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Not your father's nursing home

Lindsay Erickson serves lunch to Darrell Heinen at Emmanuel Community Thursday. (Brian Basham/DL Newspapers)1 / 2
Heidi the dog warms the lap of Stella Barr at the beauty shop in Emmanuel Community Thursday. (Brian Basham/DL Newspapers)2 / 2

Picture a nursing home: if sterile hallways, a hospital-y industrial scent, or the stereotype that people go there to die come to mind, you may want to scratch these ideas from your psyche.

Nursing homes, and care for aging adults in general, are changing -- and for folks around Becker County, there are more options than ever.

Those options put us on the leading edge statewide, said Loren Colman, an assistant commissioner at the Minnesota Department of Human Services.

Things are shifting in many ways, he said, like homey atmospheres and shorter stays, and for many reasons, like preparing for the aging baby boomer generation.

Becker County has, as a percentage, more people to care for than the average Minnesota community, and that number is rising.

According to data from the Minnesota DHS, 16.2 percent of Becker County residents were over the age of 65 in 2005. Statewide, it was only 12 percent.

Their projection for 2030 shows 26 percent of Becker County being 65 or older compared to 20.6 percent statewide.

"The time for change is now," said Tonya Clem, the nursing director at Detroit Lakes' Diamond Willow assisted living center. "The wants and needs are changing."

'The new world of nursing homes'

Emmanuel Community, which, along with it's various senior apartments, has arguably the largest area nursing home with 140 state-registered beds, has been around for 45 years and has often changed with the times, but changes could be coming again in the future, said Administrator Janet Green.

For instance, Green said, the days of the years-long waiting list are gone. The average length of stay has decreased, she said, with fewer people seeking out traditional long-term care, and more staying for a month or so for rehabilitation or "acute care."

At Emmanuel, she said, the average stay is only 21 days.

That trend started happening a few years ago, Green said, and it's the reason that Emmanuel designated a specific hallway, or "neighborhood" for people on short-term stays - 26 of their 140 beds. Before, only residents in the memory care unit were separated.

Now, Emmanuel has six open beds in long-term care (although, that number fluctuates every day), and has had up to 10 or 12 in the last few months, sometimes filled by overflow from their short-term patients.

She said Emmanuel has been looking into expanding short-term services further, but isn't sure what the need will be yet.

Still, Green said, they've maintained a 99 percent occupancy level.

"Now, we have 160 admissions a year (for 140 beds), so there's lots of admissions and discharges," she explained. "That's the new world of nursing homes."

Statewide, Colman said, nursing homes are serving more people than ever before, but like at Emmanuel, they're not staying as long.

After their short-term stay, many residents will move into assisted living complexes or senior apartments, where meals are still served and nurses are still available, even if care isn't needed 24 hours a day -- and that more independent option is becoming one of the most popular options.

"People don't need to be in a care setting that's a higher amount of care than they need," Green said. "We're looking at, what's the right care at the right time in the right place, and if you talk to anyone with an illness, their first goal is to be at home."

And even if it's not the same place they've lived for 40 years, most seniors feel much more comfortable in a private apartment than in a long-term nursing home.

For that reason, more prospective clients are being heavily screened about their needs before even being admitted, Green said, because if they can handle something less restrictive, it's usually a better fit.

In transition

At St. Mary's Innovis Health, they're in the process of creating a more comfortable, home-like atmosphere via more private rooms and welcoming design choices.

Senior Administrative Leader Christy Brinkman said before they started construction a few years ago, only 7 percent of their residents had their own rooms. After construction is done, two-thirds will have private rooms.

With a total of 96 beds (although they're ramping down their capacity to 79 by the summer) St. Mary's has also shifted much of their focus to short-term stays.

But reducing the number of beds and then trying to get occupancy back up to normal levels could have its challenges.

"Last time we did this kind of thing in the late '90s, it took a number of months for us to get back there," Brinkman said, "and now it might be harder because there are more options."

Ten years ago, she said, Emmanuel and St. Mary's were the only nursing homes around, with a couple assisted living buildings.

"Now, there's so much more," she said. "The community is definitely taking care of people more than they were before."

The remodel and additions pay off, though - since their redesigns were completed in 2004, Lake Park's Sunnyside Care Center Administrator Katie Lundmark said both staff and residents have been more comfortable in the homelike environment.

Before, she said, it was sterile with stark white walls and tile, and they made the change because they saw a shift in what the customer wanted.

Government regulations, potential budget cuts

In fact, the state government put a moratorium on nursing home beds when all these new options started becoming available and more popular -- fewer beds are needed when people don't occupy them as long, Colman said.

Under the moratorium, facilities can't offer more licensed beds without special permission, and are actually offered monetary incentives if they de-license beds.

