Focus is on individuals and quality of life

They aren't diseases, but the word that is used to describe them - plagues - is certainly morose.

Those in the long-term care business say boredom, helplessness and loneliness are the three plagues that account for most of the suffering among the elderly.

There has been a national movement that has been going on for about 20 years that's goal is to try to deinstitutionalize medical settings and promote patient-centered care. The name given to the movement is "culture change."

"It is all about the patient and their needs," said Gwynn Powell, director of home health services for Palms Home Care in Sebring. "We are the provider for the customer; they are the customer.

"It's a whole different realm of thinking," she added.

Peggy Patton, health care admissions director at The Palms of Sebring, believes the change was initiated by management looking introspectively in the long-term care business and determining that "we don't want to go to a nursing home when we get old; we don't want this kind of service..."

She said the baby boomers are definitely pushing that forward because they aren't going to accept what their parents accepted.

"We have to step it up if we are going to survive," Patton said. "Bottom line is, if we wouldn't want to be there, why would we put our loved ones there?"

When Steve Austin arrived at The Palms as executive director a couple of years ago "it kind of opened our eyes to a lot of different things," Patton said.

"Being in health care so long you've seen glimpses of different models, so it just all made sense," she said.

The culture change is a new concept here, Patton said. In conjunction with that The Palms has revised its dining operation.

Chef Mac Gentleman came to the facility on South Pine Street a year and a half ago to help change the kitchen and meal plans from institutionalized fare to restaurant-style food.

As a result, The Palms offers a full menu in each of its four dining rooms complete with soup and salad, chicken wings, New York strip steak, grilled wild-caught salmon, sandwiches, coleslaw and fresh fruit. There are two chef specials and a catch-of-the-day each day as well. The food is all fresh, cooked to order, and served up by wait staff.

Patton noted that the "serveries" have been remodeled in the dining rooms so that they can cook eggs to order.

Another change is that residents are now given the choice when they want to get up.

"It used to be the CNAs come in at 7 and the night shift has a quota they have to get so many people up. Then the day shift comes in and they have to get so many people up and they all have to do it before breakfast.

"It is not such a hurried pace, it is not such a cattle call so to speak," Patton said. "It's a big difference."

"They look presentable when they go down to the dining room," Powell said. "They are all groomed and their teeth are done."

"They are happier," Patton added.

The focus this year is on the activities department. Currently The Palms has scheduled activities such as Bingo at a certain hour and a movie at another time.

Patton said the facility is hoping to have everyone on the staff be involved in the activities process. As an example a member of The Palms' transportation staff takes dance lessons and has taught some salsa classes for the residents.

"That's what we want to do," she said. "We want to give them variety; we want to give them spontaneity and that is the key to alleviating some of the boredom."

The culture change not only involves a philosophical switch but a reversal in roles in the hierarchy with nurses and therapists no longer making decisions.

Management is more of a facilitator or a support for the frontline staff, according to Patton. It is the CNAs, the home health aides, the housekeepers who are driving the care.

That change has been difficult for some workers to adjust to.

"Some (have responded) better than others; change is hard," Patton said. "When you are used to coming to work today and you have your routine and you did this, this and this and then all of a sudden you realize you have to do that, that and that ... it's a change."

The Eden Alternative

Dr. Bill Thomas created The Eden Alternative in 1991. Thomas started it after making rounds in a nursing home.

"As the story goes, he was going to see a patient about a rash," Patton said. "He gets in there. He's looking at her rash talking to her about that.

When he is getting ready to leave, she reaches over and grabs his arm and looks up in his eyes and says, 'I'm so lonely.' "

According to The Eden Alternative Web site, the concept Thomas, his wife, Judy, the Eden home office staff, Eden Educators, mentors and thousands of associates teach is that where elders live must be habitats for human beings - not sterile medical institutions.

Patton and Powell attended an in-depth four-day Eden training session in Sarasota in February of last year.

"It was very emotional," Powell said. "It went way deep. It sorted out the things that we always thought were good maybe were not always so good.

It opened you up to see where you were in your life and how well you could adapt to this kind of change," she added. "So it was a lot of soul-searching for yourself. It was very different."

Feel at home

Donna Pontious, who is the manager of Southern Lifestyle Assisted Living Facility, ate Thanksgiving dinner on Thanksgiving Day with the residents of the ALF north of Lake Placid.

"Several family members (of residents) asked me why I'm here," Pontious said. "This is my family."

She added that the residents are just as important as her own family.

Pontious said Southern Living agrees in theory with The Eden Alternative but doesn't promote any of the many culture change programs. It is trying to change the image of long-term care facilities.

"We want them to feel at home and this be as close to home as possible," she said.

Pontious said Southern Living holds a lot of parties that always have a theme. A Noon Year's Eve party, including a toast, was held a couple of weeks and there also has been a magic show.

Angel on staff

Angel is a Bichon and is a regular visitor to the residents at Royal Care of Avon Park. The dog is part of the pet therapy program there.

Royal Care has had dogs for several years, according to Alana Lobozzo, risk manager. She said the facility had a cat and some birds.

"Animals do calm people and help with socialization," Lobozzo said. "Most animals give a lot of love."

Lobozzo said Angel fills a void for those residents who miss their animals.

She noted that dogs have been used to help people with dementia.