Are We There Yet?

For any parent embarking on a journey, the most familiar 4 word question often raised from the backseat is- "Are we there yet?"

We get the same question at Seniorsfirst in response to the "Pathways Journey" that we are on at Kirkhaven. So today I'm dedicating my Blog posting to revisiting this journey and providing an update on where we are along our pathway. To follow is a recent magazine article (authored by Amanda Brown, Executive Director and Administrator of Kirkhaven), which revisits the reason and passion for our journey.....................


When I hear someone say, “I hope I never get to the point where I need a nursing home”, it’s pretty obvious that despite our best intentions to provide quality care for seniors, something has gone terribly wrong. In fact, the nursing home industry’s attempts to care for our elders, to provide safety, security and good medical care, have actually eroded their quality of life in many ways. Even with the most caring staff, nursing homes have not been nurturing environments. With its hospital furniture, sterile rooms and endless routines day after day, there is nothing even remotely like “home” about the traditional nursing home.

How did this happen? In the 1960s, Congress passed Medicare/Medicaid legislation to fund the growing need for senior care. Overnight, tens of thousands of seniors became eligible for nursing home assistance. To meet this influx, health care providers turned to what they knew best and built very efficient, cost-effective little hospitals. And we were excellent at providing food and housing and skilled nursing to large numbers of seniors. But five decades later, we can now see the unintended consequences of institutionalizing our seniors. Nursing home life has become associated with boredom, isolation, loneliness, depression and deteriorating health.

Quality of life depends on physical and emotional well being. Replacing the daily rhythms and spontaneity of life with routines and isolating seniors from the mainstream of the community limits the opportunity for meaningful interactions and relationships that are so critical to their well being. And when the caregivers rather than the seniors themselves make life’s daily decisions, we rob our elders of their individuality, their independence and their basic humanity. The traditional nursing home may have succeeded as a business model, but it has failed miserably as a human model.

Thankfully things have begun to change. A grassroots revolution (which began here in Rochester in 1991 as the Pioneer Movement) is quickly gaining ground. Known variously as the Eden Alternative, Green Houses or simply “culture change”, nursing homes across the nation and around the world are embracing the challenge of transferring their medical model facilities into social model homes. At Kirkhaven, we have coined this journey as “Pathways to Meaningful Living”.

The keystone of this culture change in nursing homes is person-centered care. In its effort to maximize efficiency and consistency of care delivery, traditional nursing homes sacrificed individual choice for routines and regimens. Culture change is about breaking down those barriers and empowering the seniors themselves to direct the decisions that affect their daily life.

Our next step in the process at Kirkhaven is to replace our current building with one based on multiple “households” of 12 resident rooms surrounding a common living room, kitchen and dining area. With the assistance of specially trained homemakers, each household will plan their day, eat when and what they choose, share chores and interact throughout the day as housemates. Like any home, these households will reflect the individuality of its residents with distinctive furnishings, pets and their favorite hobbies and activities.

At Kirkhaven, we are daily challenging the mindset of what a nursing home should be. We have taken great strides in shifting from management-centered to person-centered care. Going forward, we will measure our success as care providers by the quality of the life of our residents.


Over the past seven years, we have been on this “Pathways” journey. We are probably further along than many think. In terms of progress, I would bullet our journey as follows:

· Assessment and planning (market analysis, facility appraisal and strategic planning)
· Education and awareness (Eden training, seminars, data research and field trips)
· Evaluation and goal setting (committee/board meetings and project team work)
· Soil warming and training (staff training and education, book club and steering committee)
· Implementation of initial initiatives (tray-less dining, remodeling, household teams and learning circles)
· Preliminary household design
· Site search
· Preliminary project cost analysis

Where do we go from here, I would bullet as follows:

· Locate our site
· Finalize our project design
· Analyze the project costs and sustainability
· Develop the project funding plan
· Implement the construction phase
· Continue the organizational change implementation

This is an exciting and crucial time for long-term care providers. Through one lens, we see a challenging economy and failing health care system that is quickly becoming unsustainable and has a questionable future. Through another lens, we see a next generation of elders who will demand and need something much different and better than the nursing homes of today. Our challenge is to design the next generation of nursing home that is sustainable under both lenses.

The Pathways model is our blend of many innovative and current thinking models pioneering this culture change movement. The beauty is that there is no one perfect scenario or solution, but this is the decade for change. If we wait any longer, we not only let our parents and the next generation of elders down, but we sentence ourselves to the institutional nursing home as well.

They deserve better than they are getting, and it’s time to step forward and get moving before time runs out. At Kirkhaven, we are well along our journey but still have a long way to go. Funding support is a key element in this journey and we are currently working towards securing major grant support. We are also continuing our dialog and planning with potential new sites on which to build upon.

Like Israel's deliverance from Egypt in the book of Exodus from the Bible, we too are on a long journey which we believe is our calling. It won't be a short trip and it won't always be easy. But we will follow our conscience and passion along the pathway that God always provides.

Are we there yet? No, but sit back and enjoy the amazing and enjoyable ride!