Scenes from a nightmare.

The other evening I was channel surfing (I may be the fastest clicker in Cleveland) when I was snagged by an old movie I hadn't seen in decades called I Never Sang for My Father. I remembered having enjoyed it when it was first released in 1970, and I stayed with it. It's a riveting story of an ambivalent adult son (Gene Hackman, great even then) trying to support his powerful but declining father (Melvyn Douglas, always great) who is living at home alone. I tuned in just before Hackman goes out on a tour of local long-term care facilities to see what might be suitable for this imposing old man.

Hackman parks his car near one of them, gets out with a friend, and CUE THE MUSIC: wailing, discordant, ominous chords punctuated with what sounded like relentless heartbeats. It told the audience, "Get ready for this."

"This" was a tour led by an administrator sporting the curly haired coif favored at the time. As the administrator leads Hackman and his friend around, pointing at this and that, the camera cuts quickly from one resident to another--slumped over in wheelchairs along corridors, staring, drooling, curled up fetus-like in bed, some peering right at you, others focused a thousand miles away. Some perfectly functional-looking elderly women are knitting or playing card games but, never mind, the grinding musical score doesn't spare them either. Hackman, needless to say, looks grim.

A visit to a second facility is more of the same. Finally, Hackman gets in his car, sits at the wheel, stares straight ahead, and says, "My God." And his friend says words to the effect that those facilities were among the better ones.

What amazes me is that 36 years later, scenes like these still linger. I'm sure that visuals like these and the experiences that reflect them underlie the fervent plea still heard commonly, "Whatever you do, do not put me in a home!" or the heartfelt promise, "Mom/Dad, I would never do that to you."

Scenes like these are the reason for a magazine like Nursing Homes/Long Term Care Management. We try to show readers that there's a better way. And from what I've seen on my own facility tours and in ten years' worth of OPTIMA Award entries, many facilities are taking that path. Every so often, though, I get a reality check from an unhappy worker in the field who writes that, from all that he or she can tell, things haven't changed that much.

That can be disheartening. But then something happened recently that recharged my batteries. I attended an Ohio-based conference on culture change sponsored by the state's Quality Improvement Organization (QIO), Ohio KePro. Organizers told me that three weeks before the conference, all of five attendees had signed up (and the organizers weren't sleeping very well). A week before, they had 20. And then, during the last three days before the conference, some 350 nursing home managers and nurses all registered to attend (causing organizers sleepless nights for a different reason). Many of these people would drive hours to the meeting site and back. While there, they sat and listened, in some cases disbelievingly, as presenters told them how resident care, staffing, and activities might be organized to personalize care and make it maximally supportive for residents and staff. One presenter mentioned how he had to take "dings" on his state surveys to get the job done sometimes, but he did it anyway.

The experience of this event showed me that long-term care providers are at least listening. I could only hope that they would return to their facilities, try a few new things, accept the slings and arrows of skeptical surveyors and nervous operators, and move the field to where it belongs in the 21st century. Indeed, QIO success stories published in recent years as part of the federal Nursing Home Quality Initiative have shown that things like this are happening nationwide.

So, perhaps when the redoubtable Mr. Hackman himself comes in need of long-term care some day, he will hear a different tune.

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BY RICHARD L. PECK, EDITOR-IN-CHIEF