June 10, 2014 // 9:31 AM

A Household Model of Skilled Nursing in Action

Written by Scott Miller

For more than 20 years, Becky Weber and her husband have gone to the same vacation spot.

“We go for the beautiful surroundings, the beach and the temperatures, but we go back because we are treated like family,” says Weber, nursing home administrator at Garden Spot Village. “The first thing the staff say to us when we get there is ‘welcome home.’”

That’s the feeling that Weber and her team strive to achieve for the people who live in the skilled care households at Garden Spot Village and Maple Farm. After all, it is home.

Putting the person first

Growing up, Weber sometimes worked in her family’s flower shop, where the emphasis was on taking care of the customer. When Garden Spot Village transitioned to the person-centered household model of skilled care, Weber and her team shifted away from an institutional model of care toward one that is driven by meeting residents’ needs and preferences. For example, medication schedules are now individualized, based on when the resident wakes up instead of on when the shift changes. Breakfast is made-to-order. Residents have “rights to the refrigerator” around the clock, and they can have parties and gatherings for friends and families.

“Residents can move our furniture out of their rooms and move theirs in,” Weber says. “One thing we do is incorporate residents’ furniture and belongings throughout the household. It really helps people to feel that this space is truly their home.”

The goal is to do whatever it takes to make people feel at home. For folks who have only ever observed the institutional model, the household model can be hard to imagine—except that it’s just like home. Prospective residents and their families ask a lot of “can we” questions.

“After we keep saying ‘yes,’ they stop asking and just start doing,” Weber says.

A Garden Spot Village resident recently spent some time in a rehab hospital, which wouldn’t allow him to see his dog unless they went outside. That wouldn’t have been the case in the households.

“It’s hard for me to believe that there is a good reason for not allowing a dog or a cat to come visit,” Weber says. “A half-hour visit with the dog would have been more therapeutic than a day of therapy. We have really tried to banish the word ‘no’ from our vocabulary.”

All in the family

Throughout Garden Spot Village, hospitality comes from the heart - from relationships. In the households, team members are consistently assigned to the same households and spend quality time with residents and their families. They do projects together. Team members are even encouraged to bring their own family members to visit. Team members and residents get together to decide how to celebrate birthdays and holidays and to talk about other issues that affect the household.

As a result of all this, team members get to know residents—and their preferences—very well. The challenge then becomes to continue to offer choices and not rely on the routine.
For example, it can be tempting “to start making someone their poached eggs before they even get seated in the dining room, because that is what they order every day,” Weber says. She once educated a homemaker who was removing the skin before she served her chicken, because skinless chicken is healthier.

“Granted, I know that it is healthier, but it is not our choice to make for someone else,” Weber says. Each individual is free to enjoy the meal the way he or she prefers.

It seems, then, that the secret to hospitality in the households starts with caring and a strong sense of connection, a dose of humility, a recognition of each person’s uniqueness and a commitment to meet each person’s needs, even as they change day by day. To make a home, the team members do more than provide care, cook meals or clean rooms. They share their lives with the people who live in the households at Garden Spot Village.

For more information on this model of care, please visit:

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Chief Marketing Officer