Traditional Influences on Nursing Home Culture and Design

Traditional Influences on Nursing Home Design

• Medical model of health care delivery

• Hospitals

• Financing and regulations

Changes During the 1980s

• Emphasis on socio-residential and aesthetic features

• The change was triggered mainly by market competition to attract private-pay clients

• Competition among nursing homes intensified as community-based options and assisted living became available

Five Stages in Nursing Home Evolution - 1

1. County-operated poorhouses served to put away the annoying and disruptive elements of society

2. Private old-age homes (boarding homes)

Old Age Assistance became available to the elderly provided they resided in a private facility

Five Stages in Nursing Home Evolution - 2

3. Construction boom began in the late 1950s with SBA and FHA assistance

4. Medicare and Medicaid fueled further growth and help establish certification standards for nursing homes

5. Cultural and social change

Person-Centered CareObjective: To overcome dependency, boredom, and loneliness• Resident empowerment • An environment that fosters independence and self-reliance• Respect for personal choices• A physical environment that fosters positive distraction – the environment contributes to the healing process

Biophilia

• Connecting with nature (plants, animals, water, soil)

• Essential for thriving

• Beneficial effects on mental health

Thriving

• Living life to the full

• Achieved through a mutually-engaging and supporting relationship between

- the person

- human environment (social

connectedness)

- physical and ecological surroundings

The Eden Alternative• Enhanced environment• Children, animals, and plants• Interaction (such as caring for pets and plants)• Positive stimulation and distraction• Human companionship• Staff interaction• Healing effects of massage and aromas

Eden Alternative: The Three Main “Plagues” and their Antidotes

• Loneliness – loving companionship• Helplessness (Isolation) – give as well as receive care• Boredom (Depression)– variety and spontaneity

Eden Alternative: Management Principles

• Management should treat the staff as it would want the staff to treat the elders

• Practices that devalue workers must be discarded

• Decentralized decision-making: elders, families, and caregivers are given a lot of say

• Opportunities for growth for elders and caregivers

Green House Project - 1

• Small cottage-like structures, each housing 8 to 10 elders, sprawled across a campus

• Self-contained Green Houses are supported by a central organization

• Nursing stations and medication carts are eliminated

• Cross-trained worker teams

Green House Project - 2• Caregivers use standardized clinical practice

guidelines• Typical supervisor-subordinate relationships are

eliminated• Central interdisciplinary clinical support• Care is based on the philosophy of person-

centered care• Easy access to the outdoors replaces indoor pets

CCRC without Walls - FHRC

Target Market – Reaching out~!

• Currently 24% of CCRC’s offer Home Care– This will jump to 63% in 4 years~!

• Currently 22% offer Web-based Education– This will soar to 69% in 4 years~!

• Currently 25% offer Wellness Programs– This will rise to somewhere above 52%

• Why the doubt…hard to find the Therapist~!

Technology will be KEY

• Your campus will not be able to contain – The Demand– The Physical Need~!– The Dementia Demand~!– The Traffic~! Or – The Capital Requirements~!

What is our Market?

• Seniors 75+ with incomes greater than $35,00– 795 individuals in your Target Market– 37% of the overall 75+ crowd

• Penetration Target Rate of 16%– 358 Individuals meet criteria~!– FH has predicted 20 in year 1

What is our Market?

• Seniors 85+ with incomes greater than $35,00– 260 individuals in your Target Market– 28% of the overall 85+ crowd

• Penetration Target Rate of 16%– 143 Individuals meet criteria~!– FH has predicted 20 in year 1

What is our Combined Market?

• 358 Seniors 75+ meeting Criteria

• 143 Seniors 85+ meeting Criteria

• 501 Seniors in Target Market

• FH plan counts on 80 in Three Years~!

• That is 16% of the 16% available– IT is achievable~!

Our Next Steps

• Complete Plan• Educate Stakeholders of Future

– Building plans– Outreach plans– Ministry connectivity

• Implement Strategy– Create Feedback Loop– Make Adjustments~!