JUST THE FACTS.

What: Nursing Home Pioneers

'99: Frustration to Pride

Where: Riverside Convention Center, Rochester, New York 

When: August 19-21

Number of attendees 360

SOME PEOPLE HAVE TRAVELED FARther than others on the journey to make nursing homes better places to live, but the journey will never be over--and no one can make it alone. That was the message of this national conference, the first held by a group of people who call themselves the Nursing Home Pioneers.

The background: The core group consists of about 35 providers, regulators, consumer advocates, researchers, and consultants. The group met four times over a two-year period before convening this national meeting.

The Pioneers' principles, as spelled out in a summary of their first meeting, center around responding to nursing home residents' "feelings of disconnection ... loss of control over significant aspects of their lives ... fear of often uncomfortable and unfamiliar routines, and ... feelings of loneliness, helplessness, and boredom." As New York City-based consultant Catherine Ursino put it in her plenary address: "It's nobody's fault the way nursing homes are designed, but it's on our watch. There are no bad people. The problem is that we have been wedded to something called efficiency." And the solution, say the Pioneers, is to reorganize daily life in nursing homes around "the natural rhythms of life."

The basics: The conference's structure reflected the group's holistic approach, encompassing prayers, songs, storytelling sessions, and a round of the Hokey-Pokey ("You put your whole self in/You put your whole self out...").

To encourage networking, attendees were divided into small groups. Each met several times to discuss what they were hearing, how it applied to their work, and how to maintain the momentum generated by the conference when they returned to "the real world."

The bottom line: At several sessions, providers who were "on the path" talked about how and why they had implemented change, what worked, and what didn't.

The panelists told of how quality of life and relationships improved when they converted long hallways to "neighborhood" clusters, each with its own staff and common areas.

They talked of how well residents responded when they were given something useful to do, whether it was taking care of an animal, helping to prepare their own food, or interviewing potential CNAs.

They spoke of how turnover went down and morale went up after they implemented the universal worker model and let caregivers schedule their own time, choose the equipment they'd be using, or even decide who to admit. "The hierarchy was flattened," said Charlene Boyd, administrator of Seattle's Providence Mount Saint Vincent. They explained how "transformational training" helped both new and current workers understand and implement the new philosophy.

They talked about simple things that make a big difference, like letting residents eat breakfast whenever they wake up, or leaving a juice dispenser, ice machine, and beverage cooler in every neighborhood for residents to help themselves, cutting down on dehydration. "We're trying to create rampant normalcy in nursing homes," said Garth Brokaw, administrator of Fairport Baptist Homes outside Rochester.

Then the audience asked questions. What do you do about regulators who would issue a citation if they saw a resident making her own bed? How about unions that resist the universal worker model, which is crucial to making small neighborhoods work? How do you change a facility if you're not the owner or administrator? And how much do these changes cost?

There were no easy answers. As Boyd acknowledged, the traditional way of life in nursing homes is "inflexible, interlocked, entrenched." Even residents generally resist change at first, having grown used to having things done for them and living in a quiet place with predictable routines.

The first step is always the hardest, acknowledged the speakers, but change never gets easy--and you'll never get everyone to sign on. "The more we change, the more we want to change," said Wendy Webster, vice president of resident services at Fairport Baptist Homes.