Living in a nursing home usually comes with dire expectations that all too often turn out to be well founded. Many scholars and policymakers believe that the sterility, depersonalization and oppressively rigid routines that characterize even the best conventional nursing homes so damage people who live there that it is difficult to tell which aspects of illness or aging are truly organic, and which are produced by the constraining and depressing regime of the institution.
Two Monroe County nursing homes have embarked on a radical enterprise intended to address these circumstances by making systemic change in the culture of their facilities while a team led by a University of Rochester professor examines the effects of these efforts.
"This project poses a challenge to society about taking seriously notions like 'lifelong education' and 'successful aging,' " says Dale Dannefer, professor at the University's Margaret Warner Graduate School of Education and Human Development and an internationally known sociologist of aging. "If we expect people in nursing homes to improve their health and thrive, to remain socially engaged and make contributions to the lives of others, it should show up in measurable gains in their health and functional status," he says.
"It's a radical idea, but one that will benefit all of us," Dannefer points out. "Everyone who lives long enough gets very, very old. Four out of every 10 people who are 65 today are likely to spend some time in a nursing home before they die."
With funding from the New York State Department of Health and the van Ameringen Foundation, Dannefer is collaborating with Fairport Baptist Homes, the Jewish Home of Rochester, and LIFESPAN, a community-based agency serving those in the second half of life. His project coincides with intensive efforts by the two facilities to change how they operate, including a $24 million architectural renovation at Fairport Baptist Homes.
Dannefer's team is documenting the structure of day-to-day activities at the homes and evaluating their impact on the health and quality of life of residents and the morale and turnover of staff. Other research has already shown that an individual's physical and mental decline can sometimes be slowed—even reversed—if given the right living conditions, he says. Findings from the study are expected in spring 2001.
"The problem is to change the system so that people can continue to make their own decisions about daily routines and to enjoy a variety of experiences and a rich social life despite their limitations and challenges," says Dannefer, "and to make the change in a way that is cost-effective."
In the research, Dannefer is joined by Paul Stein, Warner School doctoral student who is helping to coordinate the project; Craig Barclay, associate professor at the Warner School; Jeff Lashbrook, assistant professor of sociology at SUNY Brockport; Warner School doctoral students Susan Chuang, Janet Gelein, Lorraine Gianvecchio, and Naomi Schlagman; and research associates Madalina Chirieac, Jason Dauenhauer, and Pat Kraus.