Did we learn anything from the pandemic? ‘If it doesn’t turn the tables on nursing homes, shame on us.’

Established in 2006, the Mustard Seeds Project helps aged people on-site, with transportation, home repairs, friendly visits, yard clean-ups and information and referrals. “The missing piece is supportive housing,” said CEO Eric Blegen.

This rural community may be ahead of the aged care future: creating support services to help older people maintain independence; foster close-knit communities and develop small long-term care homes, rather than large facilities like hospitals, with well-trained staff, all delivered in a way that doesn’t break the bank row.

Read: Nursing home crisis ‘worse than ever’

The beauty of small nursing home

For more than 20 years, nursing home reform advocates have called for new models to replace the dreaded traditional facilities. This need has increased as the pandemic spills over into nursing homes. As of October 10, 2021, More than 138,000 nursing home residents and more than 2,100 employees have died from COVID-19, a number considered by many to be a low number.

Some smaller nursing homes, especially the Blue House model, have done a much better job than others in protecting their residents. A 2020 (pre-vaccine) study in Journal of the American Association of Medical Directors Conclusion: “African Traditional Green House / Small NH [nursing homes] have better results than traditional banks in many fields; There is now evidence that they have lower rates of death from COVID-19 and COVID-19 than other banks. They are therefore a particularly promising model because banks were reinvented after COVID. ”

Susan Ryan, senior director of the Green House Project, said, “Interest in the model is at an all-time high. Media has been through the roof. Green Houses has offered such a bright backlash to what we are seeing in nursing homes. ”

She appreciates the advantage of the model: Each resident has their own bedroom and bathroom. Smaller autonomous operating homes significantly reduce the amount of staff that comes into contact with residents. Green Houses employs “general staff” (referred to as “Shahbaz”) who directly provide care, meals, and household management, rather than staffing meals, laundry and clean room on duty. Nursing staff is consistent throughout the week.

“A lot of things about the model provide good COVID data,” says Ryan. “And you can’t underestimate the physical environment and going out.”

Green Houses, which typically serve 10 to 12 residents, are typically single-story, with patios and patios that residents can freely enter.

“We’ve proven we have a model that works really well in the worst of times,” Ryan said.

See: Nursing home occupancy rates drop significantly after COVID-19

Encourage change

The first Green Homes popped up in Tupelo, Miss., in 2003. Today there are 360 ​​in 32 states, a tiny number compared with 15,000 nursing homes nationwide. Although there is ample evidence that Green House and other small-home models have better medical outcomes and higher levels of satisfaction for residents, families and employees, change is still slow. .

Also see: 90% of people want to grow old in their own home – what is the real cost of doing so?

John Ponthie, a managing member of Southern Administrative Services management consulting firm who serves on the Green House Project Board, says one reason is that 90% of Green Houses are run by organizations. not-for-profit, while nearly two-thirds of nursing homes are for-profit.

For-profit owners have assumed that only non-profit organizations, which can raise construction funds through charitable causes, can afford to build Green Houses, Mr. speak.

While Ponthie prides himself on running good quality traditional nursing homes, from the first moment he set foot in the Blue House in Tupelo, he knew this was the future he wanted long-term care in. long. “I was surprised,” he said. “It’s too good to be true.”

He describes how different everyday life is in the model of a small house. “At Green House, you are a part of your loved one’s life,” he says. “It doesn’t smell like it shouldn’t – it smells like tortillas. Christmas is Christmas. You can go out or go to the kitchen and eat Popsicle. “

Perhaps the most important are relationships.

“When you remove everything else, that’s the model’s ability to facilitate the relationship between the elderly and caregivers,” says Ponthie. “You have a commitment that goes beyond your job duties. Having a relationship there, when it’s real, is meaningful and rewarding. That’s the difference, it’s the magic.”

Ponthie’s company has continued to grow and provide administrative services for 30 Green Homes across five properties in Arkansas, with another 23 due to open in April. Sixty percent of residents are on Medicaid.

