State embraces quality-of-life changes for nursing homes

CENTRALIA — Before a stroke robbed her of her mobility and muddled her memory, May Mattoon's passion was teaching Sunday school.

She can't manage a room full of toddlers anymore, but at the nursing home where she lives now, she can come close.

In addition to housing 128 elders, Liberty Country Place operates an in-house day-care center where residents like Mattoon can get a regular dose of the childish exuberance that gives them such joy.

It's part of a program called the Eden Alternative, one of several national movements that aim to replace the grim atmosphere of traditional nursing homes with a warm environment alive with children, plants and a menagerie of dogs, cats and birds.

Only a dozen nursing homes in Washington are Eden-certified, but a unique initiative is under way to increase that number. The state is the first in the country to teach Eden Alternative basics as part of a new federal program to improve the quality of care at the country's 17,000 nursing homes.

The program by the federal Centers for Medicare and Medicaid Services focuses mainly on measurable health yardsticks, like prevalence of bedsores and pain management.

But nursing-home experts in Washington state convinced local Medicare administrators that it's equally important to improve quality of life for nursing-home residents. And, proponents argued, happier people are usually healthier.

"We use less medication, both for pain and depression," said Wendy Wheatley, administrator of Fir Lane Health and Rehabilitation Center, an Eden facility in Shelton, Mason County. "When residents are so engaged in life, their medical problems take a back seat."

Nursing-home staff and administrators from across the state can participate in the voluntary, three-year federal nursing-home initiative, which will include an introduction to the Eden Alternative and other "culture-change" philosophies, as well as specific tips on ways to make facilities better places to live and work. The first of several workshops in Western Washington started this month.

"I think this is really going to help plant the seed out there," said Louise Ryan, Washington's Assistant State Long-Term Care Ombudsman.

Ryan hopes to document Washington's experience, to see if nursing homes that provide a more homey environment also score higher on bedsore prevention, pain treatment and the other federal yardsticks.

Dr. Bill Thomas was primarily concerned with emotional well-being when he conceived of the Eden Alternative in the early 1990s as a way to alleviate the loneliness, helplessness and boredom that permeated the nursing home he ran in New York.

"What good is quality of medical care if your life is miserable?" he asked.

But Thomas also discovered measurable medical benefits. After two years, his first Eden facility had 50 percent fewer infections and 25 percent fewer deaths than a comparable non-Eden nursing home.

He attributes those improvements to abandoning the hospital model used at traditional nursing homes, with their sterile corridors, regimented schedules and emphasis on medical treatments. In most facilities, residents are all roused at the same time each morning and wheeled to breakfast. Activities and even bath times revolve around what's convenient for staff, not what residents prefer.

Thomas introduced pets, plants and children as a way to add variety, interest and spontaneity — and create appealing living spaces.

Beyond the surface changes is an approach that puts residents first and strives to make nursing homes places where people can continue their lives — not wait passively for death, Thomas said.

Residents have more control

The difference is apparent at Liberty Country Place, where a foot-tall green parrot named Bob greets visitors from atop his open cage in the entryway. A tiny apricot poodle called Happy and a golden retriever named Annie patrol the halls, stopping to sniff and visit with residents.

In the hub of the building, a dozen toddlers from the day care sing for a group of residents, including Mattoon. With the children crowding around her feet, the 92-year-old joins in a chorus of "Jesus Loves Me," then leans forward to receive a round of hugs.

In another part of the building, a group of seven women gathers in the garden-club room, where they repot begonias and pinch dead leaves from spider plants.

"I don't know too much about plants, but I like messing around with them," says Harriet McDaniel, 81, who has lived at the facility for four years.

Though she still longs to return to her own home, McDaniel also enjoys her role at the nursing home, where she's part of a group that welcomes new residents and helps them learn the ropes.

At Eden facilities, residents have more control over their own lives, said Liberty Country Place administrator Lynn Ford. They can choose which — if any — activities to participate in, and create their own schedules. People get up when they want. For early risers, there's a regular breakfast. Late sleepers can snack from a buffet.

The flexibility suits 67-year-old Marvin Rigsby, who moved to the home after a head injury left him partially paralyzed.

"I pretty much do what I want around here," he said. That includes working on his computer and running the small store where residents can buy toiletries and candy. It doesn't include cooing over the dogs and cats.

"I was raised without animals inside the house," he said.

At Fir Lane, the Shelton nursing home, a group of residents recently ordered up a van and went out for ice cream on their own, said administrator Wheatley.

At the request of residents, the center hosts an occasional happy hour, featuring cocktails and beer. There's a monthly restaurant night, with a small dining room converted into a bistro where residents and their guests can dine by candlelight and sip wine. Last St. Patrick's Day, residents celebrated with green beer.

Catching on, but slowly

Providence Mount St. Vincent nursing home in West Seattle put Washington at the forefront of nursing-home transformation in the mid-1990s, when it became one of the first facilities in the country to implement then-radical changes like these.

Though not an Eden facility, the home and its administrators are still recognized as national leaders.

But few other homes in the Puget Sound region have followed suit, said Jeannette Franks, board president of the Washington Pioneer Network, part of a national umbrella group promoting nursing-home culture change. Nationwide, a scant 300 facilities have formally adopted the Eden principles, introduced in 1995.

"The pace is glacial," said Franks.

In addition to the 12 certified Eden facilities in the state, another 25 are incorporating some of the program's elements, said Vivian Curry, the state's Eden Alternative coordinator.

Many administrators are wary that it will be expensive and difficult, at a time when nursing homes are facing deep cuts in state and federal funding, she added.

"I'm not going to say it doesn't take any extra money," Curry said, "but it really takes more of a change in heart than change in your pocket."

Liberty Country Place spent about $3,000 to set up its day care, which is now breaking even, Ford said. The staff organized fund-raisers to buy bird cages and other pet supplies. Wal-Mart donates damaged bags of cat and dog food, and a local veterinarian treats the pets for free.

"Right now, our biggest extra expense is probably cat litter," Ford said.

But the facility just earned its second consecutive perfect score from state inspectors, and staff turnover has plummeted, Ford said.

Jim Rowe, president of Washington Health Care Association, a trade group, has rarely had to advertise for workers since converting his two nursing homes to Eden facilities. Hiring costs fell from $13,000 in 2001 to $600 last year.

Costs are no higher for patients in Eden facilities, he said. "I'm cheaper than the guy up the street, who's not Eden."

Anecdotal reports of Eden's benefits abound, but there have been few systematic studies so far.

A two-year research project at the Texas Long Term Care Institute found that five nursing homes adopting the Eden Alternative reported 57 percent fewer bedsores, 60 percent fewer behavioral problems and a nearly 50 percent drop in staff absenteeism.

However, a more recent, one-year study comparing two nursing homes in Kentucky found no improvement in residents' overall health at the Eden facility.

Nursing-home advocates predict market forces will drive more nursing homes to adopt Eden principles or similar philosophies.

Baby boomers, who are now seeking better options for their parents, will demand more livable arrangements for themselves as they age, said Ryan, the assistant state ombudsman. Already, most Eden nursing homes are always full, with long waiting lists.

"Nursing homes that don't start changing," Ryan said, "aren't going to make it."

Sandi Doughton: 206-464-2491 or sdoughton@seattletimes.com