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Chandler Hall

Nursing homes that are embracing culture change these days are realizing things that the folks at Chandler Hall have known for a long time. Unique among the homes we've profiled, Chandler Hall operates on the belief systems of the Quakers. They have never used restraints of any kind, and have always believed that a job is done best when it's done by oneself. These beliefs, among others, have helped Chandler Hall be an unwitting pioneer in the arena of long-term care. Read on to see how this home is blazing new ground using old ideas.

Visitors to Chandler Hall Health Care Services in Newtown, PA, can gain insight into the facility's unconventional philosophy of long-term care from a close look at the huge, decorative quilt hanging in the lobby.

With each block of fabric depicting a piece of Quaker history or particular belief held by the Society of Friends who founded and operate the facility, the quilt is an apt symbol of warmth and comfort for some 200 older adults who live there, and a colorful statement of the values on which the nonprofit organization is built.

Equality, freedom of expression, movement and choiceãthese same values, says Liz Wilson, Director of Admissions and Marketing, stitch together Chandler Hall's tapestry of programs to provide a continuum of care that, like a warm quilt in winter, covers each resident's unique pattern of physical, social and spiritual needs.

"Quakers believe there is the light of God in every individual. Based on that, we need to respect people and the way they choose to live rather than the way we think they should live," she explains.

That philosophy has enabled what truly is a society of friends to evolve at Chandler Hall among the staff, residents and the broader community.

Established as a nursing home in 1973, Chandler Hall has always trod a less beaten path, endeavoring to operate from a "wellness" model emphasizing quality of life rather than from a "medical" model that focuses on illness. Restraints, whether physical, chemical or emotional, have been disallowed since the early 1980s.

Today Chandler Hall also provides onsite adult day health care, assisted living, ALS (Lou Gehrig's Disease) residential care, hospice care, bereavement support, fitness and aquatic programs, childcare and development, and creative arts and educational programs. Hospice and home health care is provided in the community.

The onsite programs work in sync so residents may choose from a wide variety of activities and support systems. For example, says Wilson, an assisted living resident who begins to need more highly structured health support can participate in the Adult Day Health Program, then return to her apartment in the evening to get the social support she seeks.

Providing individualized care in an environment as "normal" or homelike as possible is a primary goal. There is no centralized nursing station or staff uniforms to encourage divisive 'us' and 'them' perceptions; no bed-bound residents or bedside meals (except during severe illnesses); no locked Alzheimer's Unit for segregating those living with dementia; and no traditional recreation staff planning the ubiquitous bingo games.

"With individualized care, we don't need to segregate people...they can get Alzheimer's and memory care support wherever they live," says Wilson.

As for the bed-bound, "we don't believe that is a natural state that anyone has to be in, so there is a tremendous amount of encouragement and support to get everyone up and moving," she adds.

All staff, with help from volunteers, is responsible for involving residents in leisure pursuits of their choosing. Rather than having to select from highly structured group activities like bingo, residents may help with child-care, tend garden, care for pets, assist with equipment maintenance, meal preparation and cleanup, attend art class or go for a dip in the facility's pool.

"If you have memory loss but are in good physical shape and want to play tennis, we'll find a partner for you," says Wilson. "Or, if you prefer pinochle, we'll set up a table and find three others who want to play."

Such accommodating service is made possible by Chandler Hall's volunteer corps, she says. "They bring the diversity that allows us to do the individualized programming."

Development of care plans tailored to the individual's needs starts even before the person is admitted to Chandler Hall. Interestingly, most Chandler Hall residents are not Quakers but from all walks of life. Many are artists, musicians and others with a bent toward the fine arts, says Wilson.

"We do an extensive history on the new resident and their family dynamics, then create a program around that person," she says. "It's ever-growing, evolutionary...as we learn more about them, a more comprehensive plan develops around their health, social, psychological and spiritual needs - the whole package."

