Residents first. A long-term care facility introduces a social model that puts residents in control

Four years ago the leaders at Providence/Mount St. Vincent, Seattle, decided to scrap the traditional medical model of long-term care and create an environment directed by the residents. The traditional system in nursing homes is designed to foster dependence. Our new social model, in contrast, is almost entirely directed by resident preference and need, and it places a high value on human interaction. So far we are having the most success with our assisted living program, which is built into apartment living as part of the rent. All services are available to all residents when they need them. The residents are forming warm relationships with resident assistants, and the flexible, nonmedical help they receive allows them to age in place. The nursing center has been divided into "neighborhoods" of about 20 residents, each with its own staff. A cross-trained, highly capable staff is essential to support resident independence and choice. In one experimental neighborhood, nonmedical tasks that nurses have traditionally done are now being reallocated to resident assistants, who are paid half as much as nurses. The physical heart of every remodeled neighborhood will be a kitchen, as we strive to create a homelike environment. Purposeful activity is replacing therapy in a void. And residents with cognitive impairments are gradually being integrated with more cognitively aware residents. We believe that in the long run, resident-directed care will be less expensive than the medical model.