Consumer Demand Encouraged Care Reform

Consumer Demand Encouraged Care Reform

One of the remarkable changes that’s taken place in recent years has been the transformation of the role of the nursing home.

At the top of the list of contributory factors to this shift have been consumer/patient demands for a different type of long-term care system in this country.

That movement goes back more than two decades now, but it was taken to heart by consumers in the mid-1990s.  It was, in a way, a rebellion against our reliance in the U.S. on institutional settings for those older adults facing intermittent and progressive frailty.

There was common complaint among these older adults:  Why do we have to go into a nursing home?  Isn’t there something else you can do for us?

In truth, initially at least, there really wasn’t.

Oh how that has changed.

Long-term care providers began to reinvent how they delivered services.  They were encouraged by the demands of patients, by provisions of the U.S. Supreme Court’s Olmstead Decision, by consumer advocates and groups that created models of care redefining what life in a congregate setting could look like, and by enlightened state governments that created mechanisms to use resources more flexibly to fashion alternatives to nursing home care.

What has that meant for people in New York City looking for services for a chronic condition or disability?  A lot.

Just take a look at what’s happened at VillageCare, a long-term care provider headquartered in the West Village.  Our organization’s founding stems from the creation of the not-for-profit Village Nursing Home on Hudson Street more than 30 years ago.  Residential skilled nursing home care for older adults was all we did in the 1970s and for much of the 1980s, until we began development of community-based AIDS care.

Today, nursing home care is only one part of what VillageCare offers in its range of geriatric care services.  Care in the nursing home now accounts for only about one-fifth of the number of people each year who are served in senior care programs that include assisted living, a variety of home care options, a primary care center, an adult day health center program, a Neighborhood Naturally Occurring Residential Community program and more.

There’s been a dramatic shift in the way Village Nursing Home has functioned, too, starting with the opening of a short-term rehabilitation unit back in 1996.  Back then, most admissions to the nursing home were for long stays, and most often were permanent moves.  Nowadays, most people aren’t going to the nursing home to stay.  They’re going there to get better, and to go back home.  Of more than 1,000 annual admissions to Village Nursing Home, the vast majority – some 90 percent – are to the short-stay program.

As for long-term stays in a nursing home?  Many who once would have had as their only option a nursing home admission, now have choices that enable them to stay at home, or live in another less-restrictive community.  VillageCare helped explore reshaping of care with a three-year SeniorChoices Long-Term Care Demonstration Program with New York State.  The Demo, one of only two in the state, was completed last year.

VillageCare isn’t alone in pursuing change, although we have worked hard at being on the leading edge of what some call “long-term care reform” here in New York.  Other care providers are also pursuing similar endeavors in Manhattan and the other boroughs.

For example, look to our neighbor to the north, Isabella Geriatric Center, which serves the upper West Side and its environs.  The CEO there, Mark Kator, was VillageCare’s chief operating officer during the era when we started internally thinking about the ways we could reconfigure senior care services, and he was an active participant and contributor to those discussions.  At Isabella, Mark has pursued establishment of many of the same types of community opportunities that we’ve done at VillageCare.

Our society in general has recognized that there are better ways to provide care for older adults with frailties and disabilities in an environment other than the traditional nursing home.   The demonstration program presented us with a tremendous opportunity, including setting out to reinvent the nursing home concept.

Last month, I briefly talked about the coming opening this fall of the new VillageCare Rehabilitation and Nursing Center at 214 W. Houston St.

The Center is the first newly constructed, geriatric skilled nursing facility in Manhattan in half a century, but it serves a purpose that is far away from that of the old Village Nursing Home of the 1970s.  It is not an end-point in life, but will be a place from which most patients will return home after rehabilitation and recovery.

VillageCare’s reconfigured services, offering many community choices, are what you will see more and more of throughout New York and elsewhere.

We foresee that much of nursing home capacity will be for patients who are transitioning from acute care to home.

While there will remain a need to provide end-of-life and palliative care – and the new Nursing Center will have a capacity to do that – the overwhelming goal of what VillageCare and other providers are pursuing is to give frail individuals every opportunity to continue to live at home, or in some other independent or supportive setting.

VillageCare is proud to be able to offer the residents of our community a new facility that takes into account today’s latest care expertise, as well as providing the appropriate array of at-home and other community services for those needing long-term care.