Orange County, CA, October 12, 1998 — PUMPING LIFE INTO NURSING HOMES
By LORI MONTGOMERY
Knight Ridder Newspapers
Rachel Leiserowitz drops to the floor, the better to scruffle with Meggie, gleefully rocking the black and white dog in her arms. Her giggles fill the corridor and draw a crowd of kids who join the Alzheimer's patient in rubbing Meggie's tummy and scratching behind her ears.
"I'm so wealthy!" Rachel Leiserowitz shouts. "I'm so wealthy!"
It's a wealth measured by laughter, task-filled days and deep-sleep nights, says her son, Ron, who searched Southern California to find a care home for his mother.
"She lives in a happy place," he says. "I know it's a home and I know she's locked in, but it's a happy place, and that makes me feel good."
Rachel Leiserowitz lives in Silverado Senior Living home in Escondido. She shares the space with 89 other Alzheimer's patients, four dogs, four cats, 56 birds, two rabbits, three saltwater aquariums, hundreds of house plants and visiting kids of all ages who spread their Legos in the activity room and share their crayons with grandmothers and grandfathers who have dementia.
Silverado is an "Eden Alternative," the first senior home in California to employ the concept developed by Harvard graduate Dr. William H. Thomas, who insists, "Someone you love can still enjoy life in a nursing home."
The cornerstone of Thomas' philosophy: Nursing-home residents should have close and continuing contact with as much of the human habitat as they choose to embrace.
That habitat ranges from animals and plants to interaction with staff.
Now "Edenizing" is St. Edna Subacute and Rehabilitation Center in Santa Ana, a 146 bed home that has moved in fish, birds, rabbits and a cat; planted a garden where residents grow some of their own vegetables; and launched an extensive staff retraining that, it's hoped, will create teams of nurses, aides and residents who interact like a family.
"Edenizing never ends," says Carole Shaw, St. Edna admissions director, who spent a week training with Thomas at his Herburne, N.Y., headquarters.
The program takes its cue from resident needs, she says. Shaw recounts the depression that once flooded Eleanor Warrum, 77, after she moved into St. Edna's from her home in the Yucca Valley to be closer to her adult children. Shaw heard that Warrum once raised parakeets, and showed up with a bird in a cage.
Warrum now grins when she talks about the bird. "His name is Elvis," she says, making kissy sounds at the cage. "He'll be talking soon. I know he's a boy because he's blue."
How much does it cost to spread Eden cheer in an average 140 bed nursing home? Ted Stulz, St. Edna's director, estimates about $40,000, primarily for training, plants and pets. The cost to patients does not change, he says. At St. Edna's, for example, 106 of the 136 residents are Medi-Cal patients, which means the federal-state program pays $99/ day for their care.
"It's not the expense, it's the commitment," says Thomas, who began his Edenizing experiment in 1991 in a New York state nursing home. Since 1994, more than 300 homes around the nation have sought his advice on the alternative mode of care.
The popularity of his program outlined in his book "Life Worth Living" led Thomas to set standards. Homes that register as Eden Alternatives pay $450 a year, for which they receive a newsletter and other materials regularly.
However, Thomas says, "This idea belongs to no one. Why don't we Edenize the world?"
Thomas' Eden objective for long-term care is simple: "Eliminate the three plagues of the long-term-care institution loneliness, helplessness and boredom."
Along the way, researchers are finding that "Edenized" residents often get a bonus: A three-year study by the New York State Health Department at Chase Memorial, the home where Thomas developed the program, showed a 50 percent decrease in infections, a 71 percent drop in daily drug costs per resident and a 26 percent decrease in nurse's aide turnover.
The institute for Quality Improvement in Long Term Health Care at Southwest Texas State University launced a study two years ago comparing six "Eden-ized" homes with five traditional models. Preliminary data indicate that the homes have seen a 33 percent decrease in anti-depression medication and a 60 percent reduction in bedsores, says project director Sandy Ransom. One facility reported a 92 percent decrease in the use of anti-depression drugs.
"We have calculated that if nursing homes in the United States achieved just half the reduction in cost per resident per day that we have realized it would save our national health-care system $1.25 billion a year," Thomas says.
Rachel Leiserowitz is living proof, her son says.
As a resident in a nursing home in her hometown of Council Bluffs, Iowa, she developed severe depression, began talking about suicide and had behavior problems including striking out at other residents. When she was "bad," the Iowa nursing home staff sent her to her room and increased her medications.
Two weeks after arriving at Silverado, her physical health problems disappeared, says her son. Her anti-depression medication has been reduced. Her emotional problems are fewer.
"When I call to talk to her I can hear her in the background, laughing," Ron Leiserowitz says. "I can leave her there and feel OK about it."
