MIDDLEBURY — Administrators, staff and residents at Helen Porter Healthcare and Rehabilitation Center are embarking on a months-long effort to overhaul the atmosphere at the nursing home, striving to make the facility less like a hospital and more like a residential care home.
Administrators at Helen Porter hope that the “culture change,” as they’ve termed the effort, will make the nursing home more comfortable for residents, and also bolster the facility financially.
The change also fits into a national movement among nursing homes to move away from the institutional models that originally cropped up in the 1960s and 1970s, said Helen Porter Administrator Neil Gruber.
“We were modeled after hospitals, and we look like a hospital,” Gruber said, “It’s only been in the last five years or so … (that) there’s been this sort of growing recognition that, for long term care residents, this model doesn’t work very well.”
Now, according to Gruber and Dementia Program Director Nancy Schaedel, reforming the system is “a must.”
“If we’re going to survive, we have to (change),” Schaedel said.
At the heart of the culture change discussion is one simple goal: Helen Porter should feel like a home to the residents who come to live out the end of their lives at the facility.
“For (our residents), we are the final home they’re going to have, and yet the way we are today doesn’t feel or look like home,” Schaedel said. That’s where the culture change comes in. “It’s deinstitutionalizing, and it’s including (residents) in the process. Any homeowner or any renter has some say about the environment they’re in and how things run. It’s flattening the traditional hierarchy.”
So far, that’s meant sitting down with residents to brainstorm ways to improve the quality of their lives at the facility. After complaints about noise control cropped up, posters went up in the foyer of building reminding staff and visitors to keep noise to a minimum.
Recently, residents voted on new names for the wings at the facility, choosing the names of Vermont rivers for individual units.
The nursing home is also exploring new ways to make meal service feel less institutional. The dining room at Helen Porter is now open throughout the day, instead of just for designated meal times, and serves as a “coffee shop” where residents can meet with friends and family over a cup of tea or coffee.
Meanwhile, members of the staff have started delivering breakfasts to residents — a change that gives residents more flexibility when they eat their meals, and frees up nurses to respond to residents’ concerns more quickly. Residents have also pushed for less rigid schedules at the nursing home, something they said would make the facility feel more like home.
Meanwhile, in the dementia care unit, staff members are considering adopting a “Namaste care” program, an approach to dementia care at other facilities that includes aromatherapy, massages, Reiki, and other sensory stimulation.
According to Betsy Gossens, the chair of the board of directors for Helen Porter, the little changes have been winning over staff, residents and residents’ families about the whole culture change endeavor.
“It wins over skeptics who think, ‘Well, a nursing home’s a nursing home. You can’t change it,’” Gossens said.
The staff has also looked outside of Helen Porter for advice, asking residents’ families and members of the community the question: What would have to change for you to embrace Helen Porter?
“Frequently what happens now is that people look at nursing homes when they have ticked off every other possible outcome for their life,” Schaedel said. “The very last thing on the list is going to a nursing home. People want to be autonomous as long as possible, they want to live independently in the community, but we don’t want to be the very last thing on that list.”
The changes are also being made with an eye toward Helen Porter’s future wave of consumers: baby boomers who are aging and beginning to seriously consider end of life care.
“More and more they’re going to be our customers tomorrow,” Gruber said, “and I don’t think what they are going to expect and want is going to be the same as the generation before them … The consumers of the very near future … have very different ideas about what they want for meals, what they want for accommodations, what they want for services. All long term care facilities are probably trying to figure out how to cope with the changing expectations.”
The nursing home is working with some constraints, of course. There are no plans to change the footprint of the building in the immediate future, for instance.
Porter spokesman Ron Hallman also said that Helen Porter is working on a limited budget when it comes to culture change. The nursing home is applying for a grant to fund some of the culture change work, and a $4,500 donation from the Brush family will act as seed money for the effort.
The nursing home will also have to learn how to offer more services for less: Medicare reimbursement rates were cut back in October, which means Helen Porter is facing an estimated $100,000 loss in payments this year.
Gruber said the nursing home is responding to financial pressures by increasing efficiency, and on the culture change front Schaedel pointed out that many of the recommendations don’t call for new money. Rather, the effort boils down to incorporating new techniques and approaches into the care already being provided at Helen Porter.
And, if a culture change brings more customers to Helen Porter’s doors in years ahead, the change could make dollars-and-cents sense for the facility.
“This is one of those unique times where the smart thing to do from a business perspective is also the right thing to do from a resident’s perspective,” Hallman said. “That’s a combination that you don’t often have come together at the same time.”