Culture change. That’s the mantra behind a model gaining traction in the senior housing space that aims to replace the institutional setting often associated with long term care with something much more inviting.
The “household model” is much like the name implies, and brings with it both design and operational elements that focus on person-centered care. And, it can help to reduce employee turnover, providers who have adopted this model say.
While providers haven’t just started putting money toward the emerging model — recently a N.J. continuing care retirement community (CCRC) pursued nearly $100 million in financing for a renovation and expansion to repurpose its existing units to a household model of care — it is notably changing the way both residents, and staff, view long term care.
The team at Naperville, Ill.-based The Springs — the short-term rehabilitation, nursing care and memory support arm of CCRC Monarch Landing — knew they wanted to operate something different than the traditional long term care model before opening The Springs’ doors in 2014.
“The industry is moving toward person-centered care,” says Jennifer Roach, administrator of The Springs. “It’s moving from tray to menu service — moving away from having residents wake up at a certain time. The household model takes this to the next level, and it’s great that we get to start The Springs with this new model.”
From bricks and mortar to operations, building the household model from the ground up requires a willingness to challenge the conventional, and arguably more outdated, notions surrounding senior care.
Before The Springs was built, Monarch Landing, a Life Care Services LLC community, visited other long term care communities operating under the household model.
“We took all of our directors at the time and went to Kansas to look at different examples of the household model,” says Monarch Landing Executive Director Renee Garvin. “We wanted to compare and contrast the pros and cons of each [community’s approach to the household model]. We rented a big old white van and hit the Kansas countryside. We looked at financially how they’re doing, and employee turnover.”
One of the communities the Life Care Services team visited was nonprofit CCRC Pleasant View Home, in Inman, Kansas. Pleasant View Home provides the household model for those needing long-term care, in addition to other services.
“When we built our household model eight years ago we didn’t have any trouble filling those beds,” says Jalane White, administrator at Pleasant View Home, noting that they now have a waiting list. “The ultimate compliment we receive is ‘This is our home.’ It’s not just a place they’re staying.”
But why travel to Kansas?
PEAK (Promoting Excellent Alternatives in Kansas) started in 2002 as a recognition and education program to encourage providers in Kansas to adopt culture change.
In 2011, PEAK was revised to PEAK 2.0, with the new initiative offering a Medicaid pay-for-performance incentive program. Homes that engage in system changes to support person-centered care or who have demonstrated implementation of person-centered care receive financial incentives through Medicaid reimbursement.
To date, 224 of Kansas’ 350 nursing homes are enrolled in PEAK 2.0, says Gayle Doll, director of the Kansas State University Center on Aging.
The Springs’ household model, implemented with the help of architecture firm Perkins Eastman, features 96 bedrooms, with six of those rooms being semi-private. All rooms have a private bathroom and shower.
The rooms are divided into “households,” with each household featuring 16 bedrooms, a dining room, living room with a TV, seating area by a fireplace, additional lounge area and kitchen. Memory care assisted living has two households made up of 14 suites.
“Think of each household as a separate house,” Roach says.
“People don’t go to a large dining hall at home, so why would they want that here?” she says, referring to the traditional skilled nursing’s cafeteria-style dining area.
Other changes, while seemingly simple, go a long way in accomplishing the household-effect, such as not installing an intercom system.
“Taking that alarm system out changes things — it eliminates all that extra noise, which can be disturbing to residents,” she says, noting that before coming to The Springs she worked in more traditional-style long term care environments. “It was scary at first. When you’re used to doing one thing and then it changes. I thought, ‘How do I inform staff when something happens?”
Enter the information technology (IT) team.
“We sat down with our nursing and IT team and discussed how we could communicate with appropriate staff when needed without using an overhead paging system,” she says.
Staff wear pagers, so when a call light is activated in a resident room the staff on that household receive a page telling them the room and which call light was activated – bed, bath or toilet. A control panel at the nurses’ station alerts and tracks the call lights.
In addition to getting IT involved in working out the logistics of the household model, a core component of the model involves staff being able to manage a variety of tasks — from preparing food to assisting with bathing.
“When looking at the household model we realized it goes well beyond a nice design,” Garvin says. “As a management team we thought, ‘How do we, as a team, enhance our operations to be truly person-centered and make sure our residents and staff feel empowered?”
Prior to starting work at The Springs, new employees must undergo two and a half weeks of training, which includes education about the household model and how to carry out a variety of tasks.
“The training covers topics such as dementia, thorough sanitation and cooking,” Roach says. “In our households not everyone wakes up at the same time. So for breakfast, nursing staff working with a resident can prepare a meal when that person is hungry.”
In more traditional models, employees are often expected to perform one role only.
“So, if the resident wanted some cereal, in a traditional model the nurse would have to alert kitchen staff and then have to wait until someone on the kitchen staff became available,” she says. “The household model empowers both the employee and resident.”
While main meals are still prepared in Monarch Landing’s main kitchen by a professional chef, giving nurse staff the authority to prepare simple meals, from cereal to grilled cheese, helps promote staff confidence, Roach says.
Self-scheduling is also a key component of the household model.
Every month, the director of nursing at The Springs will post a schedule and then all household staff, including the receptionist, sign up for what shift they want.
“There are days that don’t get filled, and then we have to ask around to see who can take that shift,” Roach says. “But overall staff have responded well to setting their own schedule. They like that it puts the power back into their hands.”
Self-scheduling promotes a healthy work/life balance, which helps reduce employee turnover, White with Pleasant View Home says.
“When we’ve empowered the workers they are more satisfied,” she says. “They have better relationships with residents.”
Ultimately, being flexible is key to the household model’s success, Roach says.
“Nursing homes are one of the most highly regulated industries,” she says. “It’s about working within the regulations, while making sure it’s all about the resident. Everyone has to be there to support each other.”
Written by Cassandra Dowell