Making the transition
By KALEY CONNER
A photo of Elton Margheim's family farm adorns the wall of his nursing home room, a sentimental reminder of home.
Margheim's skin is well-tanned from time spent outside during summer afternoons. His blue eyes sparkled as he talked about the countries he'd like to visit, the music he loves and his opinions about national health care reform.
"Yeah, I've missed it," Margheim said, becoming serious and talking about his farm near Bazine. "But I'm getting so used to it now. I suppose if I'd leave here, I'd miss a lot of things here, that's for sure."
Margheim has been living in the Rush County Nursing Home, a non-profit corporation, for about a year. He's quick to admit he's come to enjoy his new home, and feels a special connection to staff members and other residents.
"It feels like we're a family, like we're a family around here," he said.
That's exactly what the facility has been striving for. For the past few years, staff has been working to transform the nursing home's culture, taking the environment from an institutional medical facility to a comfortable home, Administrator Charlotte Rathke said.
This facility, along with Grisell Memorial Hospital Long Term Care Unit in Ransom, recently was awarded a Promoting Excellent Alternatives in Kansas award from the Kansas Department on Aging. The award is given to nursing homes throughout the state each year for their efforts in the culture change movement. Both facilities are first-time winners.
The award can be given in one or several categories: resident control, staff empowerment, home environment and community involvement. The two northwest Kansas recipients were awarded in all four categories.
The culture change movement is a national push to personalize elderly care, and the state has been encouraging these efforts for years. The PEAK award was established in 2002, said Barb Conant, director of public affairs with the KDOA.
Many of the state's facilities were constructed in the 1950s and 1960s, when nursing homes were treated like extended-stay hospitals, complete with long hallways, nurses' stations and call buttons, she said.
"They are not a health care facility; they are home," Conant said. "And there's just a number of ways that a facility can do that and embrace the whole culture change movement."
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In La Crosse, part of embracing the culture change movement is trying to give residents more input in their daily schedule. Dining has been a primary area of focus, with additional menu items available. Set breakfast times also have been eliminated, allowing residents to wake on their own schedules.
Residents are allowed to decorate their rooms the way they want, and are welcome to bring their own furniture and decorations. The licensed 56-bed skilled nursing facility has downsized to 48 residents, allowing more people to have private rooms, Rathke said.
Mandated bathing schedules also have been nixed, and all of the facility's 50-plus staff members are expected to meet residents' needs, regardless of their positions.
"It doesn't matter who you are," she said. "If the resident wants a cup of coffee, or needs to have somebody sit and hold their hand because they're lonely... We're looking for staff to take on new skills."
And it's hoped this is only the beginning. Success, as Rathke said, is a journey. There already are plans to eliminate the nurses' station to create additional living space, and a future expansion could provide the county's only assisted living facility, she said.
The key is remembering every resident is different, and the range of medical needs varies, Rathke said. However, most of the home's residents do not have acute medical complications upon admission, meaning they all need to remain engaged in daily activities, she said.
Margheim, for example, is an avid reader who regularly rides his motor scooter to the city's library and downtown shops. Another resident puts her creativity to use by creating greeting cards the facility sends to residents on special occasions.
Yet another resident missed his farm so terribly that staff found a variety of outside activities -- feeding birds, watering flowers -- to keep him busy, Rathke said.
"(It's about) how to find ways that continue to give them meaning in their lives," she said. "Yes, is it perhaps the last place you'll be? Sure. But that quality can be there in life even at that point.
"How to make home where you are is what it's about."
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The story is similar in Ransom, where staff at the Grisell Memorial Hospital Long Term Care Unit, now known as Rhode Island Suites, has been working to change the culture since 2005.
The facility's name change is reflective of its efforts. It's hoped the new alias will sound more inviting, said Susan McDonald, long-term care supervisor. Rhode Island is the name of the street in front of the facility, which legally will retain its former name.
Staff first applied for the PEAK award in 2008. The government-owned, hospital district facility was recognized for the first time this year, likely following additional changes staff have implemented, McDonald said.
"We noticed a lot of things we have improved on over the past year," she said.
The home's 25 residents now wake and bathe whenever they want, and have more dining options. Bibs are no longer required at the dinner table.
And the entire place is undergoing an extensive renovation process to make the facility feel less like an institution, McDonald said.
All of the facility's 22 rooms have been remodeled. Residents helped choose the paint colors, and laminate flooring that resembles hardwood floors has been installed.
"Prior to the things that we've done, it was much more institutional," she said. "The walls were white, and the hallways didn't have much decor in them."
They also are allowed to bring furniture from home and decorate the rooms to their tastes. The first resident placed in a newly renovated room gave staff an emotional thank-you, McDonald said.
"She was so excited she cried," she said. "She said she'd never had a room that nice."
Commons areas have also been revamped with home-inspired decor, and hallways are next on the list.
Community involvement is another initiative. Schools visit regularly and several church groups host special events at the home. An in-house Sunday Mass and Bible study meetings draw visitors, and a monthly men's breakfast invites guests for male residents to talk to.
And of course, the community was invited to celebrate the facility's award-winning status last week.
The facility also purchased a bus in partnership with a Ness City nursing home, and residents enjoy various field trips and shopping excursions.
Ultimately, it's about empowering staff and providing residents with the quality of life they desire, said Lori Foster, activity and social service director.
"They're sure a lot happier," Foster said. "The residents and the staff."