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Time to change nursing home model, geriatrician tells Utah professionals
Al Hartmann | The Salt Lake Tribune William Thomas is a leader in the online Changing Aging movement and a self-described “nursing-home abolitionist."
With their roots in Dickensian workhouses and modeled on hospitals, nursing homes in many ways have earned the dread of old people, especially those who can still remember the stigma of America’s poorhouses and county homes.
“The terror people feel is real,” said geriatrician Bill Thomas, in Salt Lake City on Thursday to boost a new type of long-term care called the Eden Alternative.
Because policymakers in the 1960s decided to help ailing elders by placing them in heavily regulated institutions, nursing homes today can seem more like jails than the kind of gentle, caring collectives Thomas envisions.
“It is highly stigmatizing to have to surrender your freedom to get the care you need,” Thomas said during a break in a daylong conference that drew about 140 long-term care professionals.
Thomas, a professor at the University of Maryland, Baltimore County, is the founder of the nonprofit Eden Alternative, an education business that teaches nursing-home administrators how to transform the way they take care of elders.
The Eden Alternative doesn’t require formal certification for nursing homes, such as Alpine Valley Care in Pleasant Grove, one of the five Eden homes in Utah. Rather, Eden homes employ a set of beliefs and practices that makes residents’ dignity and autonomy the top priority, with the residents at the helm of the ship.
“It’s not anything like a franchise,” Thomas said. “It’s more of an honor society.”
Part evangelist, part smart businessman and a bit of a ’60s throwback (he’s 51), Thomas went to Harvard Medical School and says his favorite practice was in the emergency room. A part-time stint as a nursing home doctor led him to an encounter with an old woman who told him, “I’m so lonely.”
From there his passion for caring for old people changed to a mission to reform nursing homes.
Ålthough many of the 100 nursing homes in Utah employ similar principles, only five call themselves Eden homes. They are all run by Huntsville-based Mission Health Services.
Gary Kelso, president of Mission Health Services based in Huntsville, said going the Eden way is doing the right thing.
“Once you get some success stories,” Kelso said, “you’re very willing to jump into the risk.”
Thomas and other advocates note that nursing home regulations focus on downside risk, the things that can go horribly wrong. Many of the worst abuses of old nursing homes, such as tying people to bed rails, no longer are tolerated. But institutional rules, such as making everyone eat at the same time, making staffers wear hospital scrubs and making a charge-nurse station the center of activity, still are common.
The regimentation inhibits the kind of natural life elders too often lose when they seek long-term care, advocates say. By contrast, Eden homes allow animals, encourage outings and fresh air exercise, have gardens and living-room like spaces for families to visit with elders and staffers.
They also adhere to federal regulations.
Thomas really would like to abolish nursing homes. “The reason it hasn’t been done before is, it’s not easy. And no one has done it perfectly,” he said. “But I don’t have to make it perfect. I have to make it better than the standard nursing home. I can do that.”
Medicaid or bust for nursing home
The Salt Lake Tribune
Published: April 7, 2010 06:18PMUpdated: September 9, 2010 03:21PM
The Salt Lake Tribune Administrator Romaine Tuft with longtime patient Thelma Willahan, age 101, has been working at the Hazen home since she wa 8-years-old under the direction of her father who opened the home in 1962. Hazen Nursing Home wants a special allowance under the current bed moratorium on Medicaid-funded nursing home beds. Without this, they claim they will have to close this year, since they are the only private-pay nursing home in the state. Hazen is Medicaid certified but not allowed to take people on Medicaid because of a state bed moratorium to prevent any new Medicaid beds. 4/1/10 SLC
West Valley City >> It’s well after noon, and Hazen Care Center administrator Romaine Tuft hasn’t stopped for lunch.
She has hours of bookkeeping to do. But first, she sneaks a peek at 101-year-old Thelma Willahan who, Tuft says, “has good days and bad.” She delivers medicine and a special-order soda (no ice) to another resident, and later, is called to the kitchen to help serve up a home-cooked meal.
