Here are two truths.
First, home is where you live, but not all places you live are home.
Second, most of the time most people want to live at home.
There are times in our lives when it’s fine to live in an institution. It’s fun — and broadening, and exciting, and eye-opening, and possibly liberating — to live in a dorm when you’re an undergraduate, and summer camp is many kids’ idea of heaven. But those places are temporary.
When they get old, though, people usually resist the idea of leaving home to live in an institution, which, they fear, will never become home. Institutions, in public mythology and to some extent in reality as well, manage to be at once sterile and dirty; they’re hard-edged and seem fluorescently lit even when they’re not. Many people — maybe most people — far prefer the idea of aging in place, growing old and then even older at home.
But often the elderly can no longer live at home. It’s just not possible. They can’t live alone, and either they can’t afford full-time help or that help no longer would be sufficient.
That’s when they go to nursing homes.
Most cutting-edge nursing homes belie the stereotypes about them anyway. But now the Jewish Home at Rockleigh, one of those cutting-edge places, plans to change its residents’ lives by creating homes inside the institution, so that residents can have the advantages of both.
The Jewish Home’s leaders have begun to work on an ambitious multiphase plan that will begin by updating its rehabilitation services and go from there to reconfiguring its residential area, and eventually building more and different kinds of housing for people with varying needs on other parts of its property.
All this began with a study the Jewish Home Family’s CEO and president, Carol Silver Elliott, commissioned soon after she took up her job there three years ago. (The Jewish Home Family is the umbrella organization that oversees the Jewish Home at Rockleigh, the Jewish Home Assisted Living, the Jewish Home at Home, and the Jewish Home Foundation.)
“It was an analysis of the services we deliver now, how they impact the community, what kind of reception and reputation we have, and what are the challenges and opportunities in the community for us as a Jewish eldercare agency,” Melanie Cohen, the Jewish Home Foundation’s executive director, said. She defined the community as all of Bergen and southern Rockland counties, and as not only but specifