It was my first visit ever to a nursing home where residents are free to go to bed at night at whatever hour they wish and to get up when they feel like doing so.

“We are trying to emphasize a different model, where the residents have control,” says Paul Hollings, director of Neville Manor, an institution in my home town where I stopped to see how that new model works.

Located at Youville Hospital until its new facility near Fresh Pond opens next spring, Neville Manor makes no small claim for historical roots. It traces its remote origins back to 1779 (starting with the city’s poorhouse and allowing for many changes of site and institutional culture.)  

According to Hollings, until recently the mindset for nursing homes went, “I will take care of you; you are dependent on me.” This was not all bad but it led to institutions that were focused much more on the bodies of the people who lived in them than on their overall wellbeing, psychological and spiritual as well as physical.

Neville Manor is by no means the only nursing home that recognizes the right of residents to determine their own bedtimes and to make other decisions about themselves. It is one of a significant minority of institutions across America that have begun to change the culture of nursing homes.

These innovating institutions have drawn inspiration from a group of far-sighted people from around the country. A leader among them is Bill Thomas, a Harvard Medical School-trained physician who has developed the Eden Alternative, an innovative plan for a new approach to nursing homes. I recently heard this charismatic reformer speak in Chicago, where he called for a new view of aging to propel a new kind of facility.

At Neville Manor, an important vehicle for change is the residents’ council. Paul Hollings wants it empowered not so much to address gripes as to solve problems. “We’ve been working actively with the residents to get them to come up with solutions,” says Hollings.

I talked to the three officers of this council and was impressed with their upbeat approach to life at their facility. Knowing that their opinions on important issues count for something, they would seem to experience a higher level of morale than residents of old-style homes.

In a mission statement the cultural change committee at Neville says of applicants: “Their admission to our institution should not require them to sacrifice what made their lives meaningful in order to receive (our) treatment and care.”

Just as members of the staff in their own private lives enjoy the right to make choices such as “what we will eat, what we will do to entertain ourselves, when we will get up and how often and when we will bathe,” so residents should have the same right, so far as possible.

Another principle vital to nursing home change concerns the treatment of staff members. The reformers believe that how management deals with staff determines in large measure how staff deals with residents. When staff members have their own rights and dignity respected, then they are much more likely to treat residents with respect.

At Neville, every staff member expects to answer resident requests for help. If a particular staffer cannot take care of it, he or she will find someone else who can. Regardless of their job title, they are all involved in the common enterprise of meeting the needs of residents.

Normally, however, nursing assistants are assigned to the same small group of residents, thus enabling these staff members to get to know better the people they serve.

I talked with several staff members about the changes in ways of doing things and in atmosphere. A nursing assistant, Mahnaz Akhtar, told me about the improvement in communication among staff members. “When we have a problem, we can talk to each other,” she said.

With her was Rohi Khan who explained how they resolved a problem that resulted from managers at first not talking to the staff members directly involved in a difficult situation. “It worked out really good,” she said of the solution.

Wendy Lustbader, a Seattle-based geriatric social worker and author, calls for creating a homelike environment and promoting a sense of community.

“Dogs, cats, birds, plants, children, and gardens accessible to everyone,” Lustbader writes, “can transform a sterile monoculture into a human habitat worthy of a home.”

A conversation I had with Jenni Caldwell, Ombudsman Program Director at Somerville-Cambridge Elder Services supports what I have written here.

Of Neville Manor and Paul Hollings, she observes: “What is unique is that they welcome finding out about problems so they can change things.”

And speaking at large of nursing homes committed to the new ways, Caldwell says: “Culture change is the most exciting thing that has happened in a long, long time – an idea whose time has come.”  

Richard Griffin