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Lyngblomsten Care Center

Chandler Hall

If you've visited our website before, you've undoubtedly read some of our coverage of Northern Pines Communities, a socially modeled home at the edge of the wilderness in northern Minnesota. Well, when the folks behind Northern Pines set out on their culture changing journey, one of the homes they used as their inspiration was Lyngblomsten Care Center in St. Paul. One of the early members of the culture change movement, Lyngblomsten has undoubtedly influenced others as well. Read on to see why.

Being admitted into the typical nursing home is a bit like going to military boot camp, says Dr. Leslie Grant, an associate professor and researcher at the University of Minnesota. Like fresh army recruits, elders too often are deprived of personal possessions and activities that connect them with the past, forced into rigid routines and given few choices.

"You get up at a certain time, eat with a certain group, take your medications, you don't complain... it's very depersonalizing," he says.

No surprise then, that his research reveals a much higher quality of life for elders where the emphasis is on privacy, choice and independence. Dr. Grant's two-year study of residents at the Swedish-style Service House at the Lyngblomsten Care Center in St. Paul, MN, found a far greater level of satisfaction and autonomy than among residents living in the conventional, medical-model nursing home.

Moreover, the residents' family members have higher expectations of the Service House, meaning they trust it more.

Trained as a gerontologist, Dr. Grant works in the University's Department of Health Care Management, Carlson School of Management. His study was funded by the Retirement and Research Foundation of Chicago.

Lyngblomsten, named for the national flower of Norway, modeled the Service House on a style of care delivery developed in Sweden 20 years ago. The idea, says Paul Mikleson, President and CEO, is to treat elders "exactly the way you would want to be treated and keep the environment as normal as possible."

The problem with most nursing homes in the United States, he says, is they operate like hospitals designed to cure people. Yet most people enter nursing homes not to be cured, but for help with the activities of daily living.

Mikleson became interested in the service house model in 1995 when he and the Director of Human Resources participated in Lyngblomsten's annual worker exchange program with a facility in Sweden. There, they saw a much different concept at work: "There were no nursing stations, no doctors hovering about... each person had an apartment rather than a room."

Back in the U.S., they organized a planning group and set to work carving a small service house out of one wing of the Care Center, Lyngblomsten's 250-bed, skilled nursing facility. Some 75 waivers, related mostly to the physical plant, were requested from the state health department, about two-thirds of which were granted.

Extensive remodeling converted 15 private rooms into nine efficiency apartments along with congregate living space that includes a family size kitchen, dining hall, sitting room, laundry and a small work area for staff. There is no central nursing station.

Each apartment houses one resident and has a kitchenette with a refrigerator and microwave oven, a bedroom and full bathroom. Toilets and showers are designed for easy maneuverability for the infirm and their caretakers. Outside, a mailbox and doorbell adorn each apartment.

Residents get a lot of satisfaction by having access to their own food and deciding for themselves when and what to eat, says Janet Hagfors, former Service House Coordinator. Breakfast and evening meals are prepared in the elders' apartments from items in their refrigerators, usually with help from staff or family members. Lunch is served family style in the congregate kitchen from bulk containers so the elders can take as much as they want. Volunteers and family members alternate to help with weekly grocery shopping.

Whether cooking, cleaning, doing laundry or simply getting dressed, residents are encouraged to do for themselves as much as possible. Familiar activities like these, says Dr. Grant, provide continuity with the past and give meaning to their lives.

Now three and a half years old, the Service House has proven it can accommodate elders regardless of their care needs - with one exception, says Hagfors. "The individual who develops dementia would probably not be well served in our current service house."

Nonetheless, service houses in Sweden are equipped to serve residents with dementia, she adds.

The Service House is staffed by universal workers, or "generalists". Called Care Assistants, they not only do nursing tasks (within the bounds of their certification or license), but also assist with dietary, housekeeping, activities, social work - whatever needs to be done. Having the same worker help the resident with a variety of tasks promotes trust and familiarity between the two and enhances continuity of care, says Hagfors.

Teams of 3-4 Care Assistants work with equal responsibility to serve 4-5 residents. An RN and the Program Coordinator supervise, but the teams generally are self-directed.

Originally, all Service House workers were LPNs, but now trained Medication Aids and C.N.A.s are added to the mix. That has helped round out the staff, says Mikleson, because not everyone feels comfortable in a generalist role. Some nurses did not cotton to housekeeping or found the non-nursing tasks too physically taxing. They returned to their old, familiar jobs at the Care Center.

Another challenge for staff was letting elders help themselves.

"It takes a worker who is willing to let tasks take longer by letting a resident do for themselves," says Hagfors.

Though his study showed little statistical difference in outcomes for workers at the Service House compared to the conventional setting at the Care Center, Dr. Grant believes they are happier at the former.

"When talking to the [Service House] staff anecdotally... they told me they would never want to go back to that other model," he says.

Care Center staff gave much the same response when they put themselves in the residents' shoes. Three years ago workers were asked to think of themselves as 85 years old and having lost a spouse or developed disabilities. Would they still want to live at home?

Overwhelmingly, says Mikleson, they wanted to stay at home, but if they needed to move, they wanted to go somewhere more like home, i.e., the Service House. "That really helped us lay the ground work for the change from the medical model nursing home... our own employees said they didn't want to live [in that model]."

Lyngblomsten now is working to raise $2 million to remodel the rest of the Care Center into 14 neighborhoods, five of which will be service houses.

"I don't see any way the current medical model system is going to survive," says Mikleson, "so it's about time we work on some new models."