Western Home

home

Putting

back in nursing home

The Cottages at Western Home Communities

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Not home-like, but truly home First freestanding nursing cottages in Iowa open this week LINDA HUDWALKER BOWMAN Chief Communications Officer Western Home Communities‌

What is it you love about being in your home?

Maybe it’s your favorite chair, the view from your porch, the meals you enjoy, or simply the freedom you have there.

Maybe the loss of home is why more people fear moving to a nursing home than dying.

It doesn’t have to be that way.

Starting this week, the household model of care is unveiled in the Cedar Valley as Western Home Communities begins to open two nursing cottages on its south campus in Cedar Falls. Each will be home to 16 residents.

One of them, Marge Brom, currently lives at Martin Health Center near downtown and enjoys daily visits from her husband.

“I feel very comfortable here, although I expect in the cottage that the fewer number of people

should result in ever more connection between staff and residents,” says Hovey Brom, Marge’s spouse of more than 60 years.

“They do a good job here. I anticipate that in the cottages, Marge will be more involved because activities will be integrated with the functions of daily life.”

The physical environment will be the most immediately noticeable change, with 16 residents instead of 100 at Martin Health Center. The cottage design is like that of a Cratsman-style family

home, complete with front porch, purpose, choice and spontaneity. but by helping someone create his garage, back patio and a front door Staff no longer measure success or her best day. where visitors ring the doorbell for by accomplishing a list of tasks, See HOME, page 4 access.

No more long hallways, nurses’ stations, tile floors, overhead paging, large sterile dining rooms, shared rooms, noisy med carts, and one-size-fits-all daily routines.

No more following a model of care that puts medical needs and staff efficiency first, as nursing homes have done for decades.

Instead, the new model prioritizes quality of life, dignity,

Western Home Communities on the New Cottages!

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Sales, Service, Modernization, Repair Jenny Gielau, a nurse assistant at Martin Health Center, watches resident Donna Settle as she plays a game on the computer system IN2L (It’s Never 2 Late).

The software can be programmed to accommodate each resident’s taste in music, games, trivia, news and social media.

PHOTOS by MATTHEW PUTNEY/ COURIER PHOTO EDITOR

Hovey Brom and wife Marge, a resident of Martin Health Center, bask in the sunshine on a recent spring day. Marge will be moving to The Cottages and Hovey looks forward to enjoying his daily visits with her there.

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HOME

Ager, RN, BSN, senior director of skilled nursing. “What this means is putting residents back in the From page 3 driver’s seat, letting them make choices about how they want to “We already love our residents live each day. That could be as and provide great care, and that simple as stocking the fridge with won’t change,” explains Wendy a favorite pop, or as spontaneous

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as going out for pizza on a Friday night.”

The transformation began several years ago when Western Home Communities started investigating better ways to create home for residents in long-term care.

A vision for The Cottages at Western Home Communities came to life during the spring and summer of 2012. A collaborative process involved nurses, nurse aides, housekeepers, laundry workers, volunteers, activities professionals, department heads and board members, who met several times with a facilitator and designed the new structures.

In hindsight, that process proved to be the easy part. Next came two years of training, led by a steering team of 30 employees who immersed themselves in how the household model operates.

They trained the rest of the organization’s employees.

The staff at Martin Health Center instituted the concepts. Four hallways became households, with names chosen by residents.

Caregivers – from nurses to certified assistants to housekeepers – learned that their role is as much about building relationships with residents as it is accomplishing a list of tasks.

Schedules changed as staff adapted to how residents prefer to live. Some don’t come to work as early any more, since residents decide when to get up and go to bed. Those who wish to sleep in may do so, and ask for breakfast when they wake.

“Guess what? We found out our residents are happier when they make the decision on when to get up – imagine that!” laughs Rachel Phillips, one of the first two household coordinators at The Cottages, whose job is to lead a team of household staff and advocate for each resident’s quality of life.

It’s part of the overall change in leadership structure. Administrators and nurse managers became mentors, allowing those working most closely with the residents to become leaders in decision-making with the residents.

“When we first asked our residents how they wanted something done, it was very quiet because they’d never been asked before,”

Sunday, May 31, 2015

MATTHEW PUTNEY/ COURIER PHOTO EDITOR

Martin Health Center resident Jake DeVoogd enjoys an outdoor stroll with employee Carrie Rhude. Sidewalks will allow walks like this to happen often at The Cottages, where the design also brings the outdoors in through large windows and skylights. says Beth Hines, also a household coordinator at The Cottages “Now, residents are actively participating in planning activities, where they want to go, what they want to do and how they want to do it.”

