Lexington, KY - When Jude Rabig flies around the country for her consulting business, she often sits next to a passenger who asks her what she does. When she reveals she's in the nursing home business, her seatmate immediately goes silent. It's a subject they clearly don't want to discuss. But if she tells them she's a nursing home reformer, "the other person is immediately intrigued and wants to talk about the issue," said Rabig.
What has propelled Rabig, a former nurse and gerontologist, on this life mission is a concept called small homes. It is a nationwide attempt to deinstitutionalize nursing homes by moving residents from traditional, hospital-like facilities to specially designed, cozy homes where 10 seniors live together with staff. Wesley Village Senior Living Community in Wilmore wants to build the first such homes in Kentucky.
The small home is designed to feel like a real home. That means a private room and bath for each resident. "People have their privacy restored," said Rabig. There's a home configuration with a front hall, living room, den, hearth, and most importantly, an open kitchen and dining area featuring a large dining table for residents and staff to eat together and interact. Residents are encouraged to help prepare meals or do light chores, if they choose. Seniors also have much more freedom in the house than in a traditional nursing home and can visit the kitchen any time for a snack or a drink. There is easy access to a fenced patio. "When people hear about this model, they give a sigh of relief," said Rabig. "The American Association of Retired Persons (AARP) has studies on how people feel about nursing homes, and more than 90 percent say they would rather die than go to one. It's not a hard sell."
Administrators at Wesley Village feel up to the challenge. "We hope to build six homes that would handle 60 residents, ten in each home," said Glenda Creech, president and CEO of the Village, a retirement community affiliated with the United Methodist Church. "Right now, projected cost is about $10 million for six homes." Rabig believes the small homes would be no more expensive to run than nursing homes and that Medicaid reimbursement per patient would be the same.
Creech said the small homes at Wesley Village would be for people with memory impairment all the way up to those in the final stages of life with Alzheimer's. "What they're finding is that people are coming alive in these small homes, even though they may have been bedridden or were only bed-to-chair," said Creech. "Some are starting to walk and talk again. They're interacting. I don't know if you'd call it a miracle, but from what I've seen and the research, these people are stimulated rather than stuck in a bedroom isolated from life."
Creech said her goal is for everyone who receives healthcare on campus to eventually move to a small home. The staff to elder ratio in a small home is about one to five, half that of a nursing home. Plus, there is less staff turnover. Employees seem to enjoy the work more and feel empowered, said Rabig.
There are only two groups in America that continue to be institutionalized for the remainder of their lives, Rabig said - "That's murderers and frail elders. Everyone else has a home in a community. No one wants to end their life in an institution," she explained.
Rabig is helping guide Wesley Village through the tangle of bureaucracy in order to launch this ambitious project in Kentucky. There are clearly obstacles. Nursing homes are the third most regulated industry in the United States, according to Rabig - first are nuclear power plants, and second are coal mines.
Rabig said small homes retain the licensure and certification of nursing homes. Critics say it would be cost prohibitive to build small homes that meet safety regulations, but Rabig is lobbying for revisions in the regulations, which would decrease the cost. Funding models for small homes have already been created, and with small homes now up and running in places like Ohio and Mississippi, there is solid performance data available to judge results.
Although the Wesley Village campus is relatively new, just 13 years old, 30 to 40 percent of nursing homes around the country are over 35 years old and badly in need of major renovations or replacement. Now may be the time for some operators to consider a whole new approach to senior care. Wesley Village is ready to take the plunge.
"Realistically, a lot of it depends on what happens economically and with fundraising," said Creech. "Our goal is to go public with our fundraising campaign in the fall and we hope to break ground by the end of 2010 and have occupancy by 2011."
If the goal is reached, Wesley Village will have fulfilled its dream to turn the sterile environment of a nursing home into a warm and dignified home.