Rising Challenger Takes On Elder-Care System

[question everything]

The Wall Street Journal

Rising Challenger Takes On Elder-Care System
By LUCETTE LAGNADO
June 24, 2008; Page A1

PRINCETON, N.J. -- In the spring of 2001, Bill Thomas, dressed in his usual sweat shirt and Birkenstock sandals, entered the buttoned-down halls of the Robert Wood Johnson Foundation. His message: Nursing homes need to be taken out of business. "It's time to turn out the lights," he declared. Cautious but intrigued, foundation executives handed Dr. Thomas a modest $300,000 grant several months later. Now the country's fourth-largest philanthropy is throwing its considerable weight behind the 48-year-old physician's vision of "Green Houses," an eight-year-old movement to replace large nursing homes with small, homelike facilities for 10 to 12 residents. The foundation is hoping that through its support, Green Houses will soon be erected in all 50 states, up from the 41 Green Houses now in 10 states. "We want to transform a broken system of care," says Jane Isaacs Lowe, who oversees the foundation's "Vulnerable Populations portfolio." "I don't want to be in a wheelchair in a hallway when I am 85."

The foundation's undertaking represents the most ambitious effort to date to turn a nice idea into a serious challenger to the nation's system of 16,000 nursing homes. To its proponents, Green Houses are nothing less than a revolution that could overthrow what they see as the rigid, impersonal, at times degrading life the elderly can experience at large institutions... Green Houses face a host of hurdles. Many Green House builders say they've encountered a thicket of elder-care regulations. It takes enormous capital to build new homes from scratch. Plus, experts say the concept faces stiff resistance from many parts of the existing nursing-home system. Traditional nursing homes, many of which care for 100 to 200 patients, are predicated on economies of scale -- the larger the home, the cheaper it is to care for each individual resident.

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The $122 billion nursing-home industry arose from the 1965 birth of Medicare and Medicaid, the government health-insurance programs for the elderly and poor that provide billions in government reimbursements. Made up of both not-for-profit and for-profit companies, the industry still generates most of its revenue from Medicaid and Medicare. Now, many nursing homes are aging, and the industry has suffered through so many scandals involving patient care that many elderly shun the thought of entering such institutions. A 2003 survey by the AARP, an advocacy group for older Americans, found that just 1% of Americans over 50 with a disability wanted to move to a nursing home. In recent years there have been attempts to create more popular alternatives, with mixed results. Assisted living, an ambitious effort begun in the 1980s to allow seniors to live independently in apartments and other group settings, has proved very popular but it "serves the needs of people who are relatively wealthy and relatively healthy," Dr. Thomas says. (

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One big source of resistance is the dizzying array of federal and state regulations that are mostly geared to protecting residents in large institutions. There are "life safety" rules intended to keep residents safe and prevent them from dying in fires and other disasters; "physical plant" standards that deal with building codes; health-care rules that guarantee a modicum of privacy -- requiring, for example, a curtain between beds. Infection-control regulations are meant to stop transmission of disease, while quality-of-life codes try to ensure residents receive adequate recreation and activities. As a result, the groups with the know-how and resources to build Green Houses are often nursing-home operators themselves. Some nursing-home executives argue such rules can make it difficult, if not impossible, to create the homelike environment that is a Green House's hallmark. Generally licensed as nursing homes, Green Houses are designed to provide a full range of care to the very sick.

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Perhaps the most significant hurdle to Green Houses is the perception that they are too expensive. "The biggest criticism I hear is, 'How do you make it work financially?'" says Mr. Minnix, whose association represents not-for-profit nursing homes as well as assisted-living and retirement communities... Others disagree. Robert Jenkens, who is spearheading the Green House project at NCB Capital for Robert Wood Johnson, says that some not-for-profits and at least one for-profit believe the model to be financially viable. St. John's Lutheran Ministries in Billings, Mont., operates both a nursing home and some Green Houses. In an internal review, officials found that it cost $192 a day to care for a resident in the traditional nursing home versus $150 a day in their Green Houses. While building costs were high, Vice President David Trost says the Green House model also has cost savings. "We no longer have to take a resident 200 feet to the dining room -- we only have to take them 20 feet, and that is significant," he says.


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URL for this article:
http://online.wsj.com/article/SB121426696618898605.html (subscription)

[cornermouse]

1. If you look at this closer you're going to discover major problems

with it. For starters I suspect it's just more neo-con privatization in disguise. Either they're going to have to meet the same rules and regulations as the nursing homes or the regulations will have to be waived. If they have to meet the same rules and regulations, then they're going to have to either be or have their very own nursing staff and be capable of filling out some pretty intensive paperwork or hiring someone to do it. If they're going to waive the rules and regulations or "make up new ones", watch out. This will make inspections of such facilities much harder due to sheer number compared to minute workforce of inspectors. Take a moment to visualize our food safety and current food inspectors policies expanded to elder care and you see a big problem or at the current proposal to privatize our educational system and this is just another piece of the puzzle.

I suppose you could look at this proposal as the neo-con version of a New Deal federal work program, though.

[question everything]

3. Is this what matters? Rules and regulations?

We have been chocked with rules and regulations that have drained any care system from any human compassion. Yes, there should be a different set of rules for small homes housing 20 people vs. a sprawling complex caring for hundreds.

And I think that a smaller home would be easier to inspect than a faceless huge one.

[cornermouse]

5. The rules and regulations which you would excuse these "homes"

from abiding by are there to protect the patient. And by the way 20 people is not a small home.

You don't appear to understand the extent of care that people living in "homes" receive. They (depending on the individual resident) require PT, OT, speech therapy, medication, recreational therapy to prevent depression, transportation to and from doctor appointments. Special locks on doors and windows for those with Alzheimers and other forms of dementia.

Small homes multiplied by the thousands would be much tougher to inspect due to lack of enough inspectors. Something you might want to look at that happened to a smaller "home" in this state. They already have a limited number of the type of residence you appear to favor. This was probably one of them. You could condemn yourself and those you love to a similar fate. If I remember correctly the final determination was that there were not enough inspectors on staff to do a thorough job of inspecting.

http://www.foxnews.com/story/0,2933,232084,00.html

[man4allcats]

2. Speaking as one who has had extensive nursing home

dealings, I can say without hesitation that Dr. Thomas is absolutely correct in his estimate of nursing homes. Quite simply, that model just doesn't work. Whether Green Houses are the answer is an open question for now, but it is encouraging to see there are those like Dr. Thomas willing to challenge the conventional "wisdom" with fresh ideas. For those currently dealing with nursing home issues, a very knowledgeable friend of mine who is himself a former nursing home ombudsman has recently set up a web site that may be of some help. Check it out at Family Nation.

[man4allcats]

4. Kicking

:kick: