Power to the people.

Sister Pauline Brecanier, O. Carm., administrator of the Teresian House Center for the Elderly in Albany, New York, was recently faced with a tough decision. Her 99-year-old mother suffered from congestive heart failure and expressed her wish not to be hospitalized. Sr. Pauline decided that, contrary to her own preferences, she would respect her mother's wish and accept her into Teresian House.

"We knew we could take very good care of her here, and our philosophy is that [the elderly] are better off with people they know around them, instead of going to a strange hospital," says Sr. Pauline. "It's wrong for people to think that there is better care in a hospital when tender loving care, such as we provide, is often the only cure the elderly need. We really need to change people's attitude about homes for the aged."

It is that philosophy that led to Sr. Pauline's involvement with the Pioneer Network, of which she is now a board member. The Pioneer Network is a grassroots movement to change and transform the culture of aging in America, and that's exactly what Sr. Pauline is trying to do at the Teresian House.

Teresian House was founded in 1974 by the Carmelite Sisters for the Aged and Infirm, who stress quality of life, holistic caring, and hospitality. The sisters' inspiration came from their founder, Mother M. Angeline Teresa, O. Carm., who believed that each person is worthy of respect in all stages of life, and as such is entitled to quality care for the whole person--body, mind, and soul--at all times.

With that philosophy in mind, the sisters set about updating Teresian House in the early 1990s to more comfortably accommodate skilled care residents. Specifically, they decided to tailor the building to residents with Alzheimer's disease, creating more programs for them, a unit where they could wander inside and outside, and "neighborhoods" of people living around a central social area.

"We also had to change staff impressions and attitudes regarding their traditional resident care practices," says Sr. Pauline. "We restructured the organization, eliminating the staff hierarchy and putting the residents first. And we had to change the psychosocial and spiritual environment. It took a lot of training, a lot of in-services, to get staff comfortable with the idea that the residents could eat and sleep when they wanted and do activities when they wanted."

Departments have been merged to create the neighborhoods; each neighborhood has its own consistent staff of caregivers (resident-centered care coordinator, nursing staff, nurse's aide, pastoral care workers, social workers, housekeeping, activity personnel, dietary, and volunteers). As a result, there are fewer lines of authority, says Sr. Pauline. Everyone is responsible for answering call bells, and a nurse could be serving meals, doing laundry, or even cooking up scrambled eggs for a resident.

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Another unconventional aspect of Teresian House that stems from Sr. Pauline's desire for culture change is intergenerational child care. The home has an on-site child-care program serving 65 children up to 5 years of age who do activities with the residents such as cooking, reading stories, and acting out fairy tales. "The parents love it because they get a chance to place a grandparent here with their child," says Sr. Pauline. "Our employees like it, too, because they can go visit their children at lunchtime or on their breaks." One resident whom the children affectionately call "Papa Joe" comes in every morning to play with them and read them stories.

Teresian House also features the Capitol Lounge, where residents can have cocktails with lunch and before dinner every day. Residents can even have alcohol in their rooms, as long as they don't abuse it.

The Capitol Lounge, Sr. Pauline says, is just one way to meet residents' needs and also meet the lifestyle requirements of a facility. "Just because you're aging, it doesn't mean you have to stop living," she says. "Our staff are supposed to meet the residents' schedules. We're here to help them take care of themselves. We give residents or their families a questionnaire to fill out before they move in to find out how their bedroom furniture was arranged at home and whether their bed was against the wall. We want to make their room here as close to how it was in their own home as possible."

Other reminders of home are spacious living rooms and large, open country kitchens that reinforce the "neighborhood" concept and promote social interaction.

Despite the efforts of the Pioneer Network and Sr. Pauline to change people's attitudes toward homes for the aged and embrace culture change, not everybody has been willing to buy into them. Some in the field fear that changing from a medical-model nursing home to a person-centered environment will create reimbursement shortfalls and result in higher costs. But Sr. Pauline says that Teresian House has experienced no such problems. "We haven't found our new way to be any more costly," she says. "The only higher cost was food stock, which we have in each neighborhood. But we've also saved money in that we no longer need an activities director or social services, and we haven't increased our nursing staff per unit. The resident-centered care coordinator is now in charge of the floor, and everyone works as a team and performs global duties when needed."

Documentation, says Sr. Pauline, remains just as important under the homelike environment as it was under the medical model. "The state surveyors judge you by your 'documentation,' not by what they may witness when a resident and staff member interact with one another," she observes.

So it's "power to the people" (or residents) at Teresian House, a concept that Sr. Pauline hopes gains momentum. If residents would rather browse in the country store than participate in an activity, so be it. If they want to take a nap after lunch, that's fine, too. The point is that if residents are capable of making personal decisions, they need to be allowed to do so.

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That includes wanting to be at Teresian House in the first place. "When prospective residents visit our home, they often will tell us immediately that they don't want to come here," says Sr. Pauline. "They would rather stay in their own homes. We listen to their needs, give them a tour, and hand them our Resident Handbook. If after an extensive interview they still don't see the need for coming to us for care, then we cannot accept them."

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Sr. Pauline admits that this policy has caused problems for some families, and that's why Teresian House staff help relatives seek alternate avenues for care, and even suggest that their loved one may need more motivation from the family. Teresian House also provides families with a list of realistic expectations they should have of the home, and asks them to sign each section of the list to acknowledge their understanding and acceptance.

Even if a prospective resident suffers from dementia, Sr. Pauline says, it's sometimes better to interview him or her without relatives present. "Often this works out better, and the resident agrees to come," she says. "However, if he or she still remains adamant about not living here, then we cannot accept that person."

Now that's putting residents first.

For more information on the Teresian House Center for the Elderly, visit www.teresianhouse.com or call [phone]. To send your comments to the author and editors, e-mail [e-mail].

BY JASON STAHL, ASSOCIATE EDITOR