I’m on my way home from Atlanta, site of the 2018 NICHE (Nurses Improving Care for Healthsystem Elders) conference. This organization, housed at New York University-Rory Meyers College of Nursing for the last 26 years, provides education and consultation to organizations to improve the delivery of health care to older adults. It now counts over 700 member organizations in five countries and has been successful in helping facilities implement best practices for providing care to older adults.
Redesigning long-term care.
One of the speakers, Migette Kaup, PhD, from Kansas State University and an expert in designing care facilities, spoke about current efforts to redesign long-term care. She noted that traditional nursing homes, which were designed to mimic hospitals, are “a product no one wants” and a place many people would rather die than go to.
Kaup spoke about the success of the newer “household” model of long-term care, which mimics a home setting rather than a hospital. Key aspects of this model are that it centers around an open kitchen space and is made up of a dedicated staff and small group of residents who live together and implement best practices. Kaup cited successes in decreasing depression and pressure ulcers in low-risk patients, among other parameters. Of course the real goal, as we know, is keeping older adults functional and able to age in their own homes.
Supporting family caregivers, as mandated by CARE Act
Nurse teaches family caregiver how to change ostomy bag. Photo courtesy AARP Public Policy Institute.
AJN has worked with NYU and NICHE over the years, first in partnering on the How to Try This series on geriatric assessment, with funding from the John A. Hartford Foundation, a major funder of initiatives to improve care for older adults. Now we are again all working together as part of AARP’s Home Alone Alliance network to help organizations with resources for supporting family caregivers. This work is especially important now in that the CARE (Caregiver Advise, Record and Enable) Act, passed so far in 39 states, requires institutions to inform and educate the person who will be providing care to the patient when discharged.
These resources—articles with tip sheets for the caregivers and links to videos demonstrating how to perform wound care and manage mobility—are free. The final article and video in our wound care series, “Ostomy Care at Home,” is in the current issue.
The videos are available on the AJN site as well as on the AARP Home Alone site (also in Spanish).
The other available articles in the Supporting Family Caregivers series include:
“Teaching Family Caregivers to Assist Safely with Mobility – December 2017
“Preventing Falls and Fall-Related Injuries at Home” – January 2018
“Caring for Aging Skin“ – February 2018
“Teaching Wound Care to Family Caregivers“ – March 2018
The complete collection of articles and videos on administering medications, managing mobility, and performing wound and ostomy care is available here. We hope these resources will help nurses provide the information family caregivers need. Watch for other series in the future.
Shawn Kennedy,
I am so thankful that you blogged regarding this topic. As I am currently in the process of moving my almost 70-year old father from New York City to rural Florida. The thought of him being in a Nursing home is unbearable. I have worked and volunteered at several nursing homes across the United States while I was active duty military. Quite often even the nicer nursing homes fall quite short of total care. Staff is underpaid, overworked and under qualified. Facilities are outdated or like you mentioned look like a hospital room. I am interested to know what other countries are involved and how does their participation affect the groundwork or design here in the United States. I have read that Lantern of Chagrin Valley in Chagrin Falls, Ohio has gone a step further designing their facility to mimic golf courses and 1940-1950’s towns. Though your blog mentions the actual target results are “keeping older adults functional and able to age in their own homes,” that is not a reality for all. Ultimately, I have made the choice to move my father with me in a separate 2/1 guest house on the property designed for him and fully ADA accessible should that time come. I am still interested to see with more evidence-based practice being pushed in all aspects of care what the future of nursing homes and assisted living will look like in the future. There are several phases that the nursing home structure will have to change: staffing, communication with patients and family as well physical facility design if we hope to better care for our aging population. The link to Lantern of Chagrin Valley has been provided below:
http://lanternlifestyle.com/chagrinvalley/
Shawn Kennedy,
I am so thankful that you blogged regarding this topic. As I am currently in the process of moving my almost 70-year old father from New York City to rural Florida. The thought of him being in a Nursing home is unbearable. I have worked and volunteered at several nursing homes across the United States while I was active duty military. Quite often even the nicer nursing homes fall quite short of total care. Staff is underpaid, overworked and under qualified. Facilities are outdated or like you mentioned look like a hospital room. I am interested to know what other countries are involved and how does their participation affect the groundwork or design here in the United States. I have read that Lantern of Chagrin Valley in Chagrin Falls, Ohio has gone a step further designing their facility to mimic golf courses and 1940-1950’s towns. Though your blog mentions the actual target results are “keeping older adults functional and able to age in their own homes,” that is not a reality for all. Ultimately, I have made the choice to move my father with me in a separate 2/1 guest house on the property designed for him and fully ADA accessible should that time come. I am still interested to see with more evidence-based practice being pushed in all aspects of care what the future of nursing homes and assisted living will look like in the future. [Editor’s not: the link to the specific facility’s website has been removed, per AJN policy of not endorsing.]
Shawn Kennedy,
This blogs really hits close to my heart. I was very close with my grandmother and my family did struggle with whether or not it was a good idea to place her in nursing home or not. This is a problem that many families face on daily basis. The elderly population has worked hard throughout the years and it can be difficult to go from being so independent to needing more and more assistance as the years go on. The major fear is that our loved ones will not be treated properly and that the staff will not provide adequate care. After viewing what happened after Hurricane Irma at a nursing home in Hollywood, FL it is no wonder why families will often view nursing homes as a final tactic. The deaths that occurred were ruled as homicides and were preventable.
The redesigning of nursing homes, according to your article, is a better way of going about it. People find comfort in being home and to make nursing homes mimic a home setting will be an improvement from the hospital setting it was trying mimic before. The elderly also experiences loneliness at their age. To include staff and residents that will also reside in the facility and implement the best strategies addresses loneliness. I also believe that it is beneficial that programs are being implemented to educate the family caregiver on how to provide care for their aging loved ones.
Something that I am curious about, is more specifics. This mentions that there are over 700 member organizations in five countries that has been successful in implementing best practice for providing care to older adults. This will definitely be something that I do more research on. I am interested in how this program was initially received and how has this program adapted to the various countries. A follow-up would be greatly appreciated.