Some nursing homes spend millions on remodeling and construction to achieve a more community-like environment. But in rural,
southwestern Kansas, the Liberal Good Samaritan Center is implementing a neighborhood model of care delivery at little cost while
reaping huge benefits for residents and staff.
The transition to neighborhoods and permanent care teams began in mid-2000 when the Good Samaritan was certified as an Eden
Alternative home. During that time, census at the 79-bed, non-profit facility has grown to capacity and resident care and quality
of life have improved significantly, says Tom Shumate, Administrator.
"Word is getting out that we're doing things differently," he adds. "We've always had a few beds open, but for the last four
months [since December, 2000] we've been full and have people on a waiting list." Some, says Shumate, are leaving a private-pay
nursing home across town to live at Good Samaritan.
The building is designed like many typical medical-model nursing facilities. Like spokes from an axle, four hallways extend
from where a large central nursing station once stood, and around which staff used to congregate. There was a need, says Shumate,
to move the staff's attention from the station to the hallways and among the residents.
So one of the first and rather symbolic changes involved tearing out the nursing station and replacing it with a pond and
waterfall. Not only did that dramatically change the atmosphere, it made it impossible to go back to the old care model, says
Shumate. The cost of the pond, about $4,000, was paid with funds donated by an auxiliary group.
Without further remodeling, the hallways were turned into separate neighborhoods and a smaller nursing station was placed at
the end of each one. Rooms in each hallway have been converted to a multipurpose area where residents, or "neighbors", can
congregate.
The environment is further enriched by more than 300 plants donated by family members and a local Wal-Mart, and by a dog and
three cats that roam the hallways. Birds chirp from their cages in a dozen residents' rooms, and children from two day care
centers and various organizations are regular visitors.
Care teams permanently assigned to each neighborhood are made up of nursing as well as non-nursing staff cross-trained as
CNAs. The teams report to an RN charged with coordinating care in that particular neighborhood and who, in turn, reports to the
DON. The arrangement makes it easier for workers to know the residents and identify those at risk.
As a result, the number of incidents like falls and skin tears are down by about 40% and infection rates among residents have
fallen substantially, says Shumate. "You could practically point to the day we went to permanent staffing in the neighborhoods
when those things began decreasing," he adds.
Contentment of both staff and residents are up. Turnover (including dismissals) among workers has dropped from 125% in 1999 to
45% overall, and to 30% for nurse's aides. There are few complaints, and a recent satisfaction survey among residents and family
members scored 30-40 percentage points higher than one done four year ago.
State regulators also are pleased with the changes, evidenced by the Good Samaritan's last two surveys, which were deficiency
free. From the beginning, Shumate made sure to communicate with them about the changes. "They don't like to be surprised, but
they will be supportive if you just let them know."
Meanwhile, more changes are on the drawing board. Plans include construction of a new room and remodeling of existing ones so
that each neighborhood will have its own multipurpose dining room and bathing facility. Currently, everyone eats in the single,
congregate dining hall and shares the two existing bathing quarters. "Basically, adding a 30' x 47' room is all the new
construction we will have to do," says Shumate.
And development of the permanent care teams is ongoing. The goal is for each to become its own self-directed, problem-solving
unit that works directly with the residents to plan care. Shumate hopes to better integrate the various departments-activities,
housekeeping, dietary and others-into the care teams so that everyone is involved in the decision making.
"We're not there yet, but we're over the hump and moving in the right direction," he concludes.
