New concept taking hold in long-term care
by Dwain Hebda
It’s about 30 paces from the parking lot to the back door of Cedar House, one of 10 sprawling craftsman-style homes at The Green Cottages of Poplar Grove in Little Rock. Thirty paces, that is, if you cut through the 5,000-square-foot common building housing the community’s massive physical therapy space and stroll the courtyard under a covered walkway embedded with gleaming stainless-steel heaters overhead.
Once you get there and enter the back door secured by an electronic combination lock, walk into the library where families gather and the sound of morning TV talk shows reaches your ear, you take a moment to let your senses acclimate to the warm surroundings. This being a long-term care facility, you’re conditioned to expect a certain antiseptic smell. What fills you instead is the scent of bacon and maple. You half expect your long-passed grandmother to holler at you, reminding you to remove your shoes.
John Montgomery, executive director, loves taking visitors on their first tour of the premises. Knowing what lies around each corner, he watches intently the look on people’s faces as they walk into the living areas for the first time and come face-to-face with a radical new approach to senior living.
“The overarching view is we emphasize elder choice and deinstitutionalized thinking,” he says.
Ask virtually any senior citizen of his or her greatest fear in getting older and chances are the answers include loss of independence, moving out of their private home, giving up the car keys and heading for the nursing home. And with good reason, as for generations many nursing homes have been the embodiment of life in neutral, institutionalized human warehouses, waiting rooms to the afterlife.
That’s precisely the mindset that communities such as Poplar Grove were built to debunk with homey spaces and flexible daily schedules that mimic a senior’s lifestyle in his or her own home. Want to sleep in or stay up? Go for it. Don’t like what’s being served? Place your order. Love your Hogs? There’s a watch party every game day to attend and enjoy with others.
“Everything we do we want to go away from the old mindset of we’re doing this out of convenience for us,” Montgomery says. “We’re moving to a practice where we are doing everything out of convenience for the elders and representing their choices and giving them the choices in life.”
Montgomery came to this role after 10 years in other facilities, places where he saw the stereotypical nursing home environments. While he’s only been in place here for a year, it feels like a sort of homecoming to the family-centered culture of his youth, a model he employs daily along with his 175 employees.
“I grew up in a very rural, small town, a close-knit community where my grandparents and my great-grandparents lived within a mile of me,” he says. “My grandparents and great-grandparents raised me. It was nothing to be so close with them every day, to eat lunch with them, to go out on the farm and do various things. I didn’t know there was anything else.
“I think now there’s been a push, I know there is here with taking that community aspect and making us a family here, to extrapolate that out to the people that come here and to be a family among families.”
As the number of people reaching retirement age has skyrocketed with the baby boomers, and as those seniors enter their golden years with very different attitudes and lifestyles than their parents, long-term care facilities have been challenged to keep up. Poplar Grove, and places like it, were built with a new mindset from the ground up; a mindset formalized into operational practices and design elements that achieve a home-like environment.
In Poplar Grove’s case, and in hundreds of communities nationwide, that direction has been provided by the Green House Project, a Maryland-based nonprofit. The result is a senior residential community that acts more like a summer camp or college dorm than the traditional nursing home. Or, more accurately, Green House-certified communities imitate the lives seniors would, in the past, have been forced to leave behind.
“There is a push across the nation for this type of change; I know as far as Green House homes across the nation, there are around 250 small home concepts,” Montgomery says. “It’s a push for elders’ rights, for elder choice, for culture change. A lot of people have thought, as we have, that we can do something better, something more for our elders.”
Across town, Shari McGraw takes a spin around the floor at Colonel Glenn Health and Rehab, a three-year-old, 120-bed senior community. The facility administrator and industry veteran doesn’t call them rounds – the term is too formulaic and suggests the kind of rigid schedule that they’ve never been about here.
“You know, you’ve got a plan when you walk in the door of ‘this is what I want to get done’ and three days later, it just doesn’t work that way,” she says. “You have to be very flexible coming in that door and understand your plan is probably not what is going to happen that day.”
In the span of about 15 minutes, she will greet half a dozen seniors by name, touch base on casework with three staffers and impact words of consolation to a pair of women whose mother is being wheeled out to an ambulance for transport to the hospital.