As internal changes occurred at Martin Health Center, employees eagerly looked forward to the day when the environment would allow the household model of care to be fully implemented.

“We are heading to a place that residents are proud to call home,” says Kelli McCurdy, a household coordinator at Martin Center.

“These new cottages represent the physical environment that is needed to take us to the next level.”

Each resident will have a spacious private bedroom and bathroom, with daily life happening in the great room that features a fire-

place and open kitchen – always the heart of the home.

“Think about never being able to see your meals being cooked or hear the sounds from a skillet,” explains McCurdy. “Now residents can pull up to the counter and even participate in making meals.

They’ll be able to offer visiting family members a snack or beverage, just like they were always able to do at home.”

The first two cottages are specially licensed for people with dementia who need nursing care.

Two more long term care cottages will eventually be built, each housing 20 long-term care residents.

Each cottage, at about 11,000 square feet and fully furnished, costs about $2.5 million. A fundraising campaign is helping defray construction costs.

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Centenarian donor makes project possible LINDA HUDWALKER BOWMAN Chief Communications Officer Western Home Communities‌

You could call her a pioneer.

Lifelong Black Hawk County resident Martha Nation eagerly embraced a new concept in 1989 by moving into Willowwood, the state’s first independent living community, at Western Home Communities.

She joined the organization’s board of directors and advocated for the purchase

of a 13-acre plot of farmland that, at the time, seemed far removed from Cedar Falls proper. That was the beginning of today’s 150-acre south campus, now home to 650 residents.

Martha, now 101, is helping to make another profound transformation possible through her generosity.

She provided a lead gift for 5111 Caraway Lane, now being called Nation Cottage.

At a ceremonial groundbreaking in April 2014, Mar-

tha’s two adult children paid prophet. “Someone who has tribute to their mother. Two a vision of righteousness and great-grandchildren, ages 11 calls a people to live into it.” and 8, traveled from Virginia Western Home Communifor the occasion and publicly announced their love and affection for her. A standingroom-only crowd applauded heartily, as tears welled in the eyes of those who attended.

At the age of 101, pioneer and educator Martha Nation continues to lead and teach.

Bill Witt, board member of Western Home Communities, calls her something else, too:

ties thanks Martha and all donors who are making home possible for those who need it most.

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Martha Nation, flanked by her son, daughter and extended family, at the April 2014 ceremonial groundbreaking for The Cottages.

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Directions to The Cottages You won’t find Caraway Lane on your GPS yet. This newly-finished street in Cedar Falls connects to Prairie Parkway, which runs between Greenhill and Viking Roads.

To reach 5111 and 5127 Caraway Lane,

take Greenhill Road to Prairie Parkway and head south. Turn right onto Caraway Lane and go one block to the stop sign. The Cottages at Western Home Communities will be ahead on your right.

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A long and winding road to The Cottages LINDA HUDWALKER BOWMAN Chief Communications Officer Western Home Communities‌

Ask anyone involved in a transformational process during the summer of 2012, and they’ll tell you it was a unique, unforgettable experience.

Nearly 90 people gathered several times to grapple with the concept of home – what it is, what it looks like and how to create it for people who need 24/7 nursing care.

From launderers, housekeepers, maintenance workers and certified nurse assistants (CNAs),

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to residents, volunteers and executive officers, the assembled group represented the spectrum of stakeholders.

Their facilitator, Steve Shields, helped develop the household model of care in Manhattan, Kansas, fifteen years ago. He first led the group in a discussion of home: What makes a place a home? How does it feel to live there? How many homes have you lived in throughout your lifetime? What are the “daily pleasures” you enjoy there?

Would those things you enjoy most be available to you in a nursing home?

The group, collectively, responded no. Over the past several decades, through a combination of government regulations and overemphasis on medical care, the best of intentions had produced an institutional model of care that could meet someone’s health needs but not provide home. Or anything that remotely resembled it.

With that question settled, the group’s attention turned to designing a new way, both in daily structure and design. Shields deftly managed the microphone, seeking input and then calling for votes on various topics: What size is ideal for a bedroom?

