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Nursing Homes – Developing a “Household” Model

Published on Aug 8, 2014 at 8:01 am in Nursing Home Abuse.

It’s no secret that most nursing homes are designed like institutions. Long hallways with residents lined up in a row; their meals, exercise, and everyday life is planned according to one fixed schedule.

The July Issue of Atlantic Magazine features a new type of nursing home, called the “household model.”  With the current model, you have long wings where rooms are, and then one giant eating area and one entry/main room that could rarely be described as “homey”.

The new idea is to cluster residents around a common living room and eating area. This would be smaller groups, ranging from four people in a unit the size of a small house, or larger groups of about 20, in what’s called a “household group.”

The Household Model has been around since 1984.

LaVrene Norton’s consulting firm has designed hundreds of these household models since 1984. She calls the approach “person-centered care.” This means that the residents consider the facility a home, and conduct their day as if they were in their home. The staff — nurses and caretakers — are there to help residents by administering medicine, helping with bathing, etc., when they need help.

The approach is to be less institutional, and allow for more flexibility and more personal decision making. Norton expects this model, replicating more authentic home-style living, to be the future. As baby boomers age, more will expect a higher quality of life than most current nursing homes provide.

Norton acknowledges that much of the current problem is in the physical layout of nursing homes. Their institutional style give staff who may want to try to provide more personalized care very little flexibility.

Staff Cross-Train to be More Versatile

Since the household model relies on few staff, it becomes necessary for staff to perform multiple roles. Norton says the idea of a “universal worker” does make current staff a bit resistant. She rephrases it as a “versatile worker” which means that everyone is expected to learn some other function. Everyone doesn’t have to train to become a Certified Nursing Assistant, but everyone will be expected to cross-train in something, to become a more versatile worker.

In the institutional model, staff are split up by function – housekeeping, nursing, and cooking. This old staffing approach is also dictated by the design of the building. The household physical design and the versatile worker model could discourage staff from ignoring problems they see but that aren’t in their job duties. Ideally, it would encourage staff to treat the resident as a whole person.