“Be sure to let us know how she’s doing later,” McGraw says to the women. “If they need anything, you have them call us and we’ll take care of it.”
The thing that jumps out isn’t just the newness of the place, it’s the constant motion. Nursing homes aren’t supposed to be a blur of activity; they’re supposed to be people parked in wheelchairs in front of television programs nobody watches. But not here; here everyone seems to have something to do, someplace to go, someone to say hello to or to answer hello back. And all of it happens on the senior’s time, without a universal wake-up call or bed check to end the day.
“It’s challenging to meet everybody’s needs in a small area,” McGraw says, a communicator dangling from her ear. “You have 120 patients and each one of them is an individual, but somehow you have to make it work in the grand scheme of things.”
Touring the building, one suddenly feels a lot better about celebrating more birthdays knowing that such communities exist. But that doesn’t make facing the reality of changing one’s residency any less of a transition. McGraw says no matter how nice or homelike the facility, most seniors still don’t initiate the conversation about seeking care; it’s usually adult children or life circumstances that do it for them.
One such circumstance is an injury or surgery that requires rehab and these services represent another new and substantial chapter in the senior health care industry. Faced with rising costs and shrinking Medicaid reimbursement, more long-term care facilities are providing rehab as an amenity for permanent residents and a service to short-stay patients.
Colonel Glenn Health and Rehab, like Poplar Grove, offers physical, occupational and speech therapy in surroundings that put many medical clinics to shame. Colonel Glenn also is equipped with a training kitchen and bathroom to help patients practice the activities of daily living central to a return to community.
Again, as McGraw points out, therapy is administered on the patient’s timetable not the company’s, a radical departure from long-held service models. Some patients live onsite just for the duration of their rehab and then return home, although some are so impressed with the community during their treatment they are moved to investigate moving in permanently.
“The percentage of people who are going to do their therapy and leave is about 35 to 40 percent; they’re gonna come through the door and they’re like, ‘I wanna go back to my life,’” McGraw says. “They’re active in the Red Hat club or the book club, and they’re here for a therapy model and then getting back to their life outside.”
“For others, we hear, ‘I can’t live by myself anymore, I’m leaving the stove on.’ For them, we’re going to present a model where they can transition to stay long-term, so that you don’t have to worry about the stove anymore, hon. We got the cooking for you.”
McGraw says the future of this care model lies in expanded expertise by staff both in handling physical and mental conditions, as well as by age, noting younger individuals currently are an underserved segment of the wider community.
“What I’m looking forward to happening is whatever you see done at the hospital can be done here,” she says. “Once the patient is stable, they can come here, and we can do all those things that keep people for long periods in the hospital. Hospitals are expensive; you’re around really, really sick people and that prolongs your illness and sometimes makes your illness worse.
“As for mental illness, especially PTSD, there’s not a lot of knowledge in our industry of how to care for them, there’s no policy where ‘OK, I do this this, this and this for them.’ You come in with a broken hip, I know how to get you back on your feet and get back into the community. But somebody has a broken mind, it’s so, so difficult to understand. Right now, there’s no playbook for it.”
Those missing pieces aside, McGraw says she’s proud of how radically her industry has pivoted to deinstitutionalized care. She says while it doesn’t necessarily make her job easier, it does tap into what got her into this business in the first place.
“You know, I’m never gonna be a millionaire working here,” she says. “But I can change these people’s worlds, from the day they come in here until the day they go to heaven. That’s the way I feel about it.”
It can be argued that a quality senior health home is not only good for the people who live there, but it’s good for the entire community. There’s not a better illustration of this concept than The Green House Cottages of Southern Hills in Rison, which has contributed to the physical and economic health of the south-central Arkansas town in ways that go beyond the four walls of the senior community itself.
“Rural America is dying, and it is an absolute shame,” says John Ponthie, consultant for Southern Administrative Services and developer of Green House projects in Arkansas. “If you can’t provide good public services, good fire, police and medical service, there’s nothing to build around. You have to have the fundamentals.”
In Rison’s case, officials were looking for a way to improve senior healthcare services, knowing that the local nursing home, owned by the county and of 1950s vintage, was inadequate and foundering.
