In the Clyde Edgerton novel "Lunch at the Piccadilly," L. Ray, a mover and shaker resident of a nursing home, proposes “a worldwide movement that will work to make churches and nursing homes interchangeable.”

“Big stuff,” he tells his hallway conversation group.

“Think about it: why should Christians, or anybody else, go to church on Sunday morning when they can go down the street to a nursing home and visit and gladden these wrecks of old women lining the grim halls of nursing homes?”

The story, humorous as it is, speaks to the urgent need for a culture change in nursing homes. With a focus on safety and health, somehow the patient’s satisfaction and quality of life get little attention, even in the higher rated facilities.

That pig in the python, the Baby Boom generation, is reaching senior status rapidly. According to AARP, half of us over 65 will need long-term care. One would hope that this cohort, most of whom have led more comfortable lives than our parents or grandparents, will not stand for nursing homes as they are now constructed and maintained.

“Eldercare in our country is a patchwork of housing and health services that includes short-term rehabilitation facilities, intermediate and skilled care, assisted living, home health services, continuing care retirement communities,” said Beth Baker in "Old Age in a New Age."

“Nursing homes are the most intractable and dreaded of these places,” she concludes.

We need profound, visionary change. The financial cost of long-term care is breaking our health care system. That issue is in the news front and center. But what about the quality of life for residents?

“A culture change needs to include a change in the power structure in nursing homes,” according to Susan Eddy of Chestertown, a board member of Voices for Long-Term Quality Care. “Staff should be employees of the residents, with residents involved in decision-making such as the time to get up, the time to eat, etc.”

She cites the Green House Residences in Baltimore and other cities, which are residence-centered homes for those needing nursing care.

The Greenhouse Project is described as a “de-institutionalization effort designed to restore individuals to a home in the community ... with a full-range of personal care and clinical services.” Staff and residents develop close relationships.

The Pioneer Network is another leader in innovative thinking, with a goal “to move eldercare to a place where all care and support are person-directed, not system-directed.”

L. Ray would approve.

Federal ratings of individual nursing home locations updated monthly can be found at www.medicare.gov/nursinghomecompare/search.html.

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For low income seniors who participate in the WIC Program, be sure to get coupon booklets that will double in value when you shop at the Chestertown Farmers Market. They are available at the Amy Lynn Ferris Adult Activity Center, 200 Schauber Road, Chestertown.

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