In an area where new homes and subdivisions are sprouting up all the time, the expansive houses, some decorated for Halloween with mums, pumpkins and tiny ghosts dangling from tree branches, blend in nicely.
But these homes are quite different from those in the subdivisions around them. Actually, they’re quite different than any in the state. The Avalon neighborhood represents a groundbreaking new step for Otterbein Retirement Living Communities - the first “small house” nursing care model. This model has no nurses’ stations, no long hospital-like corridors, no institutional kitchens and laundry areas and no medicine carts parked in the halls or beeping call lights over the doors.
Avalon houses, which may accommodate up to 10 people for nursing care, were designed with a home-like atmosphere featuring an open central kitchen with a traditional refrigerator, stove and microwave. A long dining table is set for lunch (featuring a menu the house residents voted upon), though eating may have to wait until the card game being played at one end of the table is wrapped up.
Just off the kitchen is a cozy great room with sofas and a fireplace, flanked with windows that offer a view of the patio/garden area and the crisp fall afternoon outside.
Off to each side are five bedrooms with private handicap-accessible baths. Each room is painted a color chosen by the resident. The house also includes a laundry room with a residential washer and dryer, a den, an administrative/office area and a spa/therapy room featuring a hair stylist’s chair and a jetted tub.
Every house is staffed by two certified nursing assistants with advanced training. The community is also staffed with a medical director and licensed nurses. In addition, Avalon residents have access to a dietitian, social worker, speech, physical and occupational therapists as well as a dentist, podiatrist, optometrist and an audiologist.
The focus of the new model is to offer people who need nursing assistance autonomy, dignity and choice, according to President/CEO Don Gilmore. “Having a place to call home is the right of everyone. At Avalon the `small house’ restores this option to people who require nursing assistance. It frees them to continue to live as full a life as possible.”
“It’s all about bringing choice to elders,” said Jill Hreben, senior vice president of strategic management. “It’s offering simple things we take for granted, like waking up when you want to, eating when you want to, doing the things you want to do.
“Traditional nursing homes have to have a more rigid schedule because of the nature of being large,” she said.
There have been many changes in the delivery of elder care since Otterbein began serving older adults some 95 years ago, Hreben said. “We started out as what they used to call back then an orphanage and an old-folks home, which was actually fairly common.
“When changes came in child care in the `60s and `70s, we came to realize that caring for children in large institutional settings was not in their best interest and the movement advanced toward group homes and foster care for them,” she said. Otterbein, which is United Methodist affiliated, continued its older-adult ministry and now has six locations, including Portage Valley in Pemberville and Northshore in Lakeside.
Advances in the medical field that have allowed people to live longer and physically healthier lives have created the need for different levels of nursing and assistive care for elders.
“We’re a retirement community and here at Portage Valley we offer skilled nursing care, assisted living, apartments that offer supportive services and patio homes - ranch-style condos which also have supported services available. Some people use the services, some don’t to different degrees,” Hreben said.
Adapting to the growing and changing needs for older adult care led to the development of the new Avalon neighborhood, she said.
“Baby Boomers have changed everything every step of the way,” Hreben said. “They have never settled for anything that their parents have. They’ve sort of quietly started this movement of wanting to transform or change the way long-term care is delivered.”
The small house model started in Tupelo, Miss., she said. Research was conducted by nationally recognized gerontologist Dr. Rosalie Kane who found that when people moved from a nursing home into small houses, outcomes were improved on all fronts. “Residents were more satisfied, families were more satisfied, ‘partners’ or staff members were more satisfied and the clinical outcomes were better than the existing model,” Hreben said. “That model got our attention and we decided to pursue it.”
And what about the cost for creating the homelike care model? “We think it’s possible to create a home environment for a comparable cost to existing care,” Hreben said. “Everything in the traditional nursing home model is all built to commercial scale – very large commercial kitchens and laundry facilities with very expensive equipment – and you need staff to operate it.
“In the houses, we have residential equipment, like what you’d have in your house,” she said. “The household is probably the simplest model of living. The model is economically feasible. If we can create some type of new (building) code for a group home/nursing care model there could potentially be even more savings.
“Currently, there are some things we have to do because of the codes, but they don’t really add any value to living with 10 people,” she said.
Relocation of the 50 nursing home units to Avalon has created more space at Portage Valley, which will allow for renovations there. Plans call for addition of apartment and assisted living space and improvements to the nursing care area. “We’re planning to create more private rooms at the nursing care area here,” Hreben said. “We also plan to add kitchen areas to offer residents more flexibility in how and when they eat.”
Wilbur Ehmke, of Woodville, has been living at Avalon for three weeks now and enjoys the home-like atmosphere. “It’s great,” he said. “Nothing will ever be like living at home, but this is the nearest thing to it.”
“We’re all very excited about this model,” Hreben said, adding that another small house neighborhood is being constructed in Monclova. "We’re hoping that by being part of this movement, we will be able to make an impact in restoring elders to home-like care in the United States.”