Assisted living apartments are designed to allow residents to "age in place" so, as elders become increasingly frail and need more services, health support can be brought to where they live.

"The nursing home is available on campus, but most people would rather choose to continue living in the area they have decorated and made their own," says Wilson.

Though housed in a 30 year-old building, the nursing home defies convention. It is filled with light, thanks to the foresight of builders who installed skylights. All residents' rooms have a large window to the outside, or French doors leading to an outside deck. Many of the rooms are decorated individually.

"Rather than displace somebody when we need to redecorate the building, we wait until the room is empty, then decorate it according to the current fashion," says Wilson.

Residents are assigned to live in small "neighborhoods" with other residents compatible with their particular level of physical and mental functioning (there are about eight individuals per neighborhood in the nursing home). They are allowed to have their own pets if they can care for them, and there are pets common to the entire household as well.

Front line staff is organized into care teams to serve both the assisted living and nursing home neighborhoods. Care is provided to the approximately 50 nursing home residents by one team consisting of a Director of Nursing, a Direct Care Nurse, a Care Manager, a Therapeutic Recreation Specialist, a Social Worker and an RN Assessment Coordinator. All front line non-nursing staff members are trained as C.N.A.s. Though staff is not departmentalized, traditional staff titles are maintained to comply with state regulations.

Each residential program has its own congregate dining area, and a privately owned onsite cafÈ allows additional choice in meal selection. Meals served in the dining areas are prepared by professional chefs who also cater weddings and other events held at Chandler Hall. Generally, each meal allows residents to choose what they want from among two meats or main dishes, two vegetables, two starches, soups, salads and sandwiches.

"Food is not a huge source of complaint," says Wilson.

When it comes to making decisions about how things should work at Chandler Hall, "Our residents are our most outspoken population," she says. They are part of the system, its not just happening around them. They know what they want, and if we follow their guide, we are generally better for it."

Residents sit on committees to help evaluate the various departmental functions, and there are frequent surveys, questionnaires and other opportunities for residents and staff to have their say.

Decisions made at the top by Chandler Hall's Board of Directors are by consensus, so new programs are well thought out when they are finally implemented, says Wilson.

The boundary between Chandler Hall and the outside community is a revolving door. Residents frequently leave Chandler Hall to attend activities in the community. Conversely, nonresidents regularly come to the facility to volunteer; attend weddings, funerals and celebrations; or to participate in the Adult Day Health Program and aquatic, fitness or arts and educational workshops offered to the community at large.

Integral to all of their services, says Wilson, is the child development program. Currently, about 40 children of Chandler Hall employees participate. Friendships between residents and the children are nurtured by planned intergenerational activities as well as ordinary, casual contact throughout the facility.

"A resident may be helping a child with homework while the child's parent is preparing the resident's food," she says. "It just makes for a nice, comfortable, family-oriented work environment."

Which is one reason why staff longevity is the norm, says Wilson, "People don't leave...many retire from here. We have workers who have been here for 10, 15, 20 years."

She believes staff morale is buoyed by Chandler Hall's nonprofit status: "Staff knows their hard work is going back into our programs, not into somebody's pocket."

Workers are relied on to help recruit and select new employees. Once hired, the orientation includes an average of one week of training on gerontology, growth and development across the life span, health promotion and interaction, leisure, family needs, and Quaker philosophy and practice.

"We do a good job screening prospective employees...it's a long process, but we would rather have a position empty for six months than fill it with someone who is wrong," says Wilson.

New staff also participates in geriatrics sensitivity training.

"We walk around with popcorn in our shoes, tape up our joints, sit in a wheelchair and experience a little of what it may be like to be an older adult," says Wilson.

During their last state survey, says Wilson, the surveyor noted the "true relationship" between the staff and residents, and how "that's not something you can fake for a week" while the surveyors are there.

"That goes such a long way in boosting the staff's confidence and pride in what they are doing," she adds.

To learn more about Chandler Hall, point your web browser to www.chandlerhall.com.