A good place to age
Suellen Beatty, CEO of Saskatoon’s largest special care home, smiles as a happy little Shih Tzu pup named Mocha trots down the hall to touch noses with Tiger, the dog that accompanies her to work at Sherbrooke Community Centre. (“Tiger’s kind of like the assistant CEO,” she jokes.) The centre is full of dogs, cats, birds and a rabbit or two, all part of an enormously successful plan to make the home vibrate with life and caring.
Gone are four-bed wards and a medically oriented mentality. “We’re trying to make this a place where each person can be the individual they are, and live a full life,” she says. In 1999 Sherbrooke adopted the Eden Alternative, a philosophy developed by a New York state physician named Bill Thomas. It targets the bane of nursing homes: loneliness, boredom and helplessness. Surrounded by pets, plants and children, residents enjoy spontaneity and variety and can satisfy their human desire to care for other living things.
Sherbrooke’s 263 residents live in small neighbourhood units within the centre, settings that feel less institutional and more like normal life. “We try to have the people who are most intimately involved have some power to ke day-to-day decisions,” Beatty says. That’s why the people who live in each neighbourhood (or their families) plan meals, decide on decor and whether they want to have a pet. In the process, loneliness evaporates, responsibility overcomes helplessness, and participation dispels boredom.
Maintaining this spirit of involvement is most difficult among those with dementia, like the several elderly residents who have been folding towels in a bright room that overlooks a fenced patio. The room is fragrant with the scent of ginger cookies their daily living assistant has just pulled from the oven. Some of the people watch Tiger as he noses about hopefully for the source of the aroma. They are all tidy, spotlessly clean and seemingly content. No one is fretful, and no one appears dozy or drugged.
“This is one of the most difficult places in which to work,” Beatty acknowledges. “People have had a lot of losses, both physical and cognitive.” But keeping them connected is important at Sherbrooke. “We have a music therapist who does a lot of work with these folks,” she says. “In fact, she had a bell choir with some of them. I would have said that wasn’t possible, but they did some Christmas carols. It was unbelievable.”
Good nourishment is critical for these frail seniors so food is always available. They can sleep in and then have breakfast when they’re fully awake. They’ll eat more when they haven’t been wakened prematurely and are still drowsy, Beatty points out.
Looking around the room, she notes, “When you have a lot of cognitively impaired people, you often get a noisy, aggressive environment. Our environments are really very peaceful. We try to have a lot for residents to do.” — including enjoying the sensual pleasure of freshly baked cookies.
A new model for eldercare
When Saskatchewan undertook major health-care reforms in the early 1990s, it divided the province into health regions and closed 52 small rural hospitals. The province opted to provide nursing-home care only to people who were so debilitated they could not live in their communities.
“We used to have four levels of care in our nursing homes,” says Dr. Allen Backman, a professor of health policy at the University of Saskatchewan in Saskatoon, “but we made the policy decision to keep the people at levels one and two in their homes if we could, with home care as a support. Budgets for home-care programs have gone up dramatically in Saskatchewan, although I would argue that it’s still not adequate.”
Next page: Changing the institutional design
Since 1990, waiting times to get into a special care home in Saskatchewan have dropped from as long as a year to a matter of weeks. People waiting to be discharged from hospital or who are in crisis go to the top of the list, taking the first available bed and transferring to their preferred facility if an opening occurs later. Residents pay for accommodation based on their income level.
Special care homes throughout the province are regulated by and receive funding from local health regions. Client/Patient Access Services (CPAS) for the Saskatoon Health Region is the sole entry point for its nursing homes. “We often work with people long before they really need access to a long-term care facility,” says Sue Melrose, CPAS director for the region. “In fact, most people don’t need [long-term care]. That level of care is really only required for a small percentage.”
People who can manage with less intensive care can choose to live in supportive care homes licensed by the government, but almost all are privately owned and operated. There are about 700 such beds in Saskatoon.
Changing the institutional design
Sherbrooke, a non-profit organization affiliated with the health region, is owned by the Anglican, Presbyterian, United, Mennonite and Roman Catholic churches. The 200-bed Parkridge Centre on Saskatoon’s west end is the city’s second largest special care home and the only one owned and operated by the health region. Both centres have put a lot of effort into developing environments that encourage patients (or their family members) to make the choices about how they want to live.
Before Sherbrooke underwent its last phase of reconstruction, Beatty went to the community to find out what people really wanted in a special care home. (She thinks the term ‘nursing home’ is both outmoded and inappropriate.) Most worried about loss of control over their own lives, having to live in a big, cold institution without their own possessions, being unable to do things they enjoyed (such as cooking) and having too many people around. The successful solution was to create two connected indoor villages.
