Our annual recognition of people who make a difference.

It is a privilege to recognize those in the industry whose advocacy, attention to detail, innovation, leadership, and understanding serve as an inspiration to others in long term care. This year's honorees have set new standards in the quality of resident care and lifestyle. We are sure their mark will be an indelible one, and that their impact will continue to be felt for a long time. In addition to these honorees, go to our Web site, <www.cltcmag.com> and read about this year's Notables.

Rev. Grant Lynn Ford and Edith Lederberg

Serving a hidden community

"The gentleman sitting over there by himself is gay."

For Edith Lederberg, executive director of the Broward County Area Agency on Aging, these words--heard during a visit to an adult day center--were a call to action, propelling her toward the realization of a dream: providing Broward County's gay and lesbian seniors with an adult day center of their own.

Collaborating with Lederberg is the Rev. Grant Lynn Ford, pastor of the Sunshine Cathedral, a predominantly gay church in Fort Lauderdale. As this issue of CLTC goes to press, renovations are underway to convert the church's parish hall into an adult day center that will initially be licensed to serve 30 seniors. It is scheduled to open later this summer as the Noble McArtor Senior Day Care Center, named for Lederberg's late fiscal director.

Broward County, Fla., is home to an estimated 15,000 gay and lesbian seniors who came of age when "don't tell" was the rule. Many could now benefit from adult day services, but most stay away fearing that they might be unwelcome. According to the National Gay and Lesbian Task Force, relatively few gay seniors have had any involvement with their local senior centers. Many gay people in their 70s and 80s, accustomed to living as outsiders and perhaps estranged from their families of origin, experience increasing isolation as they age. Some may enter nursing homes prematurely because they are unaware of--or distrust-community-based services.

Lederberg, 72, remembers when being gay or lesbian was among the topics that weren't openly discussed in mainstream society.

"We were very protected when we were younger," she recalls. "We didn't really know much of what was going on altogether. But as I grew older, I became aware that there was a population of people who were gay and lesbian, most of whom we would say 'hid in the closet' because when they came out in public they were abused, either verbally or physically. That always stayed in my mind."

The McArtor Center, which has received $200,000 in federal money from the Broward County Area Agency on Aging, is said to be the first federally funded "gay-friendly" adult day program. Broward's gay community has been instrumental in raising the $35,000 needed for renovations. The non-denominational center will be open to all eligible seniors, regardless of sexual orientation, and will offer services similar to those of other adult day programs: a hot lunch, health care services, and social activities. The defining difference will be a sense of belonging and acceptance for gay and lesbian seniors.

According to Ford, "This center will primarily be set up as a respite for the caregiver, so that the elder gets not only the care he or she needs but mental stimulation as well." He adds that whether the caregiver is someone's same-sex partner of 40 years or a gay son or daughter seeking care for an elderly parent, the McArtor Center will offer "care without judgment."

Other adult day programs in Broward County also receive federal money, but federal funding for a project focusing on the gay and lesbian community is not without its detractors. Janet Folger, director of a Fort Lauderdale-based Christian ministry called Reclaiming America, maintains that federal support for the senior center is "forcing the taxpayer to subsidize homosexuality."

Lederberg remains confident despite the backlash; emphasizing that the center falls within the guidelines of the Older Americans Act and that its location on church grounds follows the principle of faith-based social services promoted by President Bush.

"Sure there's opposition," says Lederberg. "But is. anything going to stop me? Absolutely not."

SUZANNE BILYEU

Wayne Ruga, AIA, FIIDA, HON. FASID 

Places for national treasures

A world-renowned architect and designer, Wayne Ruga's approach to health care design is based on his belief that seniors have an important role in our society. Their wisdom is a timeless knowledge that should be passed on to younger generations. To do this, Ruga thinks we need to develop a way to recognize this and give seniors a platform to be able to pass their wisdom on back into the system. "I think the way that we go about making facilities and the decisions that we make about facilities are really important in terms of recognizing that in fact aging people are national treasures," Ruga explains. This belief was honed through a career, now in its fourth decade, that has given him opportunities to work, study, and teach health care design here and abroad.

Ruga founded The National Symposium on Healthcare Design and The Center for Health Design and was president and CEO until three years ago. At that time, Ruga and the organization had reached the time to go their separate ways and did. Not one to rest on his laurels, Ruga has gone on to initiate a new organization, the Caritas Project. He named it caritas, a Latin word meaning caring, nurturing, supporting, loving, because it is a one-word summation of the environments he hopes to create.

When Ruga first started the Center for Health Design, it was a project that became an organization. This time he started with the organization and is developing projects for it. The Caritas Project's initial project was a Leadership Summit held in Esalen, Calif. Its second project is an expedition, limited for logistical reasons to 350 by-invitation-only attendees, to be held in Manchester, England, in 2003.

