My Wife Makes Front-Page News

Cottage-like elder care facilities gaining popularity in Rochester area

[credit: Chris Swingle | Staff writer | Rochester Democrat & Chronicle | July 6, 2009]

Irma Jean Chambers’ dementia has stolen her memory of her birth date, what she did earlier in the day and which of the 12 private bedrooms is hers. But she knows that she likes the unusual new assisted living home in Chili where she now lives.

“It’s very important to keep yourself young, to make you feel you’re still going,” said Chambers, 84.

Staff member Andrea D’Angelo, a music therapist by training, tucks an arm around Chambers and helps her locate the small hair salon in the home that opened in May.

“Oh, I love Andrea,” said Chambers. “She’s a buddy of mine.”

Her home and three others adjacent to it constitute Rochester Presbyterian Home’s Memory Care Residences at Cottage Grove. Located within a complex of single-story townhouses off Buffalo Road, the homes are part of a movement across the country toward smaller, less-institutional settings and more individualized care for seniors who need assistance. Elder care is following the more established trend toward smaller group homes for people with developmental disabilities.

Locally, several other elder care providers also are pursuing this strategy. St. John’s Home expects to be the first in this region to open small nursing homes in a style called “green houses” that, like the assisted living homes at Cottage Grove, take a new approach. Private bedrooms and bathrooms are part of it, but most importantly, residents have more control. They can get up and eat when they choose, instead of getting dressed or receiving a food tray at the convenience of the staff.

Kirkhaven is looking for about 10 acres in the city to build four one-story “cottage” nursing homes divided into 12-bedroom households, to replace its 147-bed building on Alexander Street within the next couple of years.

Similarly, Unity Health System is now replacing its nursing home with four duplex-style, one-story “cottages,” each for 20 elders, plus a fifth one-story building for short-term, transitional care.

The smaller homes have a better caregiver-resident ratio. Instead of separate licensed practical nurses, housekeeping staff and food service workers, universal workers do it all. D’Angelo is one such “shahbaz.” She cooks, cleans, sings and tries to encourage interests and skills of each of the five residents who’ve moved in so far.

“It’s like this is a family,” said D’Angelo, 27, of Irondequoit.

As the public discovers and demands these settings and lifestyles, they’ll likely spur the construction trend. Baby boomers are now selecting or looking into care settings for their aging parents and are less likely to tolerate shared bedrooms and showers down the hall.

The movement is also prodded by recognition that people treated like parts on an assembly line fail to thrive.

“People have those needs — feeling they belong, theyare connected to people, they are loved,” said Nancy Smyth, executive director of Rochester Presbyterian Home.

But not everyone who could benefit from assisted living can afford the price — $4,500 a month at Cottage Grove — and assisted living care isn’t covered by health insurance. Cottage Grove is pricier than assisted living care at the 102-bed Rochester Presbyterian Home on Thurston Road, but about half the cost of a month’s nursing home stay.

By contrast, the rates at small nursing homes tend to be the same as at larger nursing homes. Most nursing home residents end up on taxpayer-funded
Medicaid — which won’t pay more for a smaller setting with private bedrooms.

Rochester became a national center of nursing home reform ideas in 1997 when people from around the country met here to talk about transforming elder care. The Pioneer Network was formed to promote person-directed, less-institutional care. Fairport Baptist Homes led the way in the mid-1990s, said Rose Marie Fagan, a co-founder of the network. But progress since then has been slow in this region.

Rochester Presbyterian Home and St. John’s Home, which has a 475-bed nursing home on Highland Avenue, are registered with the Texas-based Eden Alternative nursing home reform effort. Each has made improvements to care within its multistory buildings but also decided to branch out and build smaller homes where care can be more individualized.

St. John’s plans to build 20 green house homes, each for 10 seniors, across the area over the next five to seven years. Once people move out to the new homes, St. John’s plans to renovate its existing campus into 20-some multistory green house homes.

The state and Henrietta have approved St. John’s first two green houses, to be built side by side on Jefferson Road at Edgewood Avenue. St. John’s officials are still meeting with the federal Centers for Medicaid & Medicare for approval, and then can seek federal Housing and Urban Development financing.

Spreading the green houses among single-family homes is unusual, which is prompting extra scrutiny, but could well become a national model, said Charlie Runyon, president of St. John’s.

The reason there aren’t more small elder care homes yet is due both to construction costs and to the ordeal of changing the internal culture so that the new model works.

Unity Health System first planned to build eight green houses, each with 10 private bedrooms, to replace the 1972 nursing home attached to Unity Hospital in Greece. But leaders doubled the size of each building plan, eliminating extra kitchens and saving several million dollars, to afford the mortgage, said Sandra MacWilliam, Unity’s executive vice president of aging and rehabilitation services. The $23
million project is expected to open in March.

Culture change takes time. Runyon provided three-day Eden training to more than 170 of St. John’s roughly 900 employees over the past six years and added amenities to retain staff.

“How you treat your staff is how they treat your elders,” said Runyon, quoting the golden rule of Eden.

Cottage Grove administrator Cathy Allen, a registered nurse who lives in Honeoye Falls, appreciates the close relationships that can form between staff and residents. Allen recently took Chambers to buy prizes for games. On the short trip, Chambers repeatedly asked Allen how she had slept and how her day had been, and Allen said she answered cheerfully, again and again. Then at one point Chambers said,

“I like being with you.”

Nancy Tonucci, 63, of Pittsford, one of Chambers’ daughters, appreciates the respectful care.

“There is such a feeling of dignity,” she said. “We have just been thrilled.”

Her mother, a widow since 2003, suffered ministrokes and first moved to the four-story Rochester Presbyterian Home. That setting was fine, said Tonucci, but the smaller Cottage Grove home suits her mother better.

During a recent Name That Tune game, D’Angelo brought out smiles as she moved around the room, singing along to Fred Astaire.

Her words captured the goal of providing dignity and love even as aging causes losses: “Oh no, they can’t take that away from me.”