Nursing homes across Central Massachusetts from Gardner to Milford are making a more
concerted effort than ever to put power in ‘the hands of the people:’ the residents they serve.

It is not an easy task, revolutionizing a system that is seemingly as set in its ways as a mule that refuses to budge. Nurse Karen Brennan of Beaumont Rehabilitation & Skilled Nursing Center in Westborough says the initiative will take years; "it's like turning a large ship in a small harbor," she says, of the adjustment from a hospital-like environment to a more open-minded, less-restrictive setting.

The groundswell of support for the push for culture change reached a zenith of sorts this past September when more than five hundred nursing-facility providers, state and federal surveyors, consumer advocates and others joined forces at the Worcester Hotel & Conference Center on Lincoln Street in Worcester for a day-long conference dedicated to discussions of the mission. The event—called "Quality, Culture and Caring: Envisioning the Possibilities"—was sponsored by the Massachusetts Culture Change Coalition (MCCC). Susan Misiorski delivered the main address.

Misiorski is a nationally recognized speaker and the former president of the Pioneer Network, the umbrella organization for the culture-change movement.

The gathering, which packed various rooms in the Worcester Hotel & Conference Center to overflowing, also served as a kickoff for the MCCC—an alliance of agencies, facilities, consumers and others who are playing a lead role in what amounts to a reinventing of the wheel.

All involved agree that while culture change is a daunting challenge, there is tremendous enthusiasm for it. Beaumont's Brennan, for instance, says, "there is a lot of energy in the state to move in the direction of culture change." Brennan says that at the Salmon Family of Services' four facilities (in Northbridge, Westborough, Northborough and Natick), "we are putting a lot of time and money into training" to effect culture change. "It's not as hard for us as a company to accomplish this in comparison to a standard nursing home because we have the assisted-living component already," Brennan said.

Dennis Lopata, administrator at the LaChance Center in Gardner (a 120-bed facility), said culture change is on many administrators' minds. He describes the initiative as "getting back to basics in addressing residents' needs and wants and in providing a home-like atmosphere as opposed to an institutional approach."

Lopata said it is "early on" in the LaChance Center's transition; he has found "interesting," he said, some of the things William J. "Bill" Graves, president and administrator of the St. Camillus Health Center in Whitinsville, has done as a pioneer in the cause. "Especially," he says, in the way St. Camillus is handling death and dying by pausing and "looking at this person's life as something meaningful."

"We're all accepting of the fact that the status quo isn't acceptable," Lopata said. Based on the number of people who attended the conference in Worcester in September, he said, there can be no doubt that culture change is going to be pushed. "Having DPH (the Department of Public Health) at the conference was huge," Lopata said. DPH, he said, is accepting of culture change "within the confines of the regulations" under which the industry operates.

During an interview at St. Camillus, Bill Graves said culture change there and elsewhere is happening "very gradually." It's all about changing "philosophies" and "attitudes," he says. The "baseline" at St. Camillus, he says, is having CNAs take care of the same small group of people every day so they come to know these people, and their habits, better than ever.

Meal time has already undergone a big facelift at St. Camillus, Graves said. "Before, meals were delivered on trucks and trays in assembly-like fashion. Now, residents see their food and they have choices including beverages, and our people in the kitchen are on the floor to observe what people are eating and knowing their preferences. Now, CNAs are making decisions every day."

"Our residents are empowered more than they were," Sheila Gray, a CNA at St. Camillus, said.

"When you think about it, we're doing a complete 180 in terms of practice," Graves says. "We're telling CNAs, `what we've told you for the past fifteen years is wrong.'"

A positive byproduct of culture change at St. Camillus, Graves said, is, “turnover in the last two years has been cut in half.”

“We literally bond with these residents,” Gray said. “There’s more time to give personal attention. I can’t imagine how we did it before. I’m just glad I’m one of the pioneers.”

Beth Nobles, a CNA at St. Camillus, said, “I think residents feel more stable and more open with you.”

When he first addressed culture change to a large crowd at St. Camillus in April of 2004, Graves said, “I got up in front of everyone and almost to a person people in the room said, `this isn’t going to work.’” But it is!

“Five years from now, if a nursing home isn’t running the way we do now, they won’t be in business,” Graves said.

Culture change is in full swing too at the family-owned and operated Blaire House in Milford, a 73-bed skilled nursing and rehabilitation center with a companion adult day health program, says Executive House Executive Director Martha Mancuso.

Typically, Mancuso said, nursing homes have been created on a “medical model,” like a hospital. “The whole idea now,” she says, is to “make them more home-like.” This involves radical change in some instances, she said, because the building involved isn’t always accommodating. Blaire House is such a building.

Initially, “several of us went to workshops and came back and tried to engage the staff” about culture change, Mancuso said. The staff’s response, she said, has been “very good. They’re very willing and very positive.”

One reflection of the small but significant strides Blaire House has made came when “we took a resident to vote,” Mancuso said. “She wouldn’t sign the absentee ballot for anything so we took her out to vote. She shouted to the rooftops about it!” This same resident was one “we got resistance from in the beginning,” Mancuso said. “She’d say, `I want to go home, I don’t want to eat this.’ Now there’s less rigidity, less turmoil. She’s more relaxed.

“It’s an exciting time in the industry,” Mancuso said. “I have been in the field since 1984 and this is the best thing I’ve seen happen for residents.”

Blaire House has also introduced what it calls “the Blaire House Bistro;” about once a month, six to eight residents get to sit down for a leisurely afternoon meal in the conference room—complete with linens, music and fine china. And there’s no rush.

On December 6th, Nick Hadges, Blaire House’s food service director, prepared just such a meal: salad, a variety of drinks, chicken parmesan (by election) and strawberry shortcake.

“Look at the size!” (of the entree), one resident exclaimed.

The delightful spread got participants talking about their own favorite recipes and meals. “Everyone loved my meatballs,” Stella Stoico said. Saturday nights was for “frankfurters and beans,” Isabelle Thayer said. Olga Pettinelli relishes chicken soup. “Every meal we have, I ask, `do we have chicken soup?’” she said.