By Cathryn Domrose
February 24, 2000
Photo: Courtesy of Fairport Baptist Homes

Marlene Liess, MS, RN, nursing administrator at Fairport Baptist Homes in Fairport, N.Y., recalls a woman who recently came to live at the nursing home. She expected long hallways, sterile bedrooms, and the institutional smell that makes nursing homes so dreaded. Instead she found a cozy sitting area next to a big kitchen equipped with a stove, wooden cabinets, a coffee maker, and a microwave.

"My goodness," she told Liess, "I came here to die and now I have a reason to live."

Last August, the nursing home in upstate New York completed a nearly two-year renovation of its 196-bed facility. The renovation applied not only to the buildings and grounds, but also to the very concept of a nursing home.

"We were a traditional nursing home with long hallways and nursing stations," known for quality health care, but we focused on schedules and offering hospital-style service, Liess said.

Now, the elderly who live at Fairport Baptist Homes are called residents, not patients. They live in 20 households of nine to 12 people, each sharing a fully equipped kitchen, washer and dryer, parlor, and dining area, with bedrooms off the common areas. They get up when they want, go to bed when they are tired, and eat their meals together or alone, as they choose.

They also have power beyond the decor. They meet in resident councils to discuss common concerns. They help interview prospective staff members. If they need help at night, they call a nurse using a special bedside phone.

And the smells wafting into their rooms are of cookies baking, tomato sauce simmering, or fresh laundry being taken from a dryer—the scents of home.

The renovation, instigated and carried out by Baptist Homes president the Rev. Garth Brokaw, reflects a change in nursing homes around the country, said Robert Greenwood, a spokesman for the American Association of Homes and Services for the Aging in Washington.

As baby boomers grow older and demand choices, traditional nursing homes will be a thing of the past, predicted Dolores Alford, PhD, RN, FAAN, a gerontic nursing consultant from Dallas. "Research is saying that people want quality of life and that’s why the nursing homes will have to change," she said.

Movements like the Eden Alternative, which advocates bringing plants, animals, and children into nursing homes, practice what is known as resident-directed care. Resident-directed care does away with strict eating and bathing schedules, and is becoming increasingly popular, especially in nonprofit homes. In many cases, these changes involve spending more money, which may be why they haven’t been as popular in for-profit homes, Greenwood said.

Short-term costs at Fairport Baptist did go up after the remodeling and other changes, Liess admits, but administrators are waiting to see the long-term financial effects before declaring the move bad for the budget.

The movement may benefit nursing homes in other ways. Although studies are just getting under way to see whether the new ideas are working, nursing homes that have become more homelike report lower staff turnover, Greenwood said.

At Fairport Baptist, nurses, aides, and household assistants are divided into teams that work to care for residents in a household. Instead of stations, the nurses have "work spaces," a desk and computer set up in a corner of the kitchen.

Some staff members question the changes because they eliminate the traditional barriers between nurses and residents, Liess said. The household idea means a nurse or an aide may have to wash dishes or serve meals. "It’s not just nursing care."

But once they begin working in the households, the most hesitant nurses become the new system’s greatest advocates. "They love it. They would never go back," Liess said. "They enjoy doing those little extras and they love the resident contact."

As part of the change, Alzheimer’s patients previously segregated from the rest of the nursing home residents now live in households with everyone else. At first, the other residents were skeptical, Liess said. But now they’ve started looking out for the Alzheimer’s patients, she said, calling a staff member if they suspect something is wrong, or telling a nurse, "Take care of him before you take care of me."

One of the best results of the changes at Fairport Baptist, said resident Bill Mulbacher, is that residents have grown closer to each other. Most members of a household never want to leave their group, Liess said, even for a plum such as a private room in another household.

"Before, you spent 95 percent of the time in your bedroom and you never had a chance to meet your neighbor," said Mulbacher, 75, president of the Fairport Baptist Homes resident council. "Now you’re coming from one loving household to another loving household."