A caring staff makes a nursing home shine

By Robin Erb and Kristi Tanner
Her panic is obvious; her voice pleading and forlorn: "Help me, help me," Christina Meek wails. Gnarled 87-year-old hands reach toward a passing stranger. "Please," her voice trails off.
It's midafternoon -- just after shift change at the sparse Romeo Nursing Center and Continuing Care -- and Meek is battling phantoms only she can see.
Nona Siwecki, a 52-year-old nurse's aide with a gravelly voice and a take-charge, no-nonsense gait, is suddenly at her side. She caresses Meek's hands. "It's OK, Chrissy. You're with us. You're OK."
Despite its peeling paint, stained walls and rusted eaves, care at this for-profit home -- apparent in even the most fleeting of moments -- is among the most highly rated in Michigan, according to federal ratings.
Advocates for quality care say money alone doesn't determine the top-tier homes. The key, they say, is skilled, caring staff members who put a premium on what residents want rather than the rigid, institutional routine of many nursing homes.

'Everyone knows you and cares ...'

Romeo Nursing Center and Continuing Care is a five-star, top-notch facility.
Drive up to this campus, though, and you might not believe it.
Rust stains run down the exterior. Inside, carpets are stained, furniture dated.
"I tell everybody, 'If you see it, you'd run the other way,' " said Lynn Zimmerman of nearby Washington. Her aunt, Christina Meek, lived at the facility at the time Zimmerman was interviewed, before she died in June at age 88.
"My two sisters and I took her there," Zimmerman said. "We've been laughing. We think we should call 'Extreme Home Makeover.' "
Romeo, about 35 miles north of Detroit, is one of 68 overall five-star rated facilities among Michigan's 427 licensed nursing homes.
These top-tier homes range from old to new, rural to urban. Though no one factor will guarantee perfect care, industry advocates and critics agree that the best nursing homes have some things in common: They hire and retain good staff, often with better-than-average pay. They tend to be smaller, nonprofit homes. And they invite residents and family to be part of daily decision-making.
They represent what advocacy groups say is a welcome trend among the top homes in favoring resident choice, within reason, over inflexible institutional routine.
"For a long time, we as a society wanted facilities to be pretty medical, and that's been held up as the gold standard," said Sarah Slocum, who oversees Michigan's Long-Term Care Ombudsman program, which advocates for residents. "Be a mini hospital, be clean, get meds there on time, and get bandages changed appropriately."
That might be acceptable for short-term rehabilitation, she said. But there is a growing acknowledgment that long-term residents benefit from care that is tailored to their individual needs, and that makes them feel "this really is your home."
In short, it's what your mother always said: Looks are nice, but it's what's inside that counts.

'It's like Grandma's'

Ron Schocke, who runs the Romeo home, was blunt as he toured its buildings that were constructed, as far as he can tell, around 1960. "They're old, they're tired."
Romeo's operation is small -- just 68 beds in both buildings. Like the structures, the staff has been there seemingly forever. Schocke credits this stability as "my secret" to favorable federal ratings in an otherwise plain-vanilla facility.
Romeo operators allowed the Free Press to tour its facilities unrestricted and interview any residents willing to speak about their care.
Francine Quintus, 63, a retired Chrysler secretary, arrived in the summer of 2010 following a stroke.
She said she wasn't bothered that dinner on this night is modest: peanut butter and jelly sandwiches and vegetable soup. The cook knows she hates veggies and will get her chicken noodle soup ready instead.
"It's like Grandma's house. It could use a bit of renovation, but everyone knows you and cares about you," Quintus said.

Dealing with dementia

A simple meal -- the act of chewing and swallowing -- can be a deadly choking hazard for some residents. A rest room visit for someone with balance problems can be treacherous.
High staff-to-patient ratios are critical.
So, too, are skill, compassion and incredible patience, especially as patients live longer with dementia, said Janet Wells, director of public policy at the Washington-based National Consumer Voice for Quality Long-Term Care, which runs ombudsman efforts nationally.
People who work in nursing home settings say that advanced age can sharpen some residents' worst personality traits, in part from the frustration that comes from losing their independence.
When dementia sets in, some residents become combative, even downright mean.
Wells said that the aides who make a difference are able to get past angry, confrontational, even racist remarks. "These aides say, 'We can set it aside.' "

Connecting to the outside

At Marycrest Manor in Livonia, administrator Jim Butler said its success is as much about its connection to the outside world as the care residents receive inside.
Marycrest is the only Michigan home that, at one point this year, had scored five stars in each category in rankings by the U.S. Centers for Medicare & Medicaid Services.
In addition to regular staffers, the 55-bed, nonprofit facility partners with local colleges and universities to recruit student nurses and aides in training.
Though they aren't counted in the official staff-to-resident ratio, the students are answering call lights, helping in dining halls, changing linens and engaging residents. Butler said he hires the best of these trainees after watching how they relate to residents.
"We look for a smile as much as we do for the technical expertise," he said.
The facility, sponsored by the Franciscan Sisters of St. Joseph, also offers mass daily, drawing people from the community on their way to work.
The mass helps to build relationships, boost staff and volunteers and build an energetic community, Butler said.
Butler and his wife, Janet, who heads nursing, said they are picky about whom they hire -- right down to observing whether candidates park in the handicap or clergy parking spaces. That's a measure, they say, of attentiveness and respect.

A day filled with choices

Senior advocates say the best nursing homes embrace concepts such as the Eden Alternative ( www.edenalt.org) -- a nonprofit devoted to making homes for seniors less institutional by developing individualized programs that allow wide latitude in daily routine. If residents don't like the activities for the day, they can create their own. Visitors? The more the better.
Residents can eat when they want, sleep when they want, decorate their rooms the way they want.
Rote scheduling, found at most traditional nursing homes, makes Karl Schillinger bristle.
"We're talking about life here, not the end of life," said Schillinger, director of life enrichment at the Village of Redford, off West 6 Mile Road, which embraces what it calls patient-centered care.
On this day, he was dropping by one of two greenhouses at the Redford Township campus.
Unlike a traditional nursing home, with long hallways and nurses stations, Eden-designed facilities look more like a typical single-family, suburban home. They embody the Eden Alternative ethos -- an airy, bright kitchen decorated with flowers, ringed by residents' rooms and a living room with comfy chairs and couches.
"There's at least one elder who doesn't come out to 10 (a.m.) and her breakfast often runs into lunch, and that's OK with us," Schillinger said. "I have another elder who eats a portion of her lunch but likes to have portions of it for dinner, so we'll package it up and then warm it for her, too."
Residents shower when they want and go on outings with family when it's convenient for them. Some chip in to help with light housekeeping and other chores -- which connects residents to each other and to these buildings, their home.
Last spring, a pair of cousins brought in a miniature Doberman when they came to visit their grandmother.

'I know when I'm hungry'

Nearby, Lela Jasper, 90, smiled as she stood in a beam of sunlight near the kitchen and surveyed the scene.
The mother of two grown sons, she had lived in "more of a nursing home" before this -- one that roused her before dawn for a bath and served up rigid routine and meals on plastic trays.
"I had to be there for breakfast. I had to be there for lunch. I had to be there for supper," she said, frowning: "I'm 90. I can still do things for myself. I know when I'm hungry and when I'm not."