“The county nursing board came to us and said they had heard about this new model of care that we were doing at the time in Magnolia,” Ponthie says. “We ended up partnering with them and building this replacement facility. The community went from this inadequate space and living environment to a successful person-centered care nursing facility with robust rehabilitation services.”
The wider impact of the 72-bed, long-term care community on the local economy has been substantial. Southern Hills employs 99 people and has directly or indirectly brought about or saved other businesses in town.
“I would venture to say we’re probably the second-largest employer behind the school system,” Ponthie says. “When we started, they didn’t even have a doctor’s office in town, now there is. Without our presence, I’m not sure that there would be a pharmacy in town. (Southern Hills) is part of the fabric of the community and part of a foundation that allows for other businesses and other families to prosper.”
The design of the place and its high level of amenities are a rarity in this part of the state as are Southern Hills’ speech, occupational and physical therapy services that cannot be had anywhere else in the county. Long-term residents, which make up about 75 percent of Southern Hills’ population, are drawn from a 60-mile radius. Short-term therapy patients typically reside here for 30 to 60 days, and outpatient services are also available.
The value of the senior community and the pride it inspires in Rison’s citizens is expressed almost daily.
“Our community support in Rison and Cleveland County is unbelievable,” Phillips says. “The Cleveland County Fair Board, the Pioneer Village and other parts of the community come in and do domino tournaments. There are three parades through the cottages, and they do it yearly. They do a fireworks show as well.”
“We have two schools in the county; they have both ‘adopted’ elders, and they have also bought each cottage an iPad. I mean, we’re all a family, everybody in the community and everybody here.”
The economic development potential for the facility is substantial and provides skilled jobs that are typically in short supply in smaller, rural communities. Phillips says while it was initially difficult to attract the kind of healthcare professionals she wanted, as time has gone along good help is increasingly finding its way to Cleveland County, even though the expectations for staff are high.
“The Green House brand means creating a home away from home. It’s all about the care and how you respect a code of ethics,” she says. “It’s the care, the dining experience, all the different types of coordinator roles that everybody has to pick up and learn through core training.”
Southern Hills’ impact is only going to grow as its substantial waiting list has inspired expansion. Construction on a seventh cottage, bringing an additional 12 beds, is slated to be completed late next year. The new building will also house administrative space and a new state-of-the-art rehab facility, creating 14 additional jobs.
Phillips, who grew up in Rison, has a hard time putting into words what Southern Hills means to her hometown and its survival.
“I don’t even know how to describe it other than we are just thankful to have it here,” she says. “We want to make sure that everyone in our community is taken care of. We want to make sure the elders are taken care of. It’s patient-centered care.”
Ponthis says Southern Hills is a business success story for other small communities and their leaders to follow.
“The local community leadership reached out, found something better and now they’ve developed something prosperous,” he says. “They’re full, and they’ve been full for quite some time, and they’ve got a waiting list of probably 24 people. To the extent that there’s opportunity beyond that, I think it’s unlimited. People are seeking out the type of special culture that they’ve developed.
“One time I was with Michelle and somebody was in town from California wanting to see the model. We were giving them a tour and I said, ‘No one gets up in the morning and says, I hope today is the day I get to go to the nursing home. One of the elders popped up and said, ‘You’re wrong. I prayed and hoped for this.’ What they’ve created here is that special.”
Rachel Bunch, executive director for the Arkansas Health Care Association, says the deinstitutionalized care model is taking root in Arkansas, even if on a piecemeal basis.
“Overall, facilities in the state have talked about culture change for years. We’ve done training on that for years,” she says. “Only a few are overarching and doing all of it at once, but there are different elements that you’ll see where facilities will adopt more of it in different areas.”
Bunch says the emergence of therapy services not only meets an unmet need in many communities, it also expands long-term care’s business channels, channels that offer increasingly sophisticated levels of care for a variety of conditions while improving a home’s profitability.
“Medical care over time has shifted in long-term care,” she says. “Before, it was kind of you have the hospital and long-term care and not a lot in between. The level of clinical competency that we see now in this profession just continues to get better and better, and it’s really amazing all the things that can be done.
“I think we’re getting better in long-term care at assessing, treating, care planning with dementia and with mental illness. Some people may come to a facility and have never accessed services or treatment for that. The clinical teams they’ve put together, the social services, the nurse practitioners and the direct care staff are getting so much better at care planning and assessing and monitoring. It’s really cool to see the progression and improvement in that area.”
