"Five Minutes With..." Bill Keane on the Future of Nursing Homes

Bill Keane is the Director of Dementia Services at the Mather Institute on Aging (affiliated with Mather LifeWays retirement communities). He is also a member of the Board of Directors at the Pioneer Network, an organization dedicated to stimulating a positive culture of aging in America, including the transformation of nursing homes.

(1) With all of this bad publicity about nursing homes, should families be concerned about placing a loved one?

If you monitor the national media, over and over again you will see horrific stories of neglect, abuse and poor care in America’s nursing homes. It’s getting worse. It’s a reflection of the labor shortage, but there are other complex issues affecting quality. It’s going to be a problem that continues to grow. The typical jaded nursing home administrator says that low reimbursement and regulation are to blame. But the fact is that you’re not going to ensure quality simply through regulations, reimbursement or more stringent background checks.

It takes stronger leadership, better management, and a real sense of mission in working with elders to reduce, minimize and eliminate crises of care, abuse, and neglect. The horror stories are not related to the economy, but to the values of our society.

Families should be concerned because the protections that they take for granted are not necessarily there. Regulations have not solved the problem, in part due to inadequate enforcement. Families especially today need to be concerned because of the weak enforcement on regulations in many states, and the very thin regulation in assisted living. Facilities aren’t necessarily managing issues of aging in place and transition as effectively.

(2) Why are we hearing about all of these horror stories now?

Sometimes I wonder if it is because the media is having a slow news day. But on the other hand, the media is getting better at exposing these crises. Some of the huge lawsuits that have come out have created a lot of the tension. A recent issue of The National Law Journal listed major jury verdicts in 2001. Nursing homes were at the top of the heap with several heavy fines of $20 million or more. The courts fined one nursing home $312 million in damages for the death of a resident in a Texas facility.

(3) How can families ensure the best quality care for their loved ones?

Much has been said and written on this. I will speak both from my personal experiences and from my position as a professional.

First and foremost, families need to be part of the assessment and care planning process [that is devised when the elder moves into the nursing home]. The care plan becomes their “contract document” with the facility. It can be used as a way of monitoring care and ensuring that their loved one gets all of the services they are entitled to. The care plan is updated every 6 months or when the elder’s health status changes.

Next, if you really tell families how and when to go “shopping” for good residential services, you are giving them the kinds of tools that they need to do a better job of monitoring their loved one’s care.

Other suggestions include:

  • Work hard to not be an adversary to the staff and administration in a negative sense. Be a partner and collaborator in the continuing care of their loved one, but always stand up for what you think is right. Visit as frequently as possible, and be part of the experience (for example, assist with dressing and dining), much like they were as caregivers at home.
  • Visiting as frequently as possible is the key to ensuring consistent care. Families generally visit more in assisted living facilities than in nursing homes.
  • “Staff partnering” is a critical strategy. Get to know the staff as people, develop relationships with them.
  • Stay involved in the care in the facility, not just by visiting, but perhaps by volunteering or participating in family council meetings, so that you become part of the wider community and administrators can hear your concerns.
  • Communicate with public officials about “the real issues.” The issue of elder abuse (which is a hot button issue) is just the tip of the iceberg. We need to ensure that there are educated and well-trained people in facilities.
  • Make sure you take care of yourself in a meaningful way so you don’t burnout and back off after you have placed your loved one. Empower yourself so that you get the kinds of skills that you need before and after placement.

(4) What is the future like for nursing homes?

I used to joke about investing in a bulldozer company to bulldoze all 18,000 nursing homes. Our current facilities were built on an archaic system with depersonalizing and inhuman environments. Many people feel that the system is hopelessly bankrupt.

I believe that the experience of holistic good care is based on a three-legged stool of comfortable physical environments, rich programming, and caring staff. The nursing homes that have the right kind of leadership will survive and thrive whether they have the perfect physical plant or not.

We need to create ways of living and working together different from the traditional models. Groups like the Pioneer Network support models where elders live in open, diverse, caring communities. We’re working for deep system change by both evolutionary and revolutionary means, using Pioneer values and principles as the foundations for change.

Going forward, Baby Boomers will not tolerate an environment of care where nursing homes are forever tied to “passing the survey.” The best thing that is going on is that Boomers are getting in touch with these issues. They are better consumers. It’s going to be a very unsettled time, as it should be. We have too many bad apples that are getting too much attention.

We need to encourage a change in the individual's and society's attitudes toward aging and elders; change in elders' attitudes towards themselves and their aging; and change in the attitudes and behavior of caregivers toward those for whom they care.

(5) How can busy caregivers make a difference NOW?

If you’re an active caregiver, that’s where you can make a difference. Rome wasn’t built in a day. Changing the culture is a process that evolves over time. Stay focused. Write off small pieces one at a time because that’s how it grows. Keep the balance and focus in your day to day life.

Related Articles
 - Options for Retirement Living (Basic)
 - Promises, Promises
 - Nursing Home Checklist (Adobe Acrobat Required)
 - Helping Your Elder Adjust to a Residential Facility
- Moving Into a Nursing Home: A Guide for Families

- Suggested Clothing for Nursing Home Residents
 - Nursing Home Resident Rights
 - Family Councils Help Nursing Homes Maintain Quality of Care
 - Support Groups Are Essential for Caregiver Well-being
 - Understanding and Acknowledging Negative Emotions
 - Using Family Meetings to Resolve Eldercare Issues
 - Transition Issues for the Elderly and Their Families

Recommended Readings
- Nursing Homes: The Family’s Journey by Peter Silin (Review Available)

- The New Nursing Homes: A 20 Minute Way to Find Great Long-Term Care by Marilyn Rantz and Lori Popejoy
The Home: A Brief Moment in Time by Marion Caryl Somers (available from http://www.1stbooks.com)
- Nursing Homes: Getting Good Care There by Sarah Greene Burger, et al.
- ElderCare Online's "Choosing a Nursing Home" Learning Resource Guide

- Children of Aging Parents
- Alzheimer's Association

- National Association of Professional Geriatric Care Managers
- The Pioneer Network
Mather LifeWays
- ElderCare Online's Neighborhood Networks

- ElderCare Online's Caregiver Support Network
- ElderCare Online's Nursing Home Quality Advisor

Available from ElderCare Online™             www.ec-online.net             2002 Prism Innovations, Inc.