Effects of Green House[R] Nursing Homes on Residents' Families
Lum, Terry Y., Kane, Rosalie A., Cutler, Lois J., Yu, Tzy-Chyi, Health Care Financing Review
EFFECTS OF GH[R] NURSING HOMES
This article presents results of a quasi-experimental study that examined how a dramatically changed small-house nursing home model affected behavior and outcomes for residents' family members. The model of nursing home care developed in the GH[R] in Tupelo, Mississippi, created opportunities and challenges for family members, and was expected to result in more positive family interactions with residents, and greater family engagement with and satisfaction with the nursing homes.
Family members are instrumental to the psychosocial well-being of nursing home and assisted living residents, and provide the major means for residents to retain their social affiliations and relationships outside the nursing home (Kane, 2004). Families typically are integrally involved in the decision of older people to move to a residential setting, and their choice of facility (Reinardy and Kane, 1999; 2003). If reformed models of nursing homes do not meet with family approval, they are unlikely to be chosen. Further, family members are also a major source of emotional support to elderly people receiving long-term care in all settings, including group residential settings such as nursing homes and assisted living (Gaugler, Kane, and Kane, 2002; Gaugler and Kane, 2007). Family members continue to provide both tangible and emotional support to residents after so-called institutional placement (Kane et al., 1999). Family members also often take on a watchdog role, looking after their relatives' interests and promoting their quality of care (Bowers, 1988). However, the roles of family members in relationship to the nursing home are sometimes ambiguous, fraught with poor communication and misunderstandings between nursing home personnel and family members about mutual expectations (Friedemann et al., 1998).
Although family members typically remain engaged with their members who are nursing home residents, nursing home visits can be difficult and stilted experiences. The setting appears medical and unnatural, engendering uncertainties about what relatives are permitted to do. Also family members may feel guilty and sad because they felt the need to encourage a nursing home admission. Visits may, therefore, become brief and limited to a few relatives, with children and extended family members reluctant to visit or to risk taking the nursing home resident out of the setting to participate in community life.
The movement toward culture change and individualized services in nursing homes has led to new configurations of nursing homes that are more normalized and utilize household models (Weiner and Ronch, 2003). Little is known about how family members perceive the safety and care of the residents and the demands or benefits for themselves, when their relatives live in nursing homes with transformed housing arrangements. This article examines how family members of GH[R] nursing homes (compared to families of residents in conventional facilities) reacted to their relatives' moves to a radically changed nursing home.
GH[R]s are self-contained dwellings for 7-10 residents needing nursing home levels of care. The physical environment is residential, offering residents opportunities for privacy (with private rooms and full bathrooms) and participation in community life, with a residential-style kitchen where meals are prepared on site, a dining area with a large communal dining table, a living room with a fireplace (collectively known as the hearth area), a sun room, and accessible patio and outdoor space. The GH[R] avoids nurses' stations, medication carts, and public address systems. The frontline care staff members, who are CNAs assigned to a single GH[R], have broadened roles, including, cooking, housekeeping, personal laundry, personal care to residents, implementation of care plans, and assisting residents to spend time according to their preferences. …