According to Ponthie, although the construction cost is higher than the traditional model, when amortized over 30 years, the cost difference is “negligible”. “Operating costs are also 5% to 8% higher annually,” he says, “but given the staggering difference in quality of life and all the difference in outcomes, it’s a disparity.” ,” he said.

Because Medicaid covers the cost of most nursing home care, the federal government could better use its leverage to force change, Ponthie and others argue. “I want to find the metrics and pay better vendors with better results and perform [payments] stay away from people who are not,” he said.

For example, people who build Green Homes or provide private rooms may be paid a higher price by Medicaid, Ponthie added.

The government can also provide additional low-interest construction financing to build tiny homes, as the Mustard Seed Project did. It received a $7.8 million low-interest construction loan from the U.S. Department of Agriculture’s Rural Development program and raised $5.6 million through state and county governments, state and federal agencies. fund and community for its Green Homes.

Related: ‘Carers are suffering from pandemic burnout’: Labor shortages are taking a toll on nursing homes

One obstacle to change is the entry of ill-fated private equity firms that buy up nursing homes and profit from them, often with disastrous results. Research by researchers at the University of Pennsylvania and the University of Chicago found “a sharp decline in nursing staffing, leading to a greater decline in nursing staff availability per patient.” ” after private equity purchases, even in the midst of a pandemic.

Barry Barkan, co-founder of The live oak project (part of the national nonprofit Pioneer Network working to improve long-term care), agreed that change should be encouraged.

“We need to work towards creating a tax advantage for people who invest in good care, invest in redesigning their homes,” he said. “We need a regulatory system that supports positive innovation and actually tackles the bad actors.”

A future with fewer nursing homes, better?

The broader question, according to Robyn Stone, senior vice president of research at LeadingAge (a trade group representing nonprofit aged care providers and services), is: “How do we do this? Does nursing home in the 21st century match all the other options out there? With the aid of technology and the expansion of family and community-based services, how many people can stay in their own homes with family support, some form of formal care and some technology? ”

Creating high-quality aged care across the spectrum is incredibly complex, she notes. All is well and good to promote small houses, but “what are you going to do with all the stock available? Are you going to demolish old buildings and build small houses on expensive land? You really don’t have the space in urban areas to do that.”

One option is to create “residential areas” with a home-like environment in large buildings.

“The most important thing in a nursing home is trained staff who know what they are doing and know how to implement evidence-based practices around mobility, around decubiti prevention. [pressure sores]Stone said. “That’s the challenge.”

With older adults able to extend their stay at home, Ponthie adds, moving toward fewer nursing homes could be the answer.

Go from here to there

The Live Oak project, which has been active for decades, promotes systematic cultural change in institutional aged care. Once COVID-19 was successful, the team quickly got to work, developing an action plan to move forward and lobbying key members of Congress.

Barkan says simply asking for more regulations is not the answer. Working at the facility and with the government, he noted, Project Live Oak seeks to “re-imagine, redesign and transform the entire aged care system from top to bottom and from the inside out.” .

First, it focuses on three key areas: developing and training the direct care workforce, redesigning buildings from facility to home, and creating an age-friendly culture.

Among Project Live Oak initiatives: a $55 billion Medicaid investment to better pay and benefit full-time nursing home workers; $1 billion to increase hiring and training of direct care workers; encourages the transition from large facilities to small homes and the creation of a digital network through the US government’s Public Life Administration, to share research and strategies to enhance welfare of the elderly.

Leaders of this effort are meeting with staff from key congressional committees to push funding to be included. in the Biden administration’s Build Back Better package. Barkan said. “We have to be digging deep for a long way.”

Add Ryan: “If [the pandemic] don’t turn the tables on nursing homes, and then be ashamed of us. ”

Beth Baker is a longtime journalist whose articles have appeared in the Washington Post, AARP Bulletin, and Ms. She is the author of “With a Little Help from Our Friends – Creating Community As We Grow” and “Aging in a New Age – The Promise of Transforming Nursing Homes”.

This article is part of The Future of Aged Care, a Next Avenue initiative with support from the John A. Hartford Foundation.

This article is republished with permission of NextAvenue.org, © 2021 Twin Cities Public Television, Inc. All rights reserved.

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