ADULT CHILDREN DEMAND CHANGE Why don't all nursing homes "Edenize"? Eventually they will, Thomas predicts. He calls the present nursing-home system a "dinosaur."
Local administrators "are just hearing about it," says Mike Uranga, administrator of Garden Grove's Pacific Haven and past president of the California Association of Health Care Facilities.
"It seems to have merit, and it certainly does differentiate you in the marketplace."
Uranga says his local chapter of nursing-home owners expects to hear a presentation on "Edenizing" at its November meeting.
"We need to know about cost and things like that," he says.
Thomas maintains that growing numbers of adult children will demand a change in the current nursing-home mode of operation. He already has a chorus of supporters.
Ron Leiserowitz lives in Pacific Palisades. "But I'm a typical boomer," he says. "I will not put my mother in one of those awful nursing homes. I won't go to one myself."
More than 2 million Americans, one in five 65 or older, live in 17,000 nursing homes. Aging boomers will increase that number by more than 20 percent starting in 2020, demographers say.
"As a practicing physician, I have watched mature men and women weep uncontrollably at the prospect of putting their parents in a nursing home," Thomas says. Federal investigators estimate that one in three California nursing homes fails to provide adequate care. President Clinton recently responded by ordering a crackdown on nursing homes that abuse residents or repeatedly violate health and safety standards established by Congress.
"I don't know anyone who really wants to go into a nursing home," says Shelly Woolery, coordinator of the ombudsman program for the Orange County Council on Aging. "Statistics show more than half the people in nursing homes are depressed."
But not all nursing-home- operators agree with Eden practices. Nursing homes need to be places that emphasize medical care, not homes where residents "trip over dogs," says Lori Costa, director of regulatory programs for the California Association of Health Care Facilities.
She says that in recent years skilled nursing homes have shifted from caring mainly for frail elders to providing rehabilitation and reconstructive care to people who have had hips or knees replaced, need post-stroke rehabilitation or require nursing after bypass surgery.
"About 70 percent of our patients stay less than six months," Costa says.
Jacqueline Lincer, head of the state's Department of Health Services office in Orange County, however, says the St. Edna changeover should be positive.
"When a facility remodels and there's lots of activity around, the residents perk up. Residents just watch; it's stimulating to them. And the workmen often say hello.
"So the concept of providing some stimulation to people has validity. And it follows that if the residents perk up, the staff will be happier."
SIGNS OF CHANGE
Betty Liakos, 82, sits beside the cage housing Alice, pushing at a carrot to get the bunny's attention. Until Alice arrived at St. Edna's, the Alzheimer's patient said little, and when she did speak, her words made little sense.
Alice is changing that, says Sarah King, the nurse caring for Liakos. "She talks a lot now, and her conversation is appropriate to what is going on."
As visitors leave the room, Liakos looks-up from the rabbit. "Bye-bye," she says.
"Animals work magic," Thomas says. "And that is so wonderful to see, that people rightly get pretty excited by it.
"But I tell nursing-home owners: If you don't take care of good staff, you've missed more than half your opportunity."
Too many homes currently direct staff "from the top down," says Pat McGinnis, director of California Advocates for Nursing Home Reform. "The staff gets the burden and the blame for everything. It is very difficult to keep good people with that management attitude."
Staff was the first concern of new owners when they bought St. Edna's about 15 months ago, says Executive Director Ted Stulz. At the time, the state was threatening to close the home, citing a laundry list of care violations.
"We knew we had to find people who were dedicated and com milted turn this place around," Stulz says.
In the Eden Alternative program, staff are the front-line workers capable of making decisions.
In the first four months, 80 percent of the department heads were axed; staffing was increased from the mandated ratio of 3.2 employees per resident to almost 3.5. Under the new owners, the home has passed its surveys with no problems, Lincer says.
At Silverado, the results of "Edenizing" show in the activity room, where the RB Swingtet is playing old big-band tunes. Some residents sway to the music, but a few sit in Alzheimer's lassitude. Rosa Gaxiola pulls one man from his chair, boogies with him and is rewarded with a big grin. Other staffers bring their children to the event. One youngster is sitting on a resident's lap.
"How can I explain the difference ? " asks Marjorie Pettitt, whose husband, Bob Pettitt, 76, caused trouble in two other Alzheimer's homes with his "flareups." "Here, it's like day and night."
The retired Navy officer, who once doted on a mynah bird, chirps at Lovey and Dovey. He wiggles the bell in the lovebirds' cage. Jasper, the golden retriever, comes into his room to visit.
"There's no hiding from you," Pettitt says, scruffing the dog's fur.
