Saint Elizabeth leads evolution of senior care

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Approaching the door to one of Saint Elizabeth Community’s Green House homes in East Greenwich last Thursday, Warwick resident Mark Loiselle makes a point to proclaim that not even he, the chief financial officer who has been with the organization since 2004, enters without permission first.

“We’re entering somebody’s home, so we ring the bell,” he said, extending a finger to the button.

Once inside, it becomes clear that a Green House home is not a traditional long-term care facility for seniors – in fact, that’s the point.

“It’s a new type of nursing facility. When people think of nursing facilities, they think of a two-story brick building, dark, where old people go to die. We don’t take that philosophy,” Loiselle said. “These are where our elders go to live.”

There is a living room with couches and chairs set up in front of a television, a den with a pull-out sleeper couch in case relatives or other loved ones want to stay the night and a large, eat-in kitchen with granite countertops and a long, communal dining room table for the 12 residents of the home to mingle if they so desire. Each of the private rooms has a mechanical, full-sized bed with rigging mounted above in case they need the assistance of a lift to get in and out, and a spacious en-suite bathroom.

The houses are maintained and overseen by an in-house nurse and three helpers, who call themselves the “Shahbazim,” a Persian word rooted in a mythical bird that was seen as an indispensable assistant to the king. While the assistants do things like cook and clean, they are more than that to the residents.

“They don’t see the staff as caretakers,” said Sarah Bowater, who works as a guide to the Green House Homes and has been with Saint Elizabeth for 17 years. “They see them as their family.”

The entire concept of the Green House homes is to flip the conventional nursing home model on its head. Instead of structured activities held rigidly during set dates and times, residents have freedom to form their own groups, like a wine club. They can help rake or do outside work if they choose. Instead of strict bed times, dinner times and wheeled carts making routine rounds to give people their medicine, residents are able to take charge of their own medication schedule and when they want to go to bed and wake up. They can cook their own meals if they desire.

“The whole concept behind what they call resident-centered care is that everyone is an individual, everyone is different,” Loiselle said. “I think we’re all trying to provide better service for that individual.”

This adaptability leads to better engagement with residents, improved attitudes and even better outcomes, Loiselle reasons – a winning balance between prolonging independence for seniors as long as possible while still giving them access to the assistance they need as they age.

He said Saint Elizabeth provides services along the whole “continuum of long-term care,” meaning if a senior simply wants a place to go for a day to partake in activities, they can visit one of the elder day care centers. If they want a round-the-clock living situation, then they can choose from one of their long-term care facilities. If their needs are more pronounced, Saint Elizabeth has assisted living facilities.

“When my grandmother was going through this, there weren’t these alternatives,” he said, recalling how his grandmother suffered from Alzheimer’s and wound up in a very “uncomfortable” place as she aged. “We’re providing these alternatives hoping that we’re giving these services towards what that individual’s needs and wants are.”

A changing landscape of care

Saint Elizabeth is the only elder care organization in Rhode Island that has these “Green House” homes – which is actually a trademarked term born from a collaborative project that began in 2001, with experts in the long-term healthcare field joining resources to create a new type of senior care that took into consideration the evolution of how people are choosing to age.

There are four of these homes on Saint Elizabeth’s campus in East Greenwich, each identical in internal layout and each 8,000 square feet but unique in the way they choose to operate, which together create a type of “neighborhood” that, Loiselle said, fosters the idea of building a sense of community and “hominess” to Saint Elizabeth’s brand of elder care. They were constructed two years ago as of April, when at the time there were only 150 such homes nationwide. That is changing, with over 200 of these homes constructed as of today.

However, while elder care experts such as Loiselle and Bowater recognize that the Green House model is the direction that the field needs to continue striving towards, it may not be so simple to achieve in Rhode Island.

Loiselle explained how Saint Elizabeth had to push legislation through the State House to be able to construct new nursing home facilities in the state due to there being restrictions on the total number of nursing home “beds” that can be available at any one time.

On top of the legislative challenges, Medicare and Medicaid billing has become a constant burden due to complications that were caused by the state’s transition to an online database. The “UHIP” issue, as it has been dubbed, has resulted in many people’s information being lost or improperly input, causing delays in Medicaid/Medicare approval and an inability for places like Saint Elizabeth to collect reimbursement in a timely fashion – a big problem, Loiselle said, considering that’s where 70 percent of their revenue is collected.

Loiselle said that the state has begun fronting money to the healthcare facilities affected by the issue, but the system is still far from perfectly functioning. Once the facility does get the reimbursement from Medicaid or Medicare, it has to reconcile with the state – a process that is causing a strain on the business operations people in the office due to inconsistencies in accounting that often comes with it.

“They’re very stressed right now,” he said. “Not only are they dealing with their normal workload, including explaining the process to people of how to apply for Medicaid, but now we have this other workload of all these reconciling pieces that we’ve been doing for two and a half years now. We’ve got people in our business offices who have been in this industry for 20-plus years that are burnt out, specifically because of this process.”

Through it all, Loiselle Saint Elizabeth has been able to break the mold mostly due to their significant fundraising efforts and a donor network that has had time to grow since the organization first began in Providence in 1882.

Helping senior citizens live better lives as they age is not simply a job for Loiselle, it’s a call to duty that takes into consideration a great responsibility he feels should be shared by those who have benefited from the guidance of their elders. At Saint Elizabeth, he feels he is in the right place to fulfill that sense of duty.

“I don’t think our elders get enough support,” Loiselle said from Saint Elizabeth’s administrative offices in Warwick during a recent interview. “The people who we are today are based on our elders. Whether that’s your mother, your father, your grandparent or some other significant person in your life, they’re the ones that shaped and molded us the way we are. And we owe them to be able to provide services – not just the minimal services – but a home for them to live in.”

The cost for securing a spot in one of the Green House homes is approximately $430 per day, according to Loiselle. He also stressed that, contrary to fears some may have about being priced out of the facility, and said that once a resident is placed in a Green House home, they will continue to receive that service and stay in that facility even if they have to switch from private funding to Medicaid.

“Once they’re moved in there, they stay there,” he said.

However, it may not be easy to procure one of those 48 spots in the Green House homes. In two years since their opening, Loiselle said the highest number of open spots has been only two, and those are quickly filled. Those inquiring about availability or other services offered by Saint Elizabeth should call 401-471-6060.

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