Back in Cedar House at Poplar Grove, a sign announces, “This kitchen is for dancing,” and that’s exactly what happens around here. Not long ago, an elder stood up and broke into song to entertain his breakfast companions to raucous applause. In another instance, a woman had a date come pick her up and when he arrived, he was met by a phalanx of protective cottage mates, sizing him up. Life moments bold, intimate or spontaneous happen all the time and lets Montgomery know he and his staff are doing things right.
Before departing, he greets another senior, waves to the staff preparing lunch and lets his eyes linger on the open, central kitchen, a place where past memories and new friendships spark and come to life.
“Our staff eats with the seniors; we foster relationships and build those relationships between our elders and our staff over a meal, three times a day,” he says. “In traditional nursing homes, they would chase us out of the kitchen with a skillet should we walk in there. But here, you can wash your hands, don a hairnet and jump in the kitchen and interact.
“If you have a blackberry cobbler that you and your loved one made for the last 50 years, why can’t you jump in our kitchen and make that and share that with the rest of the people in the cottage? That happens here.”
Nursing Homes by County
Long-term care in Arkansas
Arkansas is home to 285 long-term care centers. There is at least one such facility in each of the state’s 75 counties. The state has 27,287 licensed beds in Arkansas facilities with 17,252 patients residing in them as of November. Here’s a look at the long-term care facilities, broken down by county.
Crestpark DeWitt, LLC 70
Crestpark Stuttgart, LLC 100
DeWitt Nursing Home 60
Somerset Senior Living at Crossett 83
Stonegate Villa Health and Rehabilitation, LLC 76
Auburn Hills Nursing and Rehabilitation 95
Care Manor Nursing and Rehab 104
Gassville Therapy and Living 105
Good Samaritan Society – Mountain Home 70
Hiram Shaddox Geriatric Health and Rehab 81
Pine Lane Therapy and Living 105
Apple Creek Health and Rehab, LLC 114
Ashley Rehabilitation and Health Care Center 100
Bradford House Nursing and Rehab, LLC 98
Concordia Nursing & Rehab, LLC 102
Highland Healthcare and Rehabilitation Center 90
Innisfree Health and Rehab, LLC 80
Jamestown Nursing and Rehab, LLC 140
Promenade Health and Rehabilitation 114
Rogers Health and Rehabilitation Center 140
Shiloh Nursing and Rehab, LLC 80
Siloam Healthcare LLC 125
The Waters of Rogers, LLC 110
Hillcrest Home 103
Somerset Senior Living at Harrison 90
Somerset Senior Living at Mount Vista 154
Chapel Woods Health and Rehabilitation 140
Autumn Hil 114
Brighton Ridge 100
Dermott City Nursing Home 70
Lake Village Rehabilitation and Care Center 102
Courtyard Gardens Health and Rehabilitation Center 100
Twin Rivers Health and
Corning Therapy and Living Center 84
General Baptist Nursing Home of Piggott 105
Rector Nursing and Rehab 70
Somerset Senior Living at Seven Springs 140
Southridge Village Nursing and Rehab 122
The Green House Cottages of Southern Hills 75
Community Compassion Center of Magnolia 140
Summit Health & Rehab Center 70
The Green House Cottages of Wentworth Place 135
Brookridge Cove Rehabilitation and Care Center 118
River Chase Rehabilitation and Care Center 88
Community Compassion Center of Jonesboro 136
Craighead Nursing Center 121
Lakeside Health and Rehab 75
Lexington Place Healthcare and Rehabilitation LLC 117
Monette Manor, LLC86
Ridgecrest Health and Rehabilitation 135
St. Elizabeths Place 110
Alma Healthcare and Rehabilitation Center 80
Crawford Healthcare & Rehabilitation Center 129
Valley Springs Rehabilitation and Health Center 105