Since 2001, 625 beds in the West Central region of Minnesota, which includes Becker County and Detroit Lakes, have been de-licensed, compared to more than 8,000 statewide (more than 3,000 just in the Twin Cities Metro), according to data from the Minnesota Department of Health and the Aging Services of Minnesota.

Statewide, as of March 2009, the data showed that just over 33,000 people were being served by nursing homes, compared with more than 45,000 in 1995.

So why is the government reducing the number of beds?

One major reason, apart from the growing popularity of facilities outside of nursing homes, is that long-term care is much more costly to the state.

The average annual cost for a private room in a Minnesota nursing home is $76,573, according to a new national survey by Richmond, Va.-based insurer Genworth Financial Inc.

And those costs aren't going down anytime soon, the survey says.

Comparatively, the average annual cost for a one-bedroom at an assisted living facility in Minnesota is $31,656 - less than half the cost, according to the survey.

"Insurance, medical assistance, the government, they're much more willing to pay for adult day services, assisted living and that kind of thing rather than 24-hour care," Green said.

And yet, she said, long-term care is sometime inevitable.

"It's really need-based," she said. "If you've broken your hip, and you can't take care of yourself, it's not so much about the financial. You might put off going to visit the doctor, but at some point, you don't really have a choice."

Still, the state Legislature is dealing with a heavy deficit this biennium, and looking to health care as a place to cut, something Lundmark said all nursing homes are worried about.

A capitol rally in St. Paul on April 28 hopefully made some voices heard.

"They were letting them know that we are concerned and we can't just settle for cuts because it's devastating to nursing homes," Lundmark said.

As for Green, "I'm more concerned about potential cuts ... than I am about a few open beds."

'We're trying to redefine ourselves'

With all the potential changes to the health care system also comes good news: those tired stigmas and stereotypes associated with nursing homes are starting to be worn down.

"The hospital setting, we've kind of done that to ourselves," St. Mary's Administrator Brinkman said. "When they were originally built in the 1960's, they were built very institutionally because it was efficient."

Now, she said, nursing homes "are at a pivotal point where we're trying to redefine ourselves."

At Diamond Willow, clients may arrive fairly independent, using the facility as assisted living, but they can stay through the rest of their lives, and nursing care will be amped up as needed, resembling long-term care.

The lower bed count (they can host up to 22) and smaller facility actually feels like a small home. Residents eat dinner family-style together and meals are cooked in the kitchen with groceries straight from Central Market. Each private room actually feels like a small studio apartment.

"What we've done is phasing out the end of life stuff," Nursing director Clem said. "First, it's assisted living, then housing with services, and then more help, but once they come here, they can just stay. It's the reason for our success."

Redefining the traditional care center model and finding the "care center of the future" is one thing Colman and a larger team at the Minnesota Department of Health and other trade associations have been working on since they formed the project in 2008, as needs and wants for the pending baby boomers changes.

"We know that our over-65 population is going to double, and we know we need to manage our public dollars as effectively and as efficiently as possible," he said.

Although he had some "themes" in mind for what the "care center of the future" might look like, "we don't really have a great strategic plan for care centers to deal with the population yet."

At the Frazee Care Center, Administrator Austin Blilie said one key in preparing for baby boomers will be letting them make their own decisions.

"Keeping them involved in their care as much as possible, I think that'll be a key to satisfying them, basically empowerment in their health care decisions," Blilie said.

He said more and more people are coming in well informed about options and procedures, whereas 20 years ago, nursing homes were often the only option.

"They'd just go to a nursing home after retirement," he said. "Nursing homes were kind of the assisted living of today."

'Small communities in general have that fear'

As the uptick in the aging population occurs, though, the same data shows younger people, the traditional age of caregivers, dwindling -- which some see as a potential problem.

Between 2005 and 2030, projections show that the percentage of people between the ages of 20 and 54 in Becker County will shift from 46.3 percent to 38.2 percent.

It'll go down statewide, too, but still at a higher percentage than Becker County. In 2005, just over 50 percent of the Minnesota population was between 20 and 54 years old, but by 2030, that'll be down to 43.5 percent.

So, with more people to care for, but fewer young people around, will there be enough caregivers?

"I think small communities in general have that fear," Brinkman said.

Although it's not a problem yet, since there are a handful of nursing programs in the area, she said we may start seeing more of what's happening in rural North Dakota.

"They're working on bringing in nurses from foreign countries, they provide them with housing and help them get citizenship," Brinkman described.

Frazee administrator Blilie said a general shortage of nurses will impact health care nationwide.

"They're projecting that it's going to be an issue, and in a rural area, it's always challenging to recruit," he said.

Still, the Detroit Lakes area is looking stable - most facilities have already made the necessary changes and are looking to the future and preparing themselves, Department of Human Services Assistant Commissioner Colman said.

"You have some providers up there that are on the leading edge, that are on the rebranding and recasting of what life is going to look like in a care center," he said.

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