“The definition of insanity is doing the same things over and over and expecting different results.”
---Albert Einstein
I was standing in the narrow hallway of the main floor of what was now the 40th nursing home in which I worked. The familiar green and faded white vinyl floor tiles, dreary pale yellow painted walls and fluorescent bulb lit hallway were all too familiar. The name might have been different, but the dreary surroundings made it seem as if it could almost be anywhere. My 5 feet 3-inch frame in flat shoes dwarfed in front of his 6-foot stocky frame which loomed large in front of me.
The sinking feelings were also familiar. After working for only a couple of months where I was called to make a difference, exasperation, overwhelmed, disappointment, frustration, stress, and sadness set in once again. The reality is that the main reason I was called was to help them make money. Not that I’m opposed to the notion of making money, but I always thought to do so in a way that’s ethical, provides good care, and makes some moral sense should be the driving force if one goes into the “taking care of people” business.
Being a child of the 60s, I believe the idealist in me approached each place with a fresh set of eyes…hoping I’d find something different. But each time it was the same story. It was no different at number 40.
Once again it felt like I was swimming upstream against indominable currents. Advocating for better quality of life, quality care, quality of food, dignity and respect for staff and residents. The list goes on and on. Dreary hallways, little sign of life, poor food quality, exasperated, overworked, underpaid, stressed staff.
That’s when with utter exasperation I blurted out these words to the Administrator who was standing in front of me, “you know the definition insanity?... doing the same thing over and over expecting to get a different result.” His response.” It will probably be the same when you go to number 41”.
That was a pivotal moment for me. I’ve tried to divorce myself from that space, attempting to effect a change on a broader scale in a way that could truly make a difference. The original thought was to educate families so they could become more informed and effective advocates for their loved one’s care. Developing a kind of grass roots advocacy so that collectively, if they insisted on better care for their loved ones, the system would somehow have to oblige.
Four years later, at the writing of this blogpost, I’m working at number 53. The location is hundreds of miles apart from many of the other nursing homes in which I’ve worked that were in bustling, overcrowded urban or sub-urban environments. The issues are always the same.
Each time, for one reason or another, I’m drawn back into that space. Each time I feel like it’s cognitive dissonance; that I’m somehow complicit in an environment that is not providing what I know is possible….
True living environments that offer quality of life, quality of care, dignity and respect for workers and residents alike. Instead, Instead, I see an environment where people are not truly living, where workers are often performing the required daily tasks in a robot-like fashion, stressed, overwhelmed, and burned out.
When I went to number 53, I did so with the sole intention of helping a program that was short a therapist. I told myself I was not to get too involved, do what I could for the residents in my care and essentially go on from there.
But once again, I found myself feeling exasperated, and indignant over what I feel is a Moral Outrage. Too many times I heard people say the same thing. They’ve tried making a difference for years without success. The result is they give up and accept the status quo. They do what they can, do their jobs, and go home. Most recently that’s exactly what a colleague told me. She said she’d been talking about a particular issue of serious concern for 13 years, obviously that predates the new ownership of only 5 years, COVID and the like. She gave up as a means of preserving her own sanity; she felt her very well-being was at stake.
The most recent news that NYS Governor Hochul has committed an initiative to convert nursing homes to the Green House model[1] as a means to transform long-term care in the state is music, not only my ears and to many other advocates and advocacy groups, public policy researchers and political wonks, but should be to the millions of people who have loved ones in nursing homes. It should also be music to the ears of the millions of baby boomers who may have care needs as they continue to advance in years. There may be hope on the horizon for a dignified, respectful, quality life in nursing home living environments. I posit it would be wise to add to the initiative the Right to Personalized Music and a Volunteer Force that provides the added helping hands and companionship for many who are essentially alone in the latter years of their lives.
While this is a magnificent initiative, the reality of when or if this can be accomplished is a conundrum.
This would involve changing the mindset of owners and operators, something that in all likelihood will not be easily accomplished. There are approximately 630 nursing homes in New York State, ranging in size from 60 to 700 beds. The largest number, 277 are owned by for-profit corporations, followed by 179 nonprofit ownerships. The remainder are government owned or operated.
As with other well-meaning initiatives meant to improve the lives of nursing home residents, there always seems to be a work-around or loophole that operators discover as a way of checking off a box that satisfies a new regulation. That is, unless of course, it is a revenue enhancing initiative.
One of the best examples of this is the person-centered approach to care and caring that is at the heart of the Green House model of care. whereby each person has autonomy and authority to define and pursue their own life’s vision in a meaningful and purposeful manner. There are many ways this can be accomplished, even within the traditional nursing home model. This is tantamount to changing the culture, which can only be accomplished by changing the mindset. The environment must fully embrace the concept, adopt, and implement the practices needed for a person-centered approach. To do so involves person-centered thinking, planning, as well as practices.
The reality is that in many traditional nursing home environments person-centered care remains little more than a buzz word. This, despite the fact, that in Nov. 26, 2017, the Center for Medicare and Medicaid services finally included culture change, person-centered practices and principles in their wording and in their requirements for nursing home care planning. However, the overwhelming number of owners/operators do not reflect the mindset shift from profit centered to person centered. It requires understanding that when high quality care is provided the revenue will follow.
While the journey to getting the NYS Governor to adopt this initiative is a milestone almost 20 years in the making, the history of the nursing home and how we arrived to where we are today is centuries in the making and steeped in society’s consciousness. The place to start is to dispel society’s ageist attitudes and the value we place on older adult and their place in our society, in our families and in our communities.
[1]First conceived by Dr. Bill Thomas in 2001, the first Green House opened in 2003 in Tupelo, Mississippi. The project gained momentum in 2005 when the Robert Wood Johnson Foundation announced a five-year, $10 million grant to subsidize the development of 50 projects across the United States. Upon seeing the success of the Green House model, the Foundation agreed to provide additional funding in order to continue developing and sustaining the Green House homes through 2018. There are presently approximately 300 Greenhouses in the United States, compared with over 15,000 of the more traditional style nursing homes, 70% of which are owned by for profit chains