A fter extensive study and public listening, Cheshire County officials are considering alternative futures for county-run nursing home care for its poorest citizens. The two principal choices include upgrading the county’s existing Maplewood nursing home in Westmoreland or building a new facility in Keene along the lines of what is known as the “Green House” model.
I believe the latter is the wiser course, and here’s why:
From my professional perspective as a recently retired primary-care physician in Keene, I want to share my observations, which include more than 25 years of monthly visits to an average of 20 residents in local nursing homes. Many of the younger readers of The Sentinel are the children, grandchildren or great-grandchildren of some of my former long-term patients at these facilities.
All of the nursing homes in Cheshire County were built decades ago according to institutional guidelines of those earlier years; they resemble hospitals, with patient rooms generally occupied by at least two residents and with shared bathrooms. Often the shower and tub rooms are separate from the toilet and sink room. Like hospitals, they have long corridors, traditional nursing stations, and limited privacy for family and friends of the residents. Residents share the dining and activity areas. Central kitchens prepare institutional food; laundry carts and housekeeping items often clutter the hallways.
This institutional environment may be overwhelming for some, especially those who are experiencing cognitive decline. The residents encounter the faces of multiple nurses, nursing assistants, food-service staff, housekeeping and maintenance personnel, therapist, administrators, and visitors. In addition, they are often lined up in wheelchairs in narrow hallways, sometimes alone and unhappy.
On the other hand, the Green House concept, which started more than a decade ago and now has facilities in 30 states, is transforming the culture of long-term care. If this model were to be adopted locally, the new Maplewood would be a neighborhood of 15 individual homes, each of which would be designed for 10 to 12 residents, providing private rooms and bathrooms combined with a home-like atmosphere of open common spaces. These homes would include outside gardens, an entryway, a living room with a fireplace, and an open and welcoming kitchen with an adjacent dining room. The patient rooms would be large, allowing space for the resident’s own furniture.
A small, well-trained staff would provide individual care for the residents; they would prepare meals and maintain the facility. Registered nurses and physiotherapists would provide their skilled services as necessary. The group of residents and the staff would truly become a unified family. Check out the Green House Project website — http://thegreenhouseproject.org — for the details and specific advantages of this concept.
Presently, Cheshire County contributes $2.6 million to balance the Maplewood operating deficit. (The vast majority of Maplewood residents are on Medicaid support, and these reimbursements in 2014 represent only about 50 percent of the operating costs.) If a Green House village were to be built, the anticipated deficit would be a bit less at $2.4 million per year; BUT the environment in which the residents live would be far superior to that of the current facility. Independent research in operating Green House nursing homes demonstrates sustained improvement in satisfaction, clinical and financial outcomes.
Bringing the existing Maplewood facility up to an adequate standard, including adding air conditioning and meeting the requirements of the American Disability Act, would cost about $30 million. By comparison, the construction cost of 15 new homes, each housing 10 to 12 residents, with a modest administration building would also cost $30 million. HOWEVER, this project will cost taxpayers only $18 million because of New Market Tax Credits which will apply if the facility is built in a designated area within the city of Keene. The details of the financing are available on the Cheshire County website.
Truly, the Green House concept offers a welcome alternative at a time when the infrastructure of the Maplewood Nursing Home is precarious. Significant amounts of money will have to be spent to maintain the present facility, but the Maplewood Task Force and the Beyond Maplewood Coalition have strongly favored a decision to redefine nursing home care in Cheshire County. We don’t know who amongst us might be residents in that facility in future years or decades.