A Quiet Revolution

Quietly, a revolution in long-term care has been occurring here in New York City.

During the decade just ended, care providers once solely identified by their nursing homes have redirected resources to create greater access to home and community-based alternatives.

This doesn’t mean that skilled nursing facilities have, or will, cease to exist, but it does mean that the nursing home most all of you remember is fast becoming a thing of the past.  It also means, that as you age and need services, there is a far greater chance that what you require will be available in ways that will allow you to remain living in the community, sustaining and nurturing your continued independence.

Many services have been created here in the metropolitan area over the past ten years, with the help of the New York State Department of Health and the state Legislature, that have been designed to forestall nursing home placement or, even, to eliminate it completely.

This revolution can trace its roots to the mid-1990s and earlier, when aging consumers started to demand care that would allow them to choose where they would live and allow them to determine the way the services they need are delivered.  People also wanted quality services.

Many responses sprung up across the nation – the Eden Alternative and the Pioneer Network, for example, which envision long-term care not in an institutional setting but in more integrated and appropriate home-like settings – as well as a movement called “culture change” that places the individual at the center of care with his or her needs and desires the paramount concern.  Culture change, which is practiced now at Village Care’s Village Nursing Home, turns the “old way” on its head and has staff and caregivers working in non-traditional ways.

Many new community services for those who once could have found care only in a nursing home have sprung up throughout the metropolitan area – adult day health centers, PACE (Program of All-Inclusive Care for the Elderly), Medicaid Assisted Living Programs, Long-Term Home Health Care Programs as well as expansive home care networks, and short-stay rehabilitation.

Any of you who have had to seek out services at Village Care during the first decade of this century have no doubt discovered the many alternatives that have been created to help those in our own community.  You’d be surprised to know, I’m sure, that the majority of those who enter the nursing home now are discharged back home, or to some other community setting such as assisted living.

Nursing homes have ceased to be the last stop for someone whose decline in health or increasing frailty once left them with no alternative.  Instead, skilled nursing facilities for many are places where individuals can go to recover from a bout of intermittent or progressive frailty and be helped to better health and well-being so they can return to a life at home, in familiar surroundings.

In 2006, New York State authorized Village Care to launch a long-term care demonstration effort, which we called “SeniorChoices.”  Our goals were to show that institutional capacity can be reduced by increasing home- and community-based services, and that nursing home dependence and use can actually be reduced through innovative efforts.

In the three years of this demonstration program, Village Care successfully reconfigured much of its residential system, doubling the number of short-stay beds in the nursing home to 80 while adding in the community 125 Long-Term Home Health Care Program “slots” and opening a Medicaid Assisted Living Program that can serve 80 individuals.

In the nursing home, through an enhanced therapy program and with the use of electronic medical records, we’ve achieved amazing results in getting people in rehabilitation to recover better and faster.  Over three years, the average length of stay dropped from 44 days to 30 days.  People are getting home faster…and better.

By rebalancing our resources and directing them away from long-stay institutional care in favor of home- and community-based care, Village Care has also been able to serve more people – at virtually the same overall cost.  In the first year of the demonstration, our long-term care programs for older adults served 956 individuals.  Three years later that had increased to 1,396.

What’s next?

That comes later this year with the opening of the new Village Care Rehabilitation and Nursing Center.  This modern, state-of-the-art, 105-bed facility will focus on short-stay care and services, with space set aside for those who have longer-stay needs.

The Center is now under construction on West Houston Street and will open this coming fall.

That’s a story for another day, however.