Van Buren Healthcare and Rehabilitation Center 109
Community Compassion Center of West Memphis 119
West Memphis Health and Rehab 155
Willowbend Healthcare and Rehabilitation 118
Crestpark Wynne, LLC 100
River Ridge Rehabilitation and Care Center 100
St. Johns Place of Arkansas, LLC 126
Somerset Senior Living at McGehee 140
Belle View Estates Rehabilitation and Care Center 80
The Woods of Monticello Health and Rehabilitation Center 122
Conway Healthcare and Rehabilitation Center 105
Greenbrier Nursing and Rehabilitation Center 87
Heritage Living Center 140
Salem Place Nursing and Rehabilitation Center, Inc. 121
St. Andrews Healthcare 104
Superior Health & Rehab, LLC 103
Greenhurst Nursing Center 102
Ozark Nursing Home, Inc. 135
Eaglecrest Nursing and Rehab 100
Southfork River Therapy and Living 84
Abby Hill Nursing and Rehabilitation 86
Belvedere Nursing and Rehabilitation Center, LLC 110
Garland Nursing and Rehabilitation Center 95
Hot Springs Nursing and Rehabilitation – A Waters Community, LLC 152
Lake Hamilton Health and Rehab 84
Lakewood Healthcare, Inc. 80
Quapaw Care and Rehabilitation Center, LLC 126
Somerset Senior Living at Canyon Springs 95
The Pines Nursing and Rehabilitation Center 125
Village Springs Health and Rehabilitation 120
Sheridan Healthcare and Rehabilitation Center 121
Greene Acres Nursing Home 143
The Green House Cottages of Belle Meade 167
Heather Manor Nursing and Rehabilitation Center 128
Oaklawn Estates, LLC 100
Arbor Oaks Healthcare and Rehabilitation Center 100
Encore Healthcare and Rehabilitation 95
Happy Valley Nursing & Rehabilitation 83
Community Compassion Center of Nashville 78
Dierks Health and Rehab 70
Nashville Nursing and Rehab, Inc. 70
Community Compassion Center of Batesville 150
Mountain Meadows Health and Rehabilitation 110
Wood-Lawn Heights 140
Diamond Cove, LLC 78
Pioneer Therapy and Living 86
White River Healthcare 70
St. Michaels Healthcare 130
The Waters of Newport, LLC 120
Arkansas Convalescent Center 103
Pine Ridge Healthcare, LLC 41
The Villages of General Baptist Health Care East 126
The Villages of General Baptist Health Care West 177
The Waters of White Hall, LLC 120
Trinity Village Medical Center 94
Clarksville Nursing and Rehab, LLC 82
Johnson County Health and Rehab, LLC 120
The Waters of Stamps, LLC 94
Lawrence Hall Health & Rehabilitation 150
Walnut Ridge Nursing and Rehabilitation Center 119
Crestpark Marianna, LLC 80
Gardner Nursing and Rehabilitation 95
Lincoln Heights Healthcare 87
Little River Nursing & Rehab 85
Pleasant Manor Nursing & Rehab 78
Paris Health and Rehabilitation Center 140
Oak Manor Nursing and Rehabilitation Center, Inc. 120
Barnes Healthcare 141
Cabot Health and Rehab, LLC 89
Cavalier Healthcare of England 70
Chambers Nursing Home Center, Inc. 90
Greystone Nursing and Rehab, LLC 80
Lonoke Health and Rehab Center, LLC 80
Spring Creek Health & Rehab 109
Meadowview Healthcare and Rehab 105
Community Compassion Center of Yellville 96
Twin Lakes Therapy and Living 80
Arkansas Nursing and Rehabilitation Center 173
Bailey Creek Health and Rehab 115
Bentley Healthcare, LLC 111
Gosnell Health and Rehab 70
Heritage Square Healthcare Center 86
Manila Healthcare Center 70
Harris Health and Rehab 115
Cla-Clif Nursing and Rehab Center, Inc. 116
Montgomery County Nursing Home 112
Hillcrest Care and Rehab 90
Prescott Manor Nursing Center 111
Newton County Nursing Home 70
Longmeadow Nursing Center – Camden 69
Ouachita Nursing and Rehabilitation Center 142
Pine Hills Health and Rehabilitation Center 106
Silver Oaks Health and Rehabilitation 104
Perry County Nursing and Rehabilitation Center 95
Cedar Lodge Nursing Center 122