As a result of years of participating in study tours all over the world, Ruga understands the value of going out into the field and learning from some of the best examples. And he doesn't mean taking a two-hour tour. This is the basis for the development of The Caritas Project's exemplar program. The program would involve a two- or three-day visit to a facility to participate in on-site, interactive workshops and, ultimately, develop peer relationships with professional counterparts. Ruga thinks this type of learning exchange can create significant improvements.

Currently in Manchester, England, Ruga is working on a three-year research fellowship for his doctoral studies at the Manchester Metropolitan University in the United Kingdom. For this project, Ruga has been given access to the facilities, staff, and patients in a community health center by the Health Service. His goal is to learn how to make community-wide sustainable improvements in health care delivery. The first phase, an exploratory study, is complete and the project is moving into the action research phase. In this phase, Ruga will work with the health center to implement a change and then study its effects as the change is occurring.

Ruga recognizes the importance of having health care environments be supportive of everyone. A key concern is that an environment's demonstration of respect for human dignity extends to the staff. The "back of house" environment needs to respect those people who provide the care and services. If two nursing homes are recruiting staff, with all other things being equal, the one with the nicer staff facilities will attract the higher-quality candidates. Another concern for a long term care facility is to consider the residents visitors. Oftentimes, visitors will assume the role of surrogate caregivers. The environment needs to contribute to making their visit a pleasant one.

When asked what his most significant achievement is, Ruga replies, "To me the most important accomplishment is that I believe that the unit of accountability is each individual person's life, and what my work is about is working with various individuals to make a difference in their lives." Ruga strives to have a ripple-in-a-pond effect on improving the lives of the people who live, work, and visit those who live in long term care facilities.

JOYCE PAGAN

Joanne Rader, RN, MN, FAAN 

Changing the culture of care

Joanne Rader, a nurse specializing in dementia care, had only to hear the screams coming from the shower room to know that the typical nursing home bath was causing extreme distress. To find out exactly why, Rader asked a CNA to give her a shower.

As she sank into the hard plastic shower seat, Rider felt the rush of water running into her eyes and down her face. Her dangling feet turned a bluish-purple color. The overall effect was that of simultaneously drowning and freezing.

"Boy, did I learn a lot!" says Rider. "I had a very good aide giving me the shower. But the problems weren't inherent in the aide, they were inherent in the system. They were inherent in that crummy shower chair."

This chilly ordeal served as inspiration for Rader and her research team as they developed creative methods for bathing that keep residents clean while maintaining dignity and minimizing distress.

"In our study, we showed that we got people just as clean with a no-rinse soap," says Rader. "But it's not just about substituting a towel bath for a shower or tub, it's about individualizing it for that person and their needs."

Rader has compiled the results of her team's efforts into a book entitled Bathing without a Battle (Springer Publishing Co., 2001). It could be considered a natural outgrowth of Individualized Dementia Care: Creative, Compassionate Approaches (Springer Publishing Co. 1995), which Rader co-edited with Elizabeth M. Tornquist. She emphasizes that both books represent many years of teamwork and research in which some of her best teachers were CNAs and the residents themselves.

Rader became interested in long term care early in her career as a rehab nurse, having been impressed by the sense of grace and wisdom in one of her elderly patients who had suffered a stroke. Upon earning her master's degree in psychiatric and mental health nursing at Oregon Health Sciences University, Rader became a clinical specialist in mental health nursing at the Benedictine Nursing Center in Mt. Angel, Ore.

Because of her specialty, Rader was assigned all the "problem" residents, many of whom had a reputation for escaping whenever they could. The widely accepted "cure" for wandering was to tie the resident to his or her chair. To prevent further agitation, the resident might be given a psychoactive drug such as Haldol. Rader saw people who were able to outrun her when they entered the facility lose their ability to walk within two weeks.

"The residents who wandered had a lot of energy, and we wanted to utilize it in a positive way," says Rader. "So we created an exercise program for them, a way of using up some of the energy and giving them a sense of socialization--and we were very successful."

The team then began building on this success by developing more effective ways of communicating with people who have dementia.

"One way was learning how to talk with the person so you don't get in the way of their agenda," says Rader. "If somebody's trying to go out the door, you go with them, you distract them, you try to bring them in another door. In the long run, you save a lot of time and distress."

In 1991, Rader became project director on a three-year grant from the Robert Wood Johnson Foundation to develop strategies to help all Oregon nursing homes reduce the use of physical restraints and inappropriate psychoactive drugs. She frequently gives presentations and workshops at nursing conferences and is a founder of the Pioneer Network, an organization dedicated to changing the culture of aging in America,

"The bath study just reinforced for me the need for large system changes," says Rader. "The solutions generally are so simple--covering somebody, choosing the right time for the bath, the right approach. But if the nurse supervising that unit or that shift doesn't buy into it, it makes it almost impossible for the aide to put it into practice."

SUZANNE BILYEU