Turning Nursing Homes into “Homes”

Sooner or later we are going to have to face facts: We have an aging population which, thanks to medical advances, can be kept alive longer and longer.

At the same time that we can extend life, however, we have to recognize two related facts: that as we age we need more and more assistance and, second, that as we age our natural support system (family and friends) becomes smaller and smaller. These facts of contemporary (and future) life largely account for why more and more Americans find themselves living their final years, months, or days in nursing homes. Yet, from personal experience with family members, as well as from stories told to me by my patients, for the overwhelming majority of people the prospect of moving into a nursing home evokes nothing but dread. Why is that? More importantly, is there anything we can do to remedy this?

Nursing home care is dreaded simply because in most cases it is anything but a "home." Rather, it is a sterile existence marked by stagnation and, ironically, isolation. If you doubt that, just spend some time in one. Not that staff who are employed in these settings are callous and set out to create an inhospitable environment; rather, staffing in nursing homes is limited by virtue of what third-party payers, such a Medicaid, are willing to pay. And it's of little comfort to hear the increasingly loud calls from elected officials for "containing" these medical expenses. Little wonder, then, that potent tranquilizers, including antipsychotic medications and sleep aids, are so prevalent in these settings. Simply put, a medicated resident is easily managed.

It's becoming increasingly clear, as people like me take a closer look at nursing home care, that the problem is that these places lack any feeling of being a "home." Sure, some may feature a fish tank in the lobby, while others may offer a weekly movie; and even though the physical environment may be squeaky clean, they almost universally lack the one essential ingredient we associate with having a "home:" human warmth and interaction. It doesn't have to be that way.

Consider the following example.

In an article appearing in The New York Times (December 31, 2010), Pam Belluck described a model of caring for patients with Alzheimer's disease that is being implemented on an experimental basis at the Beatitudes nursing home in Arizona. This program intentionally focuses on creating individualized emotional experiences in order to restore patient's dignity and to increase a feeling of community. At Beatitudes, Bullock wrote, "they give patients their way. If they want chocolate, they can have chocolate." At the same time, the staff spends much more time interacting with residents on an individual and group basis, doing the kinds of things that happen in families: talking, playing games, sharing meals, and giving affection.

Also writing in the Times, on February 16, 2011, Paula Span described another experimental program, this one in Minnesota. Dubbed the "Awakenings" Program (remember the film of the same name?), Awakenings shares much in common with Beatitudes: increased staff-resident interaction, including one-to-one and group conversations, holding hands, and a form of listening that does not challenge residents with dementia to adhere too closely to the truth. And like Beatitudes, Awakenings relies much less on medication to control residents' behavior.

While promising, there is one big problem with experimental programs like the above: they cost money. The non-profit corporation that runs the Awakenings program was fortunate to get a grant to support it. It required adding staff to help create the home/family environment. The program could not have afforded to do that with the moneys it currently receives to provide care. Therefore, regardless of how much programs like Beatitudes and Awakenings may improve the quality of life for their residents, it is highly unlikely - given America's financial crisis - that there will be enough public funds available to extend these programs on any significant level. Rather, like the patients who temporarily regained their lucidity in the "Awakenings" film, these programs and their positive effects are likely to be sort-lived, unless…

We as communities pitch in to turn our nursing homes into "homes."

The good news for all those millions of Americans currently residing in nursing homes is that the Internet has given birth to a network whose goal is to mobilize people who want to contribute to those in their communities who need help. This network is already substantial, and it is growing. It includes organizations like LotsaHelpingHands.com, whose purpose is to help communities organize volunteer caretaking networks. On our web site, www.newgrief.com, my colleague Dr. Barbara Okun and I include a link to a number of these resources.

It is not reasonable or realistic, I would argue, to wait (and hope) that public funds will be made available to create programs like Beatitudes and Awakenings on a large scale. Nor can we afford to wait for the nursing homes themselves to create such programs. However, by marshalling and organizing resources, we can, together, help turn our nursing homes into homes. The kinds of "homelike" activities that are needed can easily be provided by non-professional volunteers, perhaps with just a bit of training. And nursing homes can easily screen and supervise such volunteers.

The bottom line is that we can improve the quality of life within facilities that we ourselves may someday have to live it - but it is up to us to do it.

For more from Dr. Nowinski:

Is Apple's Steve Jobs Being Treated for Cancer Again?

Gabrielle Giffords and the Importance of the 'Courageous Battle'

Grieving and Moving Forward After a Tragedy

Talking to Children About Illnesses

The Downside of Positive Thinking (Video): Interview With Author and Breast Cancer Survivor Barbara Ehrenreich

About the Author:

Joseph Nowinski, Ph.D. is a clinical psychologist with the University of Connecticut Health Center. He also has his own practice and is the coauthor (along with Dr. Barbara Okun) ofSaying Goodbye: How Families Can Find Renewal Through Loss (Penguin/Harvard Health Publications). Connect with him and learn more at www.newgrief.com.

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