Should there be a garage? Did visitors need a half bath or full?

What about outdoor access?

Architects from AHTS in Waterloo brought their computers. They started with a blank slate and created the design from scratch, based on the group’s decisions and revisions, as financial analysts sat nearby, computing what various models would cost.

Initial efforts focused on repurposing Martin Health Center, the current nursing home for 100 residents, into four households to serve 20 residents each. This required maneuvering around walls and windows, adding on and living with long hallways.

Next, the group designed a

craftsman-style, freestanding cottage to house the additional 20 residents.

Then, a final question: Did it make sense to do it that way?

Participants reached the unanimous conclusion that repurposing Martin Health Center wasn’t enough. To do it right for the people who would live there called for its eventual replacement by cottages on south campus.

In the midst of celebrating the 100th anniversary of Western Home Communities, this group looked to the future. The second century of service started with a resolve to put home back into nursing home.

Now the Cedar Valley watches as the vision unfolds. The completion of cottage construction marks the true beginning of this journey. The next – and most exciting – steps are watching residents live their daily lives with purpose, dignity and spontaneity, in the place they call home.

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Facilitator Steve Shields leads a session on The Cottages in May 2012.

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Essential elements of the household model 1. The household is each resident’s home and sanctuary.

2. The people who live here direct their own lives, individually and collectively.

3. The boundaries of the person and his/her home are clear and respected as a matter of course.

4. Grace, a shared sense of what is sacred about the house and its people, is deeply valued, consciously created, and preserved.

Ritual, spontaneity, friendship,

spirituality, celebration, recreation, choice, interdependence, art and humor are all manifestations of a culture of grace.

5. The people who live here are loved and served by a responsive, highly valued, decentralized, self-led service team that has responsibility and authority.

6. Leadership is a characteristic, not a position. Leaders support and are supported by values-driven, resource bearing

principles and practices as a way for each person to actualize his or her full potential.

7. All systems, including treatments, exist to support and serve the person, within the context of his or her life pursuits.

8. We build strong community with one another, our family, our neighbors and our town. Each household is part of a neighborhood of houses, dedicated to continuous learning.

9. The physical building and all its amenities are designed to be a true home. Institutional creep in design and culture is treated as a wolf at the door.

10. The establishment of a healthy and sustainable home comes through the integrated balance of resident-driven life,

leadership, organizational structure, physical environment and financial sustainability.

Excerpt from “In Pursuit of the Sunbeam: A Practical Guide to Transformation from Institution to Household,” by Steve Shields and LaVrene Norton, ©Action Pact; reprinted with permission.

because it’s about living

Comfortable living room-style settings have all the flavor of a true home.

BRANDON POLLOCK / Courier Staff Photographer

You’re invited to tour The Cottages Public Open House Sunday, June 7, 2015 1 – 4 p.m.

5127 Caraway Lane Come see this new, transformational environment and ask questions of household employees.

This will be the only public open house scheduled; when residents move in, the cottage will become their home and sanctuary.

Directions: From Greenhill Road, head south on Prairie Parkway. Turn right on Caraway Lane and go one block to the stop sign at Shooting Star Way. The cottages will be directly ahead on your right; 5127 Caraway is the second cottage.

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Congratulations

Western Home Communities!

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Cottages interiors

T

hese views of the newly built The Cottages at Western Home Communities show how homey and

comfortable the homes will be for residents.

The light-filled cottages are filled with amenities.

PHOTOS BY MATTHEW PUTNEY/ Courier Photo Editor and BRANDON POLLOCK / Courier Staff Photographer

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Can people with dementia make decisions?

LINDA BOWMAN Chief Communications Officer Western Home Communities‌

An essential concept of the household model of care is that residents direct their own daily lives. Many people may wonder how that is possible when someone has dementia.

We directed the following questions to Sherry Turner, RN, Nurse Mentor at The Cottages, and Wendy Ager, RN, Senior Director of Skilled Nursing.

When is a person with dementia no longer able to make decisions?

Sherry: That varies from person to person based on the extent or stage of dementia.

Sometimes a person may no longer know how to use a fork or spoon, yet can still communicate preferences about what to eat. It means we offer choices but keep them simple so someone with a cognitive decline is not overwhelmed.

Wendy: None of us like to have our choices restricted and it’s no different for someone with dementia. Even with limited capacity someone can still

First two cottages licensed to serve people with dementia When it comes to nursing care for people with dementia, the state of Iowa issues special licenses referred to as CCDI (chronic confusion and dementing illness) licenses.

In early 2013, Western Home Communities presented a request to the State Health Facilities Council. It asked the council to approve a specialized CCDI license to care for 32 people at The Cottages, in addition to 100 residents at Martin Health Center near downtown Cedar Falls.

The council unanimously approved the certificate of

decide: Do I want to get out of bed right now? Do I like your tone of voice and what you are asking me to do? Do I like the meal you gave me? Someone with dementia may not be able to tackle finances, but can still be included in decisions about daily life.

need, with one council member commenting, “Kudos on excellent strategic planning and thinking. We should see that more often.”

The CCDI license requires nursing, social services, housekeeping and activities staff to have six hours of specialized dementia care training at the outset, and at least six hours annually thereafter.

The next two cottages planned for Caraway Lane will each be home to 20 residents who have long-term care needs but not necessarily dementia.

What is the caregiver’s role in decision making?

Sherry: It’s common to see someone withdraw from decision-making because so many decisions are being made for them – regardless of their ability to make decisions. So the caregiver should help facilitate

day-to-day choices. It is important for people with dementia to be able to choose what food they want, what shirt they wear, what activities they prefer.

Wendy: Try to imagine the frustration for a person with dementia to have doctors, nurses, children and spouses

dictating what is “right or wrong.” The most effective caregiver strategy includes offering a simple set of acceptable choices, then supporting and encouraging decision-making.

See DEMENTIA, page 10

Congratulations on the New Cottages at Western Home Communities!

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WHAT’S NORMAL AGING AND WHAT IS ALZHEIMER’S? Aging brings physical and mental changes, but dementia is not a normal part of aging. This list helps provide a guide for distinguishing between the two; it is not a substitute for visiting with a physician about any changes being experienced.

1.

Memory loss that disrupts daily life. One of the most common signs of Alzheimer’s, especially in the early stages, is forgetting recently learned information. Others include

forgetting important dates or events; asking for the same information over and over; relying on memory aides (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own. What’s typical aging? Sometimes forgetting names or appointments, but remembering them later.

2.

Challenges in planning or solving problems. Some people may experience changes in the ability to

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control.

develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before. What’s typical aging? Making occasional errors when balancing a checkbook.

3.

Difficulty completing familiar tasks at home, at work or at leisure. People with Alzheimer’s often find it hard to complete daily tasks.

Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game. What’s typical aging? Occasionally needing help to use the settings on a microwave or to record a television show.

8. mirror and think someone else is in the room. They may not recognize their own reflection. What’s typical aging? Vision changes related to cataracts.

Decreased or poor judgment.

People with Alzheimer’s may experience changes in judgment or decision making, such as giving large amounts of money to a telemarketer.

They may pay less attention to grooming or keeping themselves clean. What’s typical aging? Making a bad decision once in a while.

9.

Withdrawal from work or social activities. A person with Alzheimer’s may start to remove themNew problems with words in selves from hobbies, social activities, speaking or writing. People with work projects or sports. They may have Alzheimer’s may have trouble followtrouble keeping up with a favorite sports ing or joining a conversation. They may team or remembering how to complete stop in the middle of a conversation a favorite hobby. They may also avoid and have no idea how to continue or being social because of the changes they may repeat themselves. They may they have experienced. What’s typiConfusion with time or place. struggle with vocabulary, have problems cal aging? Sometimes feeling weary of People with Alzheimer’s can lose track of dates, seasons and the passage finding the right word or call things by work, family and social obligations. the wrong name (e.g., calling a watch of time. They may have trouble undera “hand clock”). What’s typical aging?

Changes in mood and standing something if it is not happenHaving trouble finding the right word. personality. People with ing immediately. Sometimes they may Alzheimer’s can become confused, susforget where they are or how they got Misplacing things and losing picious, depressed, fearful or anxious. there. What’s typical aging? Getting the ability to retrace steps. A They may be easily upset at home, at confused about the day of the week but person with Alzheimer’s disease may work, with friends or in places where figuring it out later. put things in unusual places. They may they are out of their comfort zone. lose things and be unable to go back What’s typical aging? Developing very Trouble understanding visual over their steps to find them again. images and spatial relationspecific ways of doing things and Sometimes, they may accuse others ships. For some people, having vision becoming irritable when a routine is of stealing. This may occur more freproblems is a sign of Alzheimer’s. They disrupted. may have difficulty reading, judging dis- quently over time. What’s typical aging?

