for decades, promotes systemic culture change in institutional elderly care. When COVID-19 hit, the group quickly began working, developing an action plan to move forward and lobbying key members of Congress.

Simply demanding more regulation is not the answer, Barkan says. Working at the grassroots level and with the government, he notes, the Live Oak Project seeks to “remodel, redesign and transform the entire system of elder care from top to bottom and inside.”

It is focusing on the first three main areas: growing and training the direct care workforce, redesigning buildings from one institution to another, and adapting to the age…


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