A West Seattle nursing home has become a leader in industry reforms.
The fifth-floor men’s lunch group is convened around a properly set table and a good bottle of wine at Providence Mt. 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.
Six of the eight men use wheelchairs. A few wear “clothing protectors,” the adult version of bibs. 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, is called “the best in the state” of Washington 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 has 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 staffer’s German shepherd roams the halls wearing a red bandana. They’ve mixed Alzheimer’s residents with everybody else and started a child-care center on site.
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Operated by the Sisters of Providence Health Care System, the Mount is one of a few nursing homes across the country that are winning acclaim for efforts to change the nursing-home culture.
The Mount spent $9 million on renovations. But the changes are as much philosophical as physical and could be duplicated without steep fees, says administrator Charlene Boyd.
Indeed, the Mount serves a fairly broad population. Its daily private-pay rate of $163–nearly $60,000 a year–for a two-person room is about average for non-profit nursing homes in the Pacific Northwest. About half the residents enter the Mount nursing center on a private-pay basis. But most 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 Roman Catholic institution, there is no religious requirement for residents, and Catholics are not given preference in admission. Indeed, fewer than half are Catholic.
About 1.5 million people live in the nation’s 17,000 certified nursing homes. By 2050, it’s estimated the figure will be more than 5.5 million.
St. Vincent’s staff lets Lillian Carlstedt, 100, rise at dawn, eat two breakfasts and take a nap in between. August VonBoecklin, 87, participates in daily mass, though he needs help with the basics of life.
In the past, 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. Put them down for a nap until lunch, when the routine was repeated.
In 1987, Congress passed the Nursing Home Reform Act that 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.
The Sisters of Providence had always operated a good nursing home but decided to start over. Planning for changes began in 1990; two years later the reconstruction began. By 1995, the major physical and program changes were in place. Single floors for up to 56 people, with rooms off long hallways with blank white walls and yellow linoleum floors, had been 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 to be the boss. Staffers were cross-trained so everyone cleaned up, washed clothes, served food and took care of residents. The goal was to create a homelike 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, staffers say, 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.
Today, Mt. 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 homelike environment. Its child-care program can serve 90 children.