If you have questions about any tance and determining color or contrast. Misplacing things from time to time, of these warning signs, consult your In terms of perception, they may pass a such as a pair of glasses or the remote physician.

6.

4.

10.

Your provider office medical record available anytime, anywhere on-line.

7.

5.

DEMENTIA My Hospital Record Securely access personal health information on-line from your recent hospital stay.

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health when they become part of activities in life, sand representing the spontaneous moments of the caregiving team, instead of life, and water representing the feeling alone on the journey.

From page 9 meaningful relationships that are essential to life. All of these How can families best When will we know that things together are needed to facilitate this transition? it is time to move into a care fill the basket of life and make it Sherry: It’s essential that community? worth living.

Sherry: The person’s aware- families help caregivers get to Wendy: From the time we ness of how to stay safe is always know the person by providing are small children we push out information on work history, a concern. When someone hobbies, likes and dislikes. Then parents away, saying, “I’ll do starts making poor choices in it!” For most people this desire we can provide individualized that regard, it often drives the for independence continues choices and support. need for a move. Have you ever through life. Someone with stayed up too late, reached for How can others help maxi- dementia has had 50-60 years that second donut or skipped a of independent living and sudmize the quality of life for meal? A person with dementia will act on those intentions and someone living with demen- denly it changes. All rights do not disappear upon the diagnotia? cravings without regard to the sis of dementia. Can you imagSherry: At Western Home consequences. ine if you told somebody that Communities, we are inspired Wendy: Many times a move all their rights disappeared if becomes necessary because the by the story of “Caleb’s Basthey had high blood pressure or ket,” a part of our Action Pact family caregiver, usually the cancer? We need to give people spouse, can’t maintain personal training. This story uses the wellbeing because of caregiving metaphor of stones representing with dementia purpose in life and promote choices wherever the great events of life, pebbles demands. We’ve seen spouses possible. return to emotional and physical representing the important

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Test your Alzheimer’s disease knowledge Take this quiz to asses you knowledge of Alzheimer’s disease, the leading cause of dementia. Alzheimer’s is a progressive disease that brings gradual change. At stage four, a person with Alzheimer’s can still handle simple finances; as it progresses to stage seven, the ability to talk, walk and smile begins to decline.

1.

2.

People with Alzheimer’s disease are particularly prone to depression.

health problems that caused the agitation.

5.

People with Alzheimer’s disease do best with simple, instructions given one step at a time.

6.

When people with Alzheimer’s disease begin to have difficulty taking care of themselves, caregivers should take over right away.

7.

If a person with Alzheimer’s disease becomes alert and agitated at night, a good strategy is to try to make sure that the It has been scientifically proven that mental exercise person gets plenty of physical activity during the day. can prevent a person from getting Alzheimer’s disease.

In rare cases, people have recovered from Alzheimer’s After symptoms of disease.

Alzheimer’s disease appear,

3.

the average life expectancy is six to 12 years.

4.

When a person with Alzheimer’s disease becomes agitated, a medical examination might reveal other

8.

9.

People whose Alzheimer’s disease is not yet severe can benefit from psychotherapy for depression and anxiety.

10.

If trouble with memory and confused thinking

appears suddenly, it is likely due to Alzheimer’s disease.

11.

12.

13.

14.

Most people with Alzheimer’s disease live in nursing homes.

Poor nutrition can make the symptoms of Alzheimer’s disease worse.

Congratulations

Western Home Communities On the New Cottages!

People in their 30s can have Alzheimer’s disease.

A person with Alzheimer’s disease becomes increasingly likely to fall down as the disease gets worse.

Answers: 1. True; 2. False; 3.

True; 4. True; 5. True; 6. False; 7.

True; 8. False; 9. True; 10. False; 11. False. They should be where they can function at the highest level.; 12. True; 13. True; 14. True.

The disease affects the field of vision so tripping is more likely.

SOURCE: CARPENTER, B.D., Balsis, S., Otilingam, P.G., Hanson, P.K., & Gatz, M. The Alzheimer’s Disease Knowledge Scale: Development and psychometric properties. “The Gerontologist.”

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