By Benjamin E. Ruark
There’s nothing special about 2033, but that’s the year. A bunch of Floridian investors have done quite well of late; so well, in fact, that they’re looking for a tax write-off. They hear about a new concept for long-term healthcare for the aged. Why not? The vanguard group in charge of the futuristic project has made their pitch and were delightfully rewarded with not a single jaw-dropping investor jumping out of his or her chair when the price tag for startup funding was mentioned.
Sure, they got that this futuristic endeavor was going to cost a lot to put into commission. But then big dreams usually do. And it’s clear that there’s no hypocrisy present here: this isn’t the usual bunch of bottom-feeders—oops! I mean bottom-line aficionados—looking to siphon huge profits off of yet another systematized human-warehousing scheme; designed solely to satisfy federal and state regulations behind a nicely landscaped and one-time accessorized resort-like façade. It’s not that hard to prettify all the public areas in a nursing home but then leave the nondescript resident spaces to slowly decay till they’re mostly scarred and frayed, more or less permanently stench-filled, and depressingly gloomy.
Admittedly, it’s a Herculean challenge to outperform and outlast the relentless assault of human pain and suffering, and their rippling after- and side-effects, thrust upon any collection of seniors of ill-health within the confining walls of a single facility. Regretfully, many healthcare providers counterintuitively take on an institutional mind-set, replete with its usual self-serving designs on maximizing operational efficiency and stability. In so doing, they predictably fall far short of meeting the same Herculean challenge just alluded to.
Healthcare’s medicinal, overpopulated world of chemicals, in their many diverse formulations and forms of administration, is only half the solution that conventional institutions imprudently put their full attention to. The other half is quality of life. Specifically, the design of conditions for optimizing quality of life. As long as patient-residents remain on the living side of the proverbial point-of-no-return, they have the same rights to quality-of-life as their healthier peers: regardless of their capacity to take advantage of those rights. Now that they’re housed in settings providing ’round-the-clock care—their dependence literally in the hands of complete strangers—it’s imperative that both the facility and training of staff go under the microscope to identify the critical pieces needing to go into nursing-home redesign. Here’s what the group of investors were presented by the project leaders as a new vision for long-term holistic care.
Long-Term Holistic Elderly Care of Tomorrow
The Facility & Site
The site in which the facility will be built on is bordered all around by natural features juxtaposed in various combinations and permutations to include trees, gentle hillocks, scintillating flowerbeds, abundant ground coverings, faux outcroppings of river rock/slate/flagstone, burbling streams, coy- and other fish-stocked ponds, and a peppering of ornate old-world style fountains. The grounds are laced with serpentine blacktop trails wide enough for wheelchair travel and with handrails on either side; there are strategically placed bench-seated overlooks; and perhaps even a small outdoor amphitheater. Streets and parking lots are made inconspicuous by tall sycamores or similar decorative trees or high bushes.
The reception/atrium isn’t any different than those in well-appointed nursing facilities seen today. But there is where the similarities end. There are training rooms that double as conference rooms and for regular wing/unit staff meetings. There’s a large room with middle divider, serving as conference room for entire-staff sessions, visitor presentations, and gala holiday events. Residents’ rooms are all private, just as their healthier contemporaries enjoy in retirement communities. [The archaic, uncouth practice of providing semi-private rooms—a carryover from hospital (mostly short-stay) operations—is eschewed by this projects’ designers.]
There’s a large activity room for up to 20 residents at a time, with one of two dining rooms seconding as an activity room when, for example, there’s a holiday surge in activities,. Another special activities room is dedicated to inventive art projects specially designed to work around the usual disincentives of hand tremors, arthritic hands, etc. The bath & shower rooms—one of each per wing/unit—are spacious, impeccably clean, warmly inviting, and tidy; and thankfully adhere to strict sanitary standards. Nowhere will one find sickly hospital-green and similar no-frills accoutrements reminding inhabitants that they’re sick, sick, sick, sick.
In addition to Wi-Fi setup, there’s a type of ‘sprinkler’ system connecting to decorative hallway lighting in the form of sconces that also coyly double as atomizers: timed to spray mists of a special scent of room deodorant found to be universally favorable among residents and also being nonallergenic. Nurses’ medication carts are modernized, their wheels loaded with the kind of ball-bearings that facilitate impressive ease of moving. They’re mainly located in commons, functioning as satellite stations for serving arteries off main wings/units normally served by full-size permanent nursing stations.
Residents’ rooms are all acoustically insulated for noise-transfer abatement between rooms. Most (at least 90%) residents are asked to wear wireless headphones or Bluetoothearbuds for TV-viewing. TV programming is provided through contract with one of the major cable- or satellite-TV companies; in addition to the usual basic cable/satellite offerings, they’ve assembled a large number of channels specializing in programs providing:
(a) senior commentary, news programs, senior-led/sponsored projects of national interest, and even reality-TV fodder such as women’s quilting (chat) circles and senior men’s billiards;
(b) olden-days programming for like-minded aficionados (already available in basic packages); (c) play-along interactive games and mental exercises for enhancing memory and cognition;
(d) a music-embellished phantasmagoria of stimulating sights, exploding images, and a wide selection of many of nature’s own spectacular processes unraveling in slow-motion—all designed to engage the attention of persons suffering from dementia and/or anxiety; and
(e) several music channels—classical, country, oldies—as well.
The aim, here, is conspicuous presence of active seniors—both celebrities and reputed specialists—as models to induce residents, despite aggravating infirmities, to choose to remain more active and engaged in life in general.
A stuffed chair at the foot of their bed faces a 50” TV widescreen set in an enclosure. Residents can sit in the chair, or a wheelchair, or in bed (reclining), and view TV. However, also from their bed, or beside it, they can pull out any one of three swivel-trays locked onto poles (also inset in the wall) located on each side of the bed and extending from floor to ceiling. Padded trays are solid, two inches thick, and two feet wide by eighteen inches deep.
On each tray is a set of assorted materials, small tools, and visual instructions for engaging in one of a variety of projects and exercises targeting physical, sensory, or cognitive conditioning; or for pure diversion/entertainment. As needed, an aide can help get a project started. These packaged self-amusement devices reflect the latest in inventive aids for maintaining dexterity and flexibility of hands/fingers/wrists, shoulders and back; mental agility and concentration, etc., as well as eye-hand coordination for countering onset of hand tremors, for example, and so on.
Nearly every device in a resident’s room has been shown to (1) effectively divert mild-to-moderately ill seniors from succumbing to long periods of dissociation from activity of any kind; from episodes of depressive ruminating, and overall disengagement from their community. Conversely, (2) from Day-1 of intake, residents experience a setting intentionally saturated with positive reasons tacitly informing them that they’re now where they belong: their quality-of-life gets addressed equally by attentive staff and by environmental design. Instead of a warehouse for the ill and dying, they’ve struck upon a sensory festival front-end loaded with copious reasons to embark on and continue some semblance of a meaningful existence.
Each resident room has its own restroom, a privacy-curtain hung from the ceiling, a portable customized writing desk/bed-tray, a heater-A/C unit, and a large tinted window in the main-entry door. The window affords an unobstructed close-up view for monitoring residents designated at-risk for falls, with the door kept closed to further abate noise transfer. Aides frequently stop by to inquire whether assistance is needed (with call lights also equipped, per regulations).
Careful thought has also been given to prudent placement of a subgroup found in most nursing home populations: those residents whose dementia or other cognitive impairments have rendered them unintentionally loud, acting erratically, and potentially menacingly. Such behavior is usually excessive enough that their various distractions alarm, confuse, and spur anxiety and stress in those situated close by. Thus, where commons are located half-length along each wing/unit, opposite of it will be a cul-de-sac of rooms directly behind a satellite nurses’ station. Sequestered residents suffering the conditions just described will be housed there, partially removed from other residents yet closely situated near a nurse for frequent monitoring and instant assistance.
When applying for employment, nurses, nurse practitioners, and med-techs all spend a half-day in interviews, in performing scenario-based tests of critical thinking ability while also obtaining samples of their current thinking processes. If hired they then go through a 90-day probationary period coupled with intensive training before being assigned to a wing/unit.
Professional staff go through two consecutive weeks of 20 hours devoted to several workshops while working halftime. Training stresses healthcare that is patient-centered and holistically intent: focus equally allocated to caring for or preventing individual resident susceptibilities to certain ailments; to personalizing for each resident a routine for countering effects of aging; to addressing current health problems’ symptoms and medication side-effects. In short, staff focus has just mushroomed to a full 360° present-future outlook for each patient.
During training, probationary staff get feedback on how their pre-hiring thinking practices were abrupt, indicative of stock (textbook)/canned solutions being rashly supplied without benefit of first becoming better informed by, (and secondly) failing to integrate their patient’s perspective. And thirdly, for foregoing attempts to critically think through whatever personalized solution would actually be deemed most appropriate. [All indicators of groupthink practices so many healthcare institutions have become accustomed to.] Such is not to shame or embarrass new hires; rather, to demonstrate that their new employer endorses open-mindedness, constructive disagreement (healthy contention), and greater professional autonomy and forethought as countermeasures to hours-on-end confrontations with healthcare problems.
Resident patients deserve nothing less. So, new hires are now back on several learning curves—including learning how to upgrade nuances of their practice by listening to their resident patients and discerning increasingly more finite solutions based on individual patient parameters, for example. After 90 days, all developmentally-promising new hires are offered daytime positions in assigned wings/units. Less-promising workshop laggards, depending on ratings received in very-demanding workshop and probationary performance, are either let go or offered full-/part-time graveyard shift and/or weekend duty.
