Maine, with the oldest population of all the 50 states, is home to dozens of assisted living centers and residential nursing institutions. Now, thanks to a major gift from a Waterville couple, one of the state’s largest and oldest senior care facilities promises to bring a more welcoming and homelike approach to institutional elder care in Maine.
Founded in 1929 in Portland as the Jewish Home for the Aged, The Cedars is a nonprofit organization that provides independent-living apartments, assisted living, skilled nursing and short-term rehabilitation services on an 11-acre campus on Ocean Avenue. It’s funded through a mix of Medicaid, Medicare, long-term care insurance and private payment. About 200 seniors of all faith backgrounds, both couples and individuals, call the campus home.
But a recent $4 million donation from board members Sidney and Elizabeth Geller of Waterville will help usher in a new era at The Cedars. As part of a larger, $30 million fundraising effort, the Gellers’ gift will enable the transition to an emerging national model of senior care known as the “household” model.
“The Cedars has always been pretty much cutting-edge and on top of the best practices in elder care,” said lawyer Sidney Geller in a phone interview earlier this week.
The household model is “the next step” in improving residential care for seniors, he said.
“It is literally a home, with a front door and a doorbell,” he said. “It’s a whole new concept.”
The Gellers, both in their 70s, hope their gift will inspire other donors to support the project, which also is being funded through a bank loan and a private bond issue.
It’s way more than a doorbell. Construction crews will break ground this spring for two new, large buildings on the campus. One will house a memory-support household for 20 residents with dementia. The other will feature two assisted living households, each designed for 20 residents. In addition, an existing building on the campus will be renovated into three, 20-resident households for long-term care residents, who need more intensive nursing support, and rehab patients.
These household units will not look or operate like nursing homes, most of which resemble a hospital. There will be no long corridors lined with shared bedrooms, no nurses’ station, no big, institutional kitchen. Instead, each household will feature its own front door, a home-style kitchen, dining area and living room and a private bedroom and bathroom for each resident. A small, cross-trained cadre of nurses, personal care aides, dietary aides and others will be assigned to each household, aiming for a more personal and consistent relationship between residents and staff.
The shift to the household model entails a significant change in the institutional culture of The Cedars, said President and CEO Kathy Callnan, a registered nurse who has been with the organization for more than 40 years.
“This will be a more resident-centered model of care,” Callnan said. “That means the residents make more of their own decisions. The staff isn’t getting everybody up at the same time or feeding people at the same time.”
If one resident is an early riser and another likes to sleep until noon, staff will accommodate those choices. If someone wants a snack in the middle of the afternoon, or a stroll outside before lunch, it will be readily available.
Cross-training and multiple professional certifications will be encouraged, Callnan said, allowing, for example, a housekeeper also to help a resident with personal care, or a nurse to prepare an impromptu grilled cheese sandwich.
Board Chairman George Markus said the transition represents a “dramatic change” at The Cedars, adopted only after careful consideration and touring an institution in Kansas where the household model is in full effect.
“The significance is not just for our organization or for our community here in southern Maine, but for the entire state,” he said. “Maine is the oldest state and only getting older. It’s essential to find the most effective, user-friendly way to care for our seniors who need extra help.”
The new households will replace some older, more traditional facilities at The Cedars, but the Osher Inn, a relatively new facility that provides assisted living services in private apartments, will not be remodeled at this time.
Although the new facilities won’t be ready for occupancy until mid-2018, staff members are already working with residents, family members and volunteers to develop new, more flexible roles and ways of interacting with each other. These sessions are being coached by staff from Action Pact, a private company headquartered in Kansas that promotes the household model as part of a larger approach to providing more homelike elder care.
“It really is about changing the culture rather than any specific training,” said LaVrene Norton, who founded Action Pact in 1996 and serves a consultant to organizations such as The Cedars that are seeking to transform the way they care for seniors.
Key to this change, she said, is cultivating a less hierarchical, more family-like environment. For staff, this requires a more flexible job description and a sense of shared leadership within the household unit.
“There are many decisions organizations have to make,” Norton said. “One hundred percent of the staff needs to be involved in the process.”
While the household model of long-term care has been evolving informally for the past 20 years, she said, it is experiencing a wave of popularity. Action Pact has worked with “hundreds” of organizations in the United States, Canada, Ireland, Australia and elsewhere, she said. The Cedars is the first in Maine, possibly in all of northern New England.
At the Maine Health Care Association, an industry group representing nursing homes and assisted living facilities, Executive Director Rick Erb said a few smaller facilities here provide household-like care. There’s little doubt that the model offers benefits to both residents and staff, he said, but most larger facilities can’t afford to make the kind of physical and operational changes it requires.
“We’ve been hoping to see something like this in Maine for a long time,” he said. “It’s something we’ve been watching in other states, and we certainly wish [The Cedars] well with it.”
As Maine’s nursing homes get older and demand extensive renovation or replacement, Erb said, it will become possible to design for the household model. But until then, the more familiar model of institutional elder care will likely prevail.