Home away from home

Residents warm up to nursing centers

By DAVID RYAN, Register Staff Writer

Opal Daniels knows the end is coming sometime soon. Her ailing kidneys, she says, make her heart problems seem tame by comparison.

But the 83-year-old woman is determined to wait patiently at what has become the place that makes her life simple and relaxing in her last days -- a nursing home.

On a sun-soaked summer afternoon when most of the city is baking in the heat, Daniels is on a bench outside on the cool shade-covered front porch of Napa Nursing Center on Villa Lane, sampling the breeze. It's a welcome respite from past days of living with her sickness on her own.

"I was so tired at home, by the time I cooked my meals I was too tired to eat them," she said.

Nursing homes are often looked at with suspicion or dread, seen as places where ungrateful children warehouse elders. Yet many residents like life at local homes, and depending on each nursing home's specialty, many of them might stay only until they recover from injuries or recent surgery.

More than 70 percent of the statewide population of nursing homes meets that criteria, according to the Office of Statewide Health Planning and Development, which last compiled trends in 2001.

Care at nursing homes remains a controversial issue, with some homes like Pleasant Care Napa giving a black eye to the industry.

Elder advocacy groups push for more and closer regulation of the industry to fix problems, while nursing home trade organizations point to low Medicaid reimbursement rates and a state shortage of nurses as two of the main culprits behind some difficulties.

Another issue advocates focus on is among the most commonly cited measures of nursing home quality: The amount of time staff spend with each resident every day.

According to The Centers for Medicare & Medicaid Services, almost all the nursing homes the Register studied beat out state and national averages for the amount of time staff spend with their residents. But state and national averages fall below the three hours and 12 minutes per day mandated by California law.

The national average for time nursing home staff spend with residents is just over two hours. In California, it is about three hours.

Calistoga Healthcare Center, formerly Sunbridge, lagged on time low-level staffers spent with their residents, but had better-trained nurses spend more than twice the amount of time with residents than other local homes, according to CMS. Two other homes, Meadows of Napa Valley and Sierra Vista Center also fell just shy of state mandates.

Yet the Napa County Long-term Care Ombudsman Program, which often keeps a closer eye on nursing homes than government regulators, says that most of the homes in Napa have strong track records.

In particular, the Ombudsman's office credits Napa Nursing for turning itself around in recent years. Napa Nursing was once cited by state inspectors for serious problems like fouling up the medication of a dementia-addled man and restraining a wheelchair-bound woman against her will.

More recent inspections reveal the home has had only minor problems since 2002, and residents like Daniels and her 52-year-old physically disabled son, Bob, give it high marks for things that matter the most to them.

"The peace and contentment I have, the safety I feel," Opal said. "It takes all the worry away from me."

Here at the home she has her meals cooked for her, her medication monitored, her room cleaned, her laundry done, all the little chores that used to sap what energy she had. Here there is time for relaxation, her beloved bingo and watching Bob dance in his wheelchair when the singing doctor comes to the home. With all the other residents around her to chat with, she counts no more lonely days.

"We're all like family," Opal said.

Like Opal and Bob, some homes are a mix of elders and not-so elders. State figures from 1992-2001 show that 5 percent of nursing home residents are less than 45 years of age.

Bob arrived at the nursing home under different circumstances than Opal. After being hit by a car in 1980, Bob has had difficulty taking care of himself and over the years he's come to accept being wheelchair-bound.

He's also come to accept having to be in a nursing home.

"One of the best things I can do is be here," he said. "I can't be by myself."

So how did Napa Nursing Center go from being fined for two serious violations in 2002 to the place Opal and Bob value? A renewed commitment to quality at the 127-bed facility, employees say.

"Internally, it got to the point where everyone understood it was not where it should be," Chris Cousins, assistant director of nursing, said, adding there is a new attitude employees share: "It's not just a paycheck anymore."

Georgia Otterson, Napa Nursing administrator since late 2003, said those aren't just words.

"It becomes a vocation," she said. "You don't do this sort of work unless you feel it's a calling."

Walking in the lobby, one of the first things a visitor might notice is Cheyenne, the home's amiable golden retriever. She's part of a group of animals found in the lobby, including caged birds and the fish in an aquarium. Cheyenne roams the nursing home, looking for love from residents sitting together in the halls or in their rooms.

When someone passes away, the staff holds a vigil for the dead -- often with a cleric -- where the residents' family members can join in. It's more than an opportunity for family members to grieve. Employees say they need it because staff members become close to the residents they work with the most, depending on their job.

"We are truly our own little town," Otterson said.

By law, each home has to have some sort of activity calendar to keep its residents entertained, safe, cared for and monitored. Yet some local homes go farther than that. For example, Piner's Nursing Home also houses birds to make residents feel more comfortable and has a friendly dog that roves the rooms to provide easy companionship. Piner's specializes in long-term care and can boast that some of its residents have lived there for several years.

Piner's follows a similar philosophy to Napa Nursing, but Piner's, which was not fined by the state for any violations in the last five years, also ascribes to a voluntary program called the Eden Alternative. That's a program where nursing homes seek to use animals and the nursing home environment to combat loneliness, boredom and feelings of helplessness.

The philosophy was developed by New York Dr. Bill Thomas in the early 1990s. His idea was to use every day comforts like special foods, traditions, plants, animals, children and caregiver compassion to ward off institutional doldrums.

While there is no uniform way to be an Eden Alternative nursing home, Eden spokeswoman Carol Ende identified an essential component -- visionary management.

"If the manager does not have the vision to change the home, then it will not happen," she said.

Since the Eden Alternative was developed, other philosophies have branched out from it, including the greenhouse model, which replaces the physical facility of the nursing home with individual houses. Doctors and nursing aides are "visitors," rather than employees roaming the halls.

"The medicine cabinet does not dominate your home," Ende said. "No matter how sick you are the medicine cabinet does not dominate your home. The quality of life is what dominates your home."

Napa Valley Register Copyright © 2009