Seven houses look into Telemiracle Way, an enclosed street in Kinsmen Village and four more front Poppy Lane in Veterans’ Village. Each has its own outdoor patio, barbecue and gas fireplace, but the decor in each unit varies according to the wishes of its nine or 10 residents. One houses brain-injured aboriginal men, another elderly people of Ukrainian background, some are home to people with dementia. Here, people have privacy in their own rooms yet plenty of opportunity to socialize with others. And most enjoy the company of a cat, dog or bird, even if they’d never lived with a pet before. Often visiting children drawn to these animals end up chatting with the elderly, an exchange that enriches young and old alike.
“Knock, knock,” Beatty calls as she enters Korea Villa in Veterans’ Village. One gentleman watches television in the living room while the home’s daily living assistant checks the kitchen cupboards and orders groceries through Sherbrooke’s computer intranet. She grins as Beatty proudly demonstrates the kitchen sink that lowers to accommodate wheelchairs.
House-based staff members such as this daily living assistant keep track of medication and work with residents to plan meals and social activities. “They’re amazing people,” Beatty says. “They get to know the flow of the house and the people who live in it. They try and help them participate in the preparation of food and things like that.” In fact, everyone’s contribution is valued, so visiting wives feel comfortable and useful doing their husbands’ laundry, for example.
Sherbrooke has a long list of imaginative amenities that enrich life in its environment, and invite enjoyment, if not outright participation. Radio station SCCR broadcasts on any television within its walls. “We’ve got a lot of old farmers here, and sometimes we grow wheat and barley in the garden,” Beatty says. “We do a weekly crop report on the radio. It’s hilarious.”
Frail gardeners can direct the planting of their own garden boxes or work at the wheelchair accessible boxes on their own. Outdoor patios, a garden and a greenhouse allow more opportunities to care for growing things.
Next page: Putting quality of life first
The presence of children at the centre is deliberate and welcome. Residents raised money to build four playgrounds on the property to attract local youngsters, and Sherbrooke’s Oak Trees and Acorns day care accommodates 40 children. The latter regularly bring the day care’s laundry to a house and while it’s washing, they provide a happy diversion for the people who live there.
“My assistant went looking for her daughter in day care,” Beatty recalls. “It turned out the kids were visiting a group of seniors with Alzheimer’s. The pre-school kids were having a tea party, and the residents were smiling and laughing. It beats the heck out of seeing people slumped over in a chair. You can see the love there, the memories from before. That’s what makes working here so neat.”
There is inevitably a down side in a community full of people whose health is precarious. When someone dies, residents, families and staff mourn. About 80 per cent of the funerals are held in Sherbrooke’s spiritual centre, a large circular room with a round skylight that evokes Saskatchewan’s aboriginal heritage. “Residents and staff can come and say good-bye, and families know everybody. That’s been a good thing,” Beatty says.
Putting quality of life first
The Parkridge Centre’s unique population ranges from medically compromised children to very frail elders. Meeting their widespread needs was an exercise in frustration until the decision was made to reorganize, with a plan based more on providing good quality of life than having patients measure up to the needs of the institution. “We came to realize that we couldn’t run a facility on rules and regulations that only fit well for nursing staff or to expedite nursing care,” says Joan Middleton, Parkridge’s clinical nurse specialist and adjunct professor of nursing at the University of Saskatchewan.
The result was a model of care they dubbed MOSAIC, or Moving Others with Special Abilities and Interests into a Community Group. People with similar social and physical capabilities were encouraged to move to a specific “neighbourhood” within Parkridge where staff members could focus on addressing their interests and needs. Today, residents and staff find the experience much more satisfying.
“In the beginning,” says Middleton, “the staff wasn’t trained to see their job as more than providing care. Now they’re expected to take someone for a walk or do a puzzle with them, and they’re really enjoying it.”
Parkridge also maintains close connections with the wider community of Saskatoon. People recovering from stroke or orthopedic surgery stay for physical and occupational therapy. There’s also speech therapy for people with aphasia. The centre researched and developed a standardized method for assessing pain in people who are too ill to express the degree of discomfort they’re feeling.
Although Parkridge’s attractive building lacks the intimacy of Sherbrooke’s villages, there’s no doubt residents, visitors and staff appreciate its caring and homelike atmosphere. “One of the things we hope will come of the mosaic model is that residents themselves will feel they have a responsibility to their fellow residents to improve the quality of life,” Middleton says. “We should all be helping each other out.”
Beyond bricks and mortar
Suellen Beatty of Sherbrooke Community Centre muses, “We do have a nice physical structure, but I don’t think that’s what it’s about. I think it’s about the philosophy. People come in the doors, and they think, ‘Boy, life’s happening here.’ That’s how it should be. Sometimes people say, ‘How can you work in this setting?’ Well, it’s sacred work. It’s a privilege to be part of these people’s lives. We have an incredibly caring staff that is really committed. They all come with their own talents and passions, and we weave those into the fabric of our community.”