It’s this level of personalized attention that for 48 years has given Tuft’s small family-owned, family-operated nursing home an edge on larger, corporate convalescent centers.
And it might have seen Hazen through the recession were it not, says Tuft, for “unjust” government regulations that stymie competition, penalize the “little guy” and threaten to force Tuft out of business this year.
“I’ll land on my feet,” says the 55-year-old Tuft, who inherited the business from her father. “But I worry about my staff. No one is hiring in this economy. And I’m absolutely devastated about our clients who will be displaced.”
Hazen is the only private-pay nursing home in Utah – a dinosaur in an industry where 80 percent of patient care is paid for by government-run health programs, Medicaid and Medicare.
Tuft would like to take Medicaid patients, and has applied to the state Health Department for permission. But a moratorium on new Medicaid beds stands in her way.
The moratorium was imposed in the late ’80s to keep long-term care costs in check, said Dirk Anjewierden, executive director of the Utah Health Care Association.
At the time, an explosion of new nursing homes was causing occupancy rates to plummet, which in turn, drove up costs, he said. “Medicaid doesn’t just pay whatever nursing homes charge. So when costs go up, nursing homes fold, leaving patients with limited access to quality care.”
But Tuft says the moratorium amounts to government-sanctioned job protection for outdated facilities. She would like to see it abolished, but would settle for a special allowance under the law.
“I just want to compete on a level playing field,” she says.
Moved by her plight, Sen. Luz Robles, D-Salt Lake City, sponsored legislation this year that would have allowed the state to re-certify a nursing home for Medicaid as long as the center has remained operable and hasn’t grown since its certification lapsed. SB238 sailed through the Senate then got hung-up in a logjam in the House.
But Robles is pushing to revive it, possibly in time for a special Legislative session planned for May.
“We hardly have any facilities on the west side,” said Robles. “Those families deserve access to quality care too.”
Hazen is the only nursing home to fit the parameters of Robles’ bill. It used to take low-income, disabled patients on Medicaid, but dropped its certification in the mid-’70s. Medicaid’s low payment rates weren’t worth new regulatory hurdles and paperwork imposed by the federal government, says Tuft.
The decision paid off, and Hazen thrived. Until last year the cozy, 26-bed nursing home boasted 95 percent occupancy.
Statewide occupancy rates now hover at 68 percent.
“We’ve served our community with integrity, employing hundreds of people and supporting countless vendors. We have no debt and little employee turnover,” says Tuft. “I have some staff who have been here for 30 years.”
But Tuft never anticipated Medicaid would grow like it has. Nor did she foresee the recession or being hit with a series of Medicaid bed taxes. All long-term care centers pay the tax, which funds grants to raise industry wages and upgrade older facilities.
Since 2005, Hazen has contributed $330,000, said Tuft. “I have to pay it. But I get none of it back, because I’m not Medicaid certified.”
Anjewierden sympathizes with Tuft, but says federal law won’t permit the state to exempt her from the tax. His group is neutral on Robles’ bill.
Occupancy rates remain low in Utah, despite an aging population, which Anjewierden attributes to growth of community-based programs. “That’s a good thing, aging in place is a good thing. If you need to place your mom somewhere, you’ve got plenty of options.”
Also, he says, Hazen is free to purchase Medicaid beds from facilities that are looking to dump them.
But for Tuft, the purchase doesn’t pencil out. The recession has hurt business, but she says, “it’s the tax that’s really killing us.”
Anticipating the worst, Tuft has arranged to have one of the residents, Carol Barben, live with her. Barben, a mentally disabled woman in her 70s, has lived at Hazen for 43 years.
“She’s family,” says Tuft.
But others will be uprooted and relocated to other facilities.
“This is my home,” says longtime resident Willahan.
A career bureaucrat in an era when few women had jobs, Willahan spent her adult life working for the Department of Agriculture in Washington D.C. She never married or had children.
She checked into Hazen in 2005, returned home for a period, and came back because she says, “the people here are so good to me.”
If Hazen closes, Willahan says, “heaven only knows where I’ll go. I’d rather not think about it.”
Thursday, March 3, 2011
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