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Nursing Homes Find Aides Key to Good Care
Wisconsin Coalition Improves Quality Without Raising Costs
 Listen to Joseph Shapiro's report.
Sept. 18, 2002 --
Most news about the nursing home industry is bleak: poor care, overworked staff, aides who abuse the residents. It's little wonder that nursing homes have gotten such bad reputations, or that most Americans fear living in one. But a recent report delivers some good news about a group of nursing homes in Wisconsin. As NPR's Joseph Shapiro reports, the Commonwealth Fund says a coalition of 11 homes there have succeeded in improving their facilities without raising costs.
Under the Wellspring program, the independently operated homes have banded together, sharing resources, data and ideas. Care at the homes has improved, according to the Commonwealth Fund report, in part because the lowliest of workers -- the nurse aides -- were empowered to take charge and solve problems.
CNAs -- certified nurse assistants -- do most of the hands-on care for residents at nursing homes. It's hard work, with low pay and usually little respect. But good aides make good nursing homes, says Shapiro. Turnover in the industry is typically high. Before the Wellspring program began, turnover of aides at Good Shepherd Home in Seymour, Wis., was running at 110 percent a year. That's considered a normal rate, says Shapiro. Now, Good Shepherd's rate is down to 17 percent, and even though the pay is still low, there's a waiting list of aides who want to work there.
Shapiro made a visit to Good Shepherd. He says the program's benefits are evident throughout the home.
Wellspring aides are given extra training, and are encouraged to make changes without a supervisor's approval. A common nursing home practice to control wandering Alzheimer's residents is to install alarms on doors. When a resident wanders through, the alarm sounds and aides go retrieve the resident.
But nurse aides at Good Shepherd came up with a quieter, hands-off solution. At a training session, they learned that for people with dementia, a patch of black on the floor will look like an open pit.
Without seeking administration approval, the aides had janitors paint black spots near off-limit doors. It worked; residents turned back when they encountered the spots.
Good Shepherd administrator Mary Ann Kehoe tells Shapiro her first reaction was, "What did they do to my floor?" But she had encouraged the aides to solve problems, and she soon saw that things were changing for the better.
"They identified a challenge," says Kehoe. "They identified a solution to that challenge. They implemented the approach that would fix it. They solved their problem, and the CEO knew nothing about it. And I don't need to know about it today. They're the ones that make a difference in our residents' lives. They know how to critically think about information. And they just change things."
Evidence of change can be seen throughout Good Shepherd, from a better layout of grab bars in bathrooms to rummage drawers in the lobby. Residents with Alzheimer's were going into other people's rooms, and taking their clothes. So aides bought a second-hand set of drawers and filled it with items that could be taken without being missed.
The quality of care has improved at the facilities, says the Commonwealth Fund report, and at no additional cost to the nursing homes. The Wellspring model is still losing money, but not as much. Even so, the Wellspring program has worked so well that other nursing homes are interested in buying it.
Kehoe says the methods they developed can work anywhere, and make nursing homes not just better places to work, but better places to live.
In Depth
 Browse the NPR archives for more stories on nursing home care.
Other Resources
• Read a summary and the Commonwealth Fund report on the Wellspring model. (The report is a pdf files and requires Adobe Acrobat Reader. Get a free download.)
Recent reports on nursing home care:
• Abuse of Nursing Home Residents, a report by the Special Investigations Division for Rep. Henry Waxman (D-CA), found that nearly one-third of nursing homes were cited for violations involving abuse between January 1999 and January 2001. Read the report.
• Report on flaws in the Health and Human Services' "Nursing Home Compare" Web site. The report, released in February 2002 by Rep. Waxman and Sen. Charles Grassley (R-IA), found that the
federal Web site "Nursing Home Compare" was incomplete because it did not include tens of thousands of recent violations of federal health standards. Read the report.
Nursing home resources on the Web:
• The Wellspring Program Web site.
• National Citizen's Coalition for Nursing Home Reform Web site.
• LongtermCareLiving.org, a consumer information site sponsored by the American Health Care Association and the National Center for Assisted Living.
• The U.S. House Committee on Government Reform special investigations into nursing homes Web site.
• United States Special Committee on Aging Web site.
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