We all know we will get old but we prefer not to think of the days when we may lose our independence and quite possibly our good health. The nursing home concept has been around for a half century and it will only get bigger with double the number of frail elderly likely to spend some of their golden years in a nursing home.
But does it need to be a place where one fights tooth and nail not to go there? Does it have to be a one way street you go in and don’t come out?
In the late 1980s health care professionals wanted to change that negative image. Observing the success of teaching hospitals, a forward thinking nurse Linda Aiken, wanted to bring that concept to the nursing home, and envisioned the Teaching Nursing Home (TNH). She was interested in the correlation between the development of nurses’ professional role and patient outcomes. Encouraged and funded by the Robert Wood Johnson Foundation with co sponsor the American Academy of Nursing and the U of Pennsylvania as administrator, the program set out to formalize partnerships between academic nursing schools and nearby nursing homes.
11 schools chose 12 nearby nursing homes for a 5 year pilot program. The pilot program had four goals. The first was to raise the quality of geriatric care. The program also aimed to raise interest and awareness of geriatric care in nursing education, because they foresaw the future of health care would be in professionals that understood the process of aging. The third goal was to increase training of staff in nursing homes. The last goal was financial survival after the pilot ended, which did not happen. The initiative encountered challenges along the way and in the end the Foundation decided not to renew the grant. But the apparent lack of success could be attributed in part to the recessionary era in which the pilot was launched, a period of cost cutting in health care where financial viability took precedence over any patient needs.
However, the legacy of the program remains alive in enduring partnerships of schools of nursing and nursing homes. Although the original pilot program did not continue it did serve as a model for a program at Emory University which has 2 TNHs on campus and the Emory Center for Healthy Aging which is known for its innovative approaches to health care for the elderly. In a similar manner Texas University has a TNH facility where certified nursing assistants are trained. At both campuses the on site nursing homes are where students learn and conduct research in an interdisciplinary environment.
Also the pilot program did result in collection of data on issues specific to quality geriatric care. Such challenges as pressure ulcers, incontinence, and use of restraints have all been examined and techniques for evaluating them have been developed. This allows them be addressed in a positive fashion so that care is more compassionate.
For example, more nursing homes are moving towards a restraint free policy, and prevention of falls is a much researched topic. The collection and evaluation of the data on specific elder care issues is invaluable to home health care. The improvement and refinement in evaluation of geriatric care was a direct result of pioneering outcomes measure research in the original TNH outcomes based methodology for quality improvement. The TNH also paved the way for the expanded role of nurse practitioners who provide increased level of care, especially in patient education to manage chronic diseases. High level humane care allows residents to remain in at the home instead experiencing the disruption of going to the hospital.
Perhaps the biggest accomplishment of the pilot program was to challenge the health care profession on the topic of professional preparation in geriatric care. To this end in 2008 nurses convened in a Teaching Nursing Home summit to discuss the TNH pioneering concepts that have paved the way and how that ambitious legacy can be built on today. The summit revisited the nuts and bolts of a productive academic nursing home partnership. The mission and vision were sound in the 1980s but a practical viable paradigm was needed.
If a TNH was to survive and thrive in a community it would need to have a positive image, stable leadership, and be willing to invest in staff development. If successful, a present day TNH could be a better way of establishing geriatric training than present programs. This is important because a greater number of skilled staff are needed in nursing homes today.
The summit emphasized that any academic nursing home partnership must be mutually beneficial in both outcomes and opportunities. There must be clarity in academic goals and research in relation to practice. Academic lessons and research projects must result in better quality care for nursing home residents. Educational institutions and nursing homes are mutually accountable through a reciprocal relationship where staff from each location participate in shared collaborative learning towards the goal. The path to health care quality is achieved by developing evidenced based best practices and interdisciplinary preparation. Best practices should be duplicable and the TNH should promote acquisition of geriatric care knowledge through all care stages involved with the elderly. The TNH should act as an advocate for nursing homes at all policy levels and with educational institutions and communities to bring about optimal preparation of health care professionals. To illustrate that point, if there had been support from policymakers at the state level in the original program, it may have continued longer.
There are today more nursing home beds than hospital beds and that trend isn’t changing anytime soon. The original TNHs were ahead of their time in advocating better geriatric care. It is possible to have therapeutic care in nursing homes and for patients to improve and return to their own home. Nurses want to give true meaning to the term nursing home where there is compassionate care that values the dignity of residents and they can feel it is their home.
- Sources:
http://www.rwjf.org/files/research/anthology2004chapter4.pdf
http://gerontologist.oxfordjournals.org/content/48/1/8.long
http://www.ttuhsc.edu/centers/aging/
http://www.emoryhealthcare.org/elderly-care-center/index.html
&Copy; Young Lion Incorporated 2011. Photo Courtesy of: ulrichkarljoho