Added to permanent staff is a professional Learning & Development Specialist who designs all training courseware and strategies; recommends professional and nurses’ aide performance standards; devises and installs new skills transfer-to-workplace strategies; creates various job aids and healthcare failsafe practices for prevention of human error; constructs test simulations for hiring practices as well as classifying job applicants’ levels of qualification; co-trains in training workshops, and occasionally co-facilitates organizational development sessions under direction and endorsement of the facility director.
Nurses’ aides also get hired under probationary conditions. They’re also tested in a half-day’s series of interviews, plus job-related scenario-testing, plus cognitive-testing ability. The latter testing is designed to screen out individuals with inadequate thinking skills. As aides tend to have the greatest exposure to, and time spent with residents, it’s imperative that they be trainable and receptive to learning a wide array of interpersonal skills; and not be left to invent their own devices. For these reasons they both need and merit opportunity to attend an intense ‘boot camp’ that more or less converts them from semi-skilled aide to paraprofessional almost overnight. To where they’ve sensed their own growth beyond what they’d been led to think was possible; and are every bit as much a contributing factor, in the best possible way, to both the well-being and quality-of-life impetus residents can ever hope for.
Even the housekeeping crew gets training. They know fully about types of infections, about spread of bacteria, and how to maintain living quarters, restrooms, commons, dayrooms, activity rooms, offices, and bath/shower rooms at impeccably high standards. Unlike what’s easily detectable in middling institutions, no detail goes unnoticed, unaddressed.
Also unlike the run-of-the-mill facilities, where their telltale age, in decades, of operational wear-and-tear—like a tree’s outer-growth rings—can be accurately read by an untrained eye, this facility retains its original mint condition. Regardless of payment method being applied, each accepted new resident pays a one-time, up-front entry fee of, say, two grand. The rationale is similar to that of a few more-progressive retirement communities: putting that money back into facility restoration. They also have a maintenance budget, of course. But this money is strictly for preserving original stateliness and ensuring that the facility unremittingly operates at its utmost: electricity, plumbing, heating and A/C, carpeting/floors, furniture and equipment, and so on. Styles aside, practically ageless.
Achieving a Quality-of-Life (QoL) Atmosphere
Naturally there’s a rub. As the years pile on, at some point for a majority of seniors life’s inevitable downward spiral will attest to a certain state of being old. It’s now time for them to experience a half-dozen or more of the following in various scathing arrangements: nagging physical ailments, persistent emotional aggravations, pestering disease-related symptoms, with a number of relentless, trying medication side-effects making it a forbidding foursome. Whatever the actual number and pattern, they’re sure to play rough and tumble on QoL.
As though being taunted for living so many past carefree, happier days of youth, many seniors now fear it’s their past visiting upon them the trial-by-ordeal just described. Thus asking themselves, ‘is life at this point worth facing fully alert—all faculties intact—or is the numbness served up in the chemical concoction my physician prescribes a better option?’ In other words, has a tipping point been reached where the debilitating forbidding foursome’s daily trial-by-ordeal renders QoL a non-starter? If so, that’s when the aforementioned medicinal half of the healthcare solution, of necessity, rightfully takes command. Which is why only seniors of mild-to-moderate illness have a glimmer of hope for QoL.
So, assuming medication’s aptly doing what it needs to do, in order to truly afford a QoL atmosphere, certain things also need not to happen: the concept of ‘workplace’ at our visionary facility intentionally gets cast off. It doesn’t exist. In this facility, staff are not brazenly in control. They do not carry on in some form of high-key, king-of-the-hill enactment playing daily; where the elderly are their possessions to look after as they please, as they dictate, and at their efficiency and convenience-served whims.
As a resident-centric facility, the setting is first and foremost home to a second-tier community of seniors: the majority being beyond active-retirement years, true; yet they’re still active to a degree and engaged in life as much as their specially-trained healthcare staff the envisioned facility will effectively make possible. Retrained staff both understand and abide by the new boundaries of human-conduct they’ve been taught to honor, and as imparted by the progressive vision and supporting rationales that are to be in place.
The implication are that some staff are predictably destined to revolt. Jump ship, resign. Unable to adapt to a radical one-eighty-degree shift from conventional quasi-authoritarian command-and-control bureaucratized service to one that’s patently facilitative in mode; firmly designed to tenaciously safeguard-and-serve patients’ best interests. We have two diametrically opposed constructs, here. The dictatorial one goes, the facilitative one stays, becoming an eminent permanent fixture.
In this facility, no one body of people rules. Only the vision: quality-of-life—which has been reified for seniors in the most dignifying manner feasible. Here we witness the strategic pairing of a high volume of service personnel with an equally high volume of elderly people for purposes of preserving for the latter a minute-by-minute means of advocacy, relative comfort, and a multitude of respectful adult-to-adult interactions. And permeated throughout with numerous meaningful instances to believe that life—at least, life in this particular setting—is worth both living and continuing, as it has been so tolerably and convincingly contrived.