Crestpark Helena, LLC 100
Glenwood Health and Rehabilitation, LLC 80
Murfreesboro Rehab & Nursing, Inc 66
Arlington Cove Healthcare LLC 77
Three Rivers Healthcare and Rehabilitation 110
Woodbriar Nursing Home 80
Mena Manor 69
Rich Mountain Nursing and Rehabilitation Center 115
Atkins Nursing and Rehabilitation Center 90
Legacy Heights Nursing and Rehab, LLC 122
Russellville Nursing and Rehabilitation Center 100
Stella Manor Nursing and Rehabilitation Center 124
Des Arc Nursing And Rehabilitation Center 98
Maple Healthcare 70
Colonel Glenn Health and Rehab, LLC 120
Allay Health and Rehab 70
Hickory Heights Health and Rehab, LLC 120
Midtown Post Acute and Rehabilitation – A Waters Community, LLC 154
Pleasant Valley Nursing and Rehabilitation 97
The Village at Valley Ranch 110
The Waters of Woodland Hills, LLC 140
Woodland Hills Healthcare and Rehabilitation 120
Arkansas State Veterans Home at North Little Rock 96
Lakewood Health and Rehab, LLC 85
Robinson Nursing and Rehabilitation Center, LLC 110
Sherwood Nursing & Rehabilitation Center, Inc. 98
Somerset Senior Living at Premier 132
The Lakes at Maumelle Health and Rehabilitation 70
The Waters of North Little Rock, LLC 140
Barrow Creek Health and Rehab 139
Cottage Lane Health and Rehab 143
Nursing and Rehabilitation Center at Good Shepherd, LLC 120
Parkway Health Center 105
Presbyterian Village, Inc. 78
The Waters of Cumberland, LLC 120
Briarwood Nursing and Rehabilitation Center, Inc. 120
The Green House Cottages of Poplar Grove 118
The Waters of West Dixon, LLC 140
Pocahontas Healthcare and Rehabilitation Center 97
Randolph County Nursing Home 140
Alcoa Pines Health and Rehabilitation 120
Amberwood Health and Rehabilitation 101
Arkansas Health Center 290
Evergreen Living Center at Stagecoach 116
Good Samaritan Society – Hot Springs Village 50
Heartland Rehabilitation and Care Center 119
Southern Trace Rehabilitation and Care Center 116
Stoneybrook Health and Rehabilitation Center 80
Waldron Nursing Center, Inc. 105
Highland Court, A Rehabilitation and Resident Care Facility 78
Ashton Place Health and Rehab, LLC 122
Chapel Ridge Health and Rehab 157
Covington Court Health and Rehabilitation Center 140
Fianna Hills Nursing & Rehabilitation Center 102
Legacy Health and Rehabilitation Center 115
Methodist Health and Rehab 145
Pink Bud Home for the Golden Years 110
The Waters of Fort Smith, LLC 117
Bear Creek Healthcare LLC 131
Ash Flat Healthcare and Rehabilitation Center 105
Cave City Nursing Home Inc. 90
Crestpark Forrest City, LLC 100
The Waters of Mountain View, LLC 97
Advanced Health and Rehab of Union County 122
Courtyard Rehabilitation and Health Center, LLC 101
Hudson Memorial Nursing Home 108
Oak Ridge Health and Rehabilitation 180
Timberlane Health & Rehabilitation 106
Indian Rock Village Health Center 55
Ozark Health Nursing and Rehab Center 118
Arkansas Veterans Home at Fayetteville 90
Butterfield Trail Village 87
Fayetteville City Hospital and Geriatric Center 123
Fayetteville Health and Rehabilitation Center 140
Katherine’s Place at Wedington 119
North Hills Life Care and Rehab 92
Prairie Grove Health and Rehabilitation, LLC 70
Springdale Health and Rehabilitation Center 140
The Maples at Har-Ber Meadows 140
Walnut Grove Nursing and Rehabilitation Center 102
Westwood Health and Rehab, Inc. 85
Windcrest Health and Rehab, Inc. 70
Beebe Retirement Center, Inc. 105
Community Compassion Center of Searcy 245
Oakdale Nursing Facility 154
The Crossing at Riverside Health and Rehabilitation 138
Woodruff County Health Center 120
Dardanelle Nursing and Rehabilitation Center, Inc. 110
Deerview, LLC 74
Mitchell’s Nursing Home, Inc. 105