A different kind of nursing home
Imagine the ideal nursing home or assisted living facility. Where would it be located? What amenities would it offer?
The picture comes easy for Even because it also describes his Bay City farmstead, hidden away in a cornfield northwest of the village; but, just as people have different likes and dislikes, Even admits his vision of the best care environment won’t be the same for everyone.
That is one component of Share-in-Care, an alternative nursing and dementia care model Even developed to replace the current and, according to him, fundamentally flawed way society treats people as they age.
“I call it not a revolution but an evolution back to how we used to care for our elderly,” said Even, who spent 35 years as a psychiatric social worker in community mental health clinics.
He proposes a cooperative approach that splits daily tasks among family, friends and other unpaid volunteers in a joint-run facility. A skill assessment would determine if each person would be best suited providing direct care or support services.
“Housekeeping, cooking, laundry and food preparation can be done by normal people,” he said, likening the idea to church and senior center programs commonly run by volunteers. Professional help still would be necessary at times, but such workers could be hired as needed to control costs.
The model keeps people “intimately involved” with the care of their loved ones while also providing a support network to help share in the often overwhelming responsibility of 24/7 care.
Because such facilities would be small — limited to around 15 to 18 residents — and locally based, Even said each facility could be tailored to meet the specific tastes and preferences of its residents.
“The key is to look at it as not a step down from institutional care,” he said, “but a step up from home care.”
A common tune
Share-in-Care is the product of two decades of research and personal experience, starting in 1993 when Even’s late wife, Betty Even, was diagnosed with Parksinon’s disease at age 55. Four years later she was diagnosed with Lewy body dementia, which causes memory loss and hallucinations.
Even cared for her in their Bay City home for 14 years until he could no longer handle the hardship alone. Betty was placed in a care facility for five years before she died in 2012.
After his wife had two bad reactions to prescribed medication, Even said he learned the importance of an “active advocate” for anyone with dementia. The years also gave him an immersive look at the state of the elderly care system in the region.
“I’ve made this the passion for the rest of my life,” he said. “I’ve looked at the situation of nursing homes and it’s problematic.”
Among the weaknesses Even identified are high staff turnover and low pay, adding that many positions are filled by entry level candidates who stay just long enough to become certified nursing assistants.
Nursing home conditions made headlines earlier this year after the Minnesota Department of Health announced the takeover in May of a Minneapolis nursing facility over numerous violations. The 87-bed Camden Care Center, which houses residents receiving senior and dementia care, “failed to maintain a basic level of safety and security,” according to the MDH.
Even said families across the country are facing experiences similar to his own, some of which he continues to hear from people at a local Alzheimer’s support group.
“As they talk, the lyrics are different,” he said, “but the melodies are pretty close to the same.”
In Even’s home state of Wisconsin, an estimated 28,000 people resided in nursing homes at the end of 2012, according to the Department of Health Services. Around 45 percent of them were diagnosed with dementia.
With the elderly population in the U.S. expected to grow, the Centers for Disease Control and Prevention predicts there will be a “sharp increase” in the need for long-term care services in the coming decades.
At $100,000 a year to live in a nursing home and $20 an hour for in-home care, Even said the system is no longer financially sustainable for many people.
“I don’t think our counties or states can afford it either,” he said, “and certainly not the national government.”
By incorporating family members and volunteers in the administration and daily tasks of care facilities, Even said his Share-in-Care model could cut the cost of elderly and dementia care in half.
The facilities also would be humanely sustainable, he added, providing a stimulus-rich environment that is important as people age.
Even said he understands his model is a niche solution, and that the countless investments in the current system will make it difficult to fix. For now, he said his hope is that Share-in-Care will spur discussion and help get things moving in the right direction.
Wisconsin is one of the first states in the country to step forward, having launched a dementia care redesign initiative last year. The Department of Health Services held a number of listening sessions this summer to get input from the public.
“We just need to do more homework,” Even said. “And we need to make some drastic changes in how we handle people in the latter years, especially those who are most vulnerable.”