The Pursuit Of Happiness . . . Even In Old Age
Seattle Times Staff Reporter
Providence Mount St. Vincent nursing home in West Seattle has reinvented itself with the goal of making residents' lives enjoyable. Today, it's considered a national model of what nursing care can be.
The fifth-floor men's lunch group is convened around a properly set table and a good bottle of wine at Providence Mount St. Vincent nursing home.
With a little prompting from a staffer, the fellows limber up with a quick game of "Name the State Capitals," then move on to "Should the President Be Impeached?"
"No," grouses one man. "Many of the senators have cheated on their wives."
"Sometimes, you just can't help yourself," another observes. Takes care of that topic.
Six of the eight men use wheelchairs. A few wear "clothing protectors," the adult version of bibs. Like it was yesterday, they can remember riding a horse to school or sitting on President Roosevelt's lap. But a few, who are very frail or confused, aren't so sure what to do with a knife and fork. And, it's a good guess several won't be able to recall this lunch.
But that's not the point.
This ordinary gathering is a sign of respect for the freedoms these men used to enjoy and the worth of their lives now. It helps make this a good place to live, instead of a lonely institution where they wait to die.
What the Mount, as it's called, is doing in the old brick building in West Seattle seems like simple common sense. But it's considered at the forefront of a revolution in the nursing-home industry.
The Mount, 75 years old this year, is no less than "the best in the state," in terms of how it's managed and the social life it has created for residents, says Kary Hyre, the state's long-term-care ombudsman.
The Mount's staff encourages residents to exercise control over their own lives - be it eating bacon despite being on a salt-free diet, attending daily Mass or staying up all night to watch TV. They've converted hospital-like floors into small, carpeted "neighborhoods."
They've invited a couple of cats, a few birds and other pets to live there. A staff member's German shepherd roams the halls wearing a red bandana. They've mixed in Alzheimer's residents with everybody else and started a child-care center on site.
Operated by the Sisters of Providence Health Care System, the Mount is one of a handful of nursing homes scattered across the country that are winning acclaim for efforts to change the nursing-home culture.
They call themselves the "Pioneers."
Administrators from these nursing homes meet regularly to share ideas and advocate for change throughout the industry.
They have variously brought plants, animals and children into their facilities and created more sensitive ways of bathing residents, allowing them more privacy, for example. They've designed care plans that focus on making residents' lives enjoyable as opposed to focused on solving their medical problems.
Mount St. Vincent, in particular, has ". . . pulled back from that extreme medical model and increased the chance for meaningful relationships, which is the thing that's been missing in nursing homes," says Sarah Greene Burger, executive director of the National Citizens Coalition for Nursing Home Reform.
The Mount spent $9 million on renovations. But the changes there are as much philosophical as physical and could be duplicated without expensive renovation or steep fees, says administrator Charlene Boyd.
Indeed, the Mount serves a fairly broad population, not just the wealthy. Its daily, private-pay rate of $163 - nearly $60,000 a year - for a two-person room is about average for nonprofit King County nursing homes. About half the residents enter the Mount nursing center on a private-pay basis. But typically, they wind up supported by Medicaid in three to six months, after they've spent almost all of their savings.
About 80 percent of residents have some form of dementia. Their average age is 89.
While the Mount is a Catholic institution, there is no religious requirement for residents, and Catholics are not given preference in admission. Indeed, less than half of the residents are Catholic.
Experts say the nursing-home industry is under pressure to change, as baby boomers struggle to do right by their parents and start imagining heading into old age themselves.
"There's got to be more than keeping them clean and fed," says Bob Ogden, the Mount's former administrator who currently heads Providence Home Services Agency.
"When we get there, we're going to say: `Damn it. I'm getting up when I please. I'm not rooming with some stranger. And, if you tear up my laundry, you're going to pay for it."
About 1.5 million people live in the nation's 17,000 certified nursing homes. By 2050, it's estimated that number will be more than 5.5 million.
Even as Washington state beefs up programs such as home health care intended to keep people out of institutions, the nursing-home population likely will climb. Its estimated that the number of state residents 75 and older will increase from a little over 300,000 today to more than 978,000 by 2040.
`A work in progress'
All the national attention - the Mount was profiled in The New York Times and its administrators have been asked to testify before Congress - stirs some ambivalence.
"We're not perfect. We are a work in progress," says Boyd. "Every nursing home intends to treat people with dignity and compassion and love."
Providence Mount St. Vincent is definitely going about it differently.
The staff lets Lillian Carlstedt, 100, rise at dawn, eat two breakfasts and take a nap in between. August Von Boecklin, 87, participates in daily Mass, even though he needs help with the basics of life.
And Catherine MacDonald, who died at 102 last month, celebrated her last Saint Patrick's Day on a group outing to a Ballard pub, where the regulars gave her a standing ovation.
In the past, residents weren't allowed this much fun.
Their days followed an unchanging routine: Wake the residents up. Roll them to the dining room. Pass out food trays and medicine. Pick up the trays. Roll the residents back. Lay them down for a nap until lunch, when the routine was repeated.
Most people stayed in their rooms or sat in the hall until time for an activity or physical therapy. Or they could circle the nursing station in their wheelchairs.
Floors were organized by level of care, the lightest-care residents on the bottom, the heaviest on top. As people became more disabled, they joked about moving toward heaven. The Alzheimer's floor was locked.
"It was noisy and chaotic sometimes. . . . Dinner time was the worst," remembers resident assistant Tamara Allen.
In 1987, after months of hearings highlighting the horrors of nursing-home life, Congress passed the Nursing Home Reform Act. It set standards for everything from use of restraints to training of nurses aides. It guaranteed residents the right to privacy, to voice grievances and to freely associate with other residents.
All nursing-home assistants had to get a minimum of 75 hours training. Patients and their families were given the right to help develop their own care plans.
Many institutions are going beyond these required improvements, to try truly innovative things. But, for the most part, nursing homes have kept caring for residents as if they were hospital patients, says Burger.
The hospital model "is not appropriate for people who are old and frail. That way of doing things simply doesn't work," she says.
Most residents in nursing homes, for example, still must get up at a certain time in the morning for the convenience of the administration, she explains.
What they've neglected to learn, she says, is that those tasks will be completed more efficiently if they're performed on the resident's schedule.
It's only going to take one staff member to get a resident to physical therapy if the resident is feeling energetic, she says. But it may take four ". . . if you have to drag them."
The Sisters of Providence had always operated a good nursing home but still decided to start over.
Planning for changes at the Mount began in 1990; two years later the first neighborhood was constructed. By 1995, the major physical and program changes were in place. But the Mount continues to refine and reinvent itself.
Single floors for up to 56 people, with rooms off long hallways with blank white walls and yellow linoleum floors, were reconfigured into cozy "neighborhoods" for 20 to 24. Each neighborhood included a care station that opened onto a full kitchen, small dining area and laundry.
Rigid feeding and activity schedules were out. The resident was supposed to be the boss.
At the same time, the staff was cross-trained so everyone cleaned up, washed clothes, served food and took care of residents.
The vision was to create a home-like environment where it was more important for people to know and support each other than make the beds on time.
Residents of varying abilities were mixed together. One outcome, the staff says, has been to dramatically decrease the agitation levels among Alzheimer's residents. A large child-care program was started downstairs to encourage interaction between the residents and children.
The changeover "was unbelievably hard," says Ogden.
The staff balked, though there was no mass exodus. One daughter threatened to sue because her 92-year-old mother who was on a salt-free diet was allowed to have bacon. Later, the daughter admitted the Mount was right: At that age, mom should enjoy her bacon.
Like a small city
Today, Mount St. Vincent is like a small city. It offers assisted-living apartments, a nursing center, a short-stay physical-rehabilitation unit and an adult family-home for six residents with severe dementia who need a small home-like environment. Its child-care program can serve 90 children.
The more than 300 residents can take tai chi, art therapy or swimming classes. Acupuncture, dental care, medical care and spiritual counseling are available. Lattes are sold in the gift shop.
Residents join the day-care children for activities such as sing-alongs. Wagonloads of kids visit the nursing-center floors.
Residents are encouraged to stay as long as they can in assisted living, where a range of support services makes it possible to give care almost as intensive as in the nursing center. Crossing over from the apartments to the other side ". . . isn't something you want to think about," says one resident.
Residents, their families and staff members say the neighborhood concept works. They become friends, get together for parties and potlucks, exchange Christmas gifts.
"You feel like you're treating people as people, instead of patients. That we're equals." says Allen.
Not all of the Mount's ideas draw praise.
Some question the wisdom of integrating Alzheimer's residents with the mentally alert. Critics say those with dementia may be ostracized, while more alert residents can feel as if their privacy is being invaded by those who are confused and wander through the rooms.
Former administrator Ogden says the Mount and other nursing homes should have all private rooms, less regimentation and more individual choice.
But try as hard as it might, the Mount can't feel exactly like home.
Lillian Carlstedt understands that and adjusts.
"When I sold my house, I had no more address. This is my address now. To begin with I felt kind of funny," she says.
Her daughter, Doris Prescott, observes that it can be frightening at first to room with a stranger and have other strangers take care of your most intimate needs.
Even though the Mount has been her home for about two years, Carlstedt still keeps her daughter's phone number and name "DORIS" printed in big capital letters on a piece of paper. That paper is folded up small and stuffed into her glasses case. The case is tied up in a soft hairnet. That way Carlsted can recognize the feel of it when reaching into her tote bag. That way it's close by and easy to remember in case she decides to call.
It's a little extra security in her new neighborhood.
Older people often can't or won't express what they would like, staffers say. So it's important to talk with the family about what residents enjoyed in their old lives and to identify their exact physical needs.
And you have to notice the littlest things. "You have to see. You have to hear. You have to feel," says Kris Schons, a licensed practical nurse. "You just have to evolve with them."
She remembers resident Ray Wogsland, who had a week or two left to live.
"Ray, if there was one thing you could have, what would it be?" she asked.
"I'd love to have a shot of Canadian whiskey," he said.
There happened to be a little booze in the medication room, so she poured him a small shot.
"Ray, be sure to smell that first."
"Ooooh, that was great."
Several nights later, she gave him a couple more shots after getting a doctor's order for it. Wogsland, a carpenter by trade and a great reader until the end, didn't live much longer. He died Jan. 5 at age 94.
"I helped him have a smile on his face at least for a day or two," says Schons.
Little things like that.
Marsha King's phone message number is 206-464-2232. Her e-mail address is: firstname.lastname@example.org
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