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KEARSLEY Our Nation's First Retirement Community Keeps Growing.

Kearsley's mission of providing quality care to low-income older adults has been its inspiration for 228 years. Now it's providing 21st-century care.

It started in the 18th century with Dr. John Kearsley, who envisioned a place that would provide housing and healthcare for widowed members of his church. Upon his death in 1772, as specified in his will, Christ church of Philadelphia accepted a large part of Dr. Kearsley's estate and established the first retirement community in the pre-revoulation United States. More than two centuries later, his legacy of caring lives on at Kearsley, an independent, nonprofit, senior care facility that provides a continuum of care for lower income adults.

The core of Kearsley's mission is taken directly from Dr. Kearsley's will: "[Part of the estate is] for the purchasing of a piece or lot of land and then building there-more poor or distressed women of the communion of the Church of England." These pensioners, as they were called, had few other choices.

Christ Church Hospital (the word "hospital" originally conveyed "hospitality") officially opened in April 1778 upon Dr. Kearsley's wife's death, when the rest of his three poor women under its Philadelphia roof: Sarah Kidman, Susanna Hacket and Elizabeth Frazer. Although it was originally intended to house no more than 10 women at a time, larger quarters were eventually developed. It soon evolved into 24 rooms to accommodate 40 residents.

In 1856, the decision was made to move, and new architectural plans were drafted. The goal: "To erect a building of substancial character capable of accommoding one hundred inmates...In order to avoid the sources of discord that had occasionally arisen in the old hospital, each should have a separate apartment." This would become kearsley's dramatic and stately main stone building, which serves as a backdrop for Kearsley's 13 acres and still houses many of its independent living residents today. The structure was originally lit by acetylene gas, boasted indoor plumbing and was built of fire-resistant material, including more than one million bricks.

Kearsley's history is inextricably entwined with America's history. For example, despite the devastation of the Civil War, the main stone building was completed in September 1861--two months after the Battle of Bull Run. As World Wan raged in Europe, Kearsley's residents knitted and rolled bandages to do their part to help ease the suffering of our soldiers abroad. In 1961, the year of the first U.S. manned space flight, Kearsley reached its own important milestone with the completion of its nursing home. In 1981, the same year Sandra Day O'Connor became the firstwoman on the U.S. Supreme Court, Kearsley added a new building featuring modern independent living apartments.

In the 21st century, history is being made again by the unprecedented growth of the older adult population. Kearsley's response to this trend is the Continuum of Care expansion project, which was officially completed in March 1996 and was designed to bridge the gap between housing for independent living and nursing home care. The Continuum added a new 84-bed nursing home and 60 personal care (assisted living) apartments, including a hallway of shops and services called "The Gallery," a new front desk and reception area, and a spectacular dining room.

Recently, Nursing Homes/Long Term Care Management asked Valerie Deorio, public relations coordinator at Kearsley, to describe the evolution of its continuum of care, as Kearsley enters its fourth century of operation. Assistant Editor Nancy Pine posed the questions.

A continuum of care is a concept that many long-term care facilities are embracing. At Kearsley, what independent living, assisted living and nursing home services are offered today?

Deorio: For independent living we have 87 studio and one-bedroom apartments. Services include transportation for shopping and other activities; onsite medical care; an extensive social network and schedule of events (e.g., concerts by highly regarded professional performers such as the Philadelphia Concerto Soloists); religious services; and a meal plan. Meals are not included in the monthly fees, but there's an extremely affordable meal plan for independent living residents who want to enjoy their meals in Kearsley's dining room.

For assisted living we have new private studio apartments that have full bathrooms and kitchenettes. Residents get assistance with activities of daily living, such as administering medications, dressing, bathing--whatever is needed to help them in their own individual situations. And, of course, there's 24-hour-a-daypersonal assistance provided by certified nursing assistants. All meals are included, as with the nursing home.

Our nursing home is a skilled nursing facility that is certified by Medicare and Medicaid. Our medical directors and medical staff are from one of the best hospitals in the country, Thomas Jefferson University Hospital. Activities include everything from gardening to assisting residents in registering to vote.

What was the driving force behind Kearsley's Continuum of Care expansion project?

Deorio: There's a lot of history at Kearsley and we saw, as the next step in its progression, the establishment of a continuum for low- to moderate-income people. In the Philadelphia area, the percentage of seniors who live at or below the poverty level is very high. Yet almost all of the continuum-of-care facilities charge extremely high entrance fees and monthly fees. Where are these people who can't afford it going to go?

Kearsley was the first to offer a continuum of care for lower-income adults, and many residents pay what they can afford. How is this made possible?

Deorio: The nursing home fees are usually paid by Medicare, Medicaid or private insurance. For independent living and personal care, there is a maximum income requirement--not assets or what's in the bank, but what the potential resident's annual income is. It varies for independent living and personal care and operates on a sliding scale based on monthly income. We don't want residents to pay more than 30% of their income for rent. It's mostly made possible through funds from a variety of sources, such as the Department of Housing and Urban Development, Community Development Block Grants and money brought in by our development department.

How costly was the expansion and how, specifically, was it funded?

Deorio: It cost $15.4 million. The funding, as I mentioned, was a patchwork of different public and private sources, but there were a couple of key ones. First of all, there were some generous gifts and pledges to our capital campaign, called the "Campaign for Kearsley Care." These donations came from individuals, foundations, corporations and organizations in the Philadelphia area and throughout the country. We also received a Community Development Block Grant through the Philadelphia office of Housing and Community Development. Additionally, we received funding and were awarded a low-income housing tax credit from the Pennsylvania Housing and Finance Agency. We also were given a Neighborhood Development Fund Loan from the Philadelphia Industrial Development Corporation, and we received a tax-exempt bond issue.

Long-term care administrators often express difficulties with high staff turnover. How has Kearsley risen to this challenge, especially in light of the recent expansion?

Deorio: We offer extremely competitive pay and benefits. We also try to capitalize as much as possible on our reputation, our mission and our standards for quality care. We feel it is important to recognize and appreciate the good work people do and not let it go unnoticed. We give our staff an orientation that allows them to really become a part of our mission. They feel that they're connected to something important and know that their overall contribution is part of our history, which is more than 200 years old.

Of course, there's still going to be turnover. It's a matter of taking staffing seriously and making adequate staffing a top priority. Our human resources coordinator and nursing director are very committed to having the CNAs and nursing staff that we need in the facility and trained as quickly as possible.

In addition to first-rate medical care, what do you see as the key components of high-quality eldercare?

Deorio: Again, it is the commitment to staff orientation and training. Staff members are with the residents daily--not just the CNAs, but the activities people, maintenance people, etc. Kearsley is the residents' home. It's not just a place where they receive medical care, so it's really important to create a home environment.

Also, high-quality care is really individual to each resident, depending upon what they need and how they feel. So it's really about taking the time to understand each resident as an individual.

How has the recent expansion enabled residents to remain at Kearsley when their independence diminishes?

Deorio: We created the Continuum for that reason. If residents in independent living suffer a serious illness or have to be hospitalized for any reason, when they're released from the hospital they can transfer to our nursing home and still be at Kearsley, or return to their apartments if they're able. Or if someone's independence diminishes, he or she can go from independent living to personal care, surrounded by the same friends and familiar faces. Residents in the nursing home and personal care use the same front door.

It also goes the other way. We have residents who started out in the nursing home and are now in personal care. It's all available as the residents' needs change.

What if residents don't want to move from one level of care or apartment to another?

Deorio: We work hard to make transitions as seamless as possible. The buildings are connected by ramps and hallways. Personal care residents and independent living residents eat in the same main dining room; nursing home residents go there when they're able. They share many of the same common areas with other residents.

When it has been determined that a move is necessary, our approach is to communicate with the resident through our social worker, medical director and the resident's family. We try to explain why this move is the best thing, how it might prevent the resident from suffering an injury and having to go into the nursing home as opposed to personal care, for example. Ultimately, if some-one really doesn't want to do it--if that individual is in independent living and doesn't want to go to personal care--that is his or her decision. But we work with people as best we can to help them make the right decision.

We have many families living at Kearsley. We have married couples in which one spouse is in personal care and the other is in the nursing home, or one's in the nursing home and one's in independent living. We also have a father and daughter who live here in different residences, and a family of four sisters who are in every level of care--two in personal care, one in the nursing home and one in independent living. They enjoy the proximity and being able to see each other often. In that sense we feel that the Continuum of Care has worked.

What are Kearsley's plans for the next century?

Deorio: Our plans are to continue to perfect the Continuum of Care and provide the highest-quality services. We also see as part of our mission trying to get other organizations to provide this kind of continuum of care. On a limited scale, we plan to offer our advice and expertise on how to do this for low-income older adults and obtaining the necessary funding. Hopefully, we can be real advocates and consultants for getting other facilities like Kearsley established throughout the country.

Valerie Deorio is public relations coordinator, Kearsley, Philadelphia, Penn., and has been with Kearsley for four years.
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Publication:Nursing Homes
Geographic Code:1USA
Date:May 1, 2000
Next Article:One Facility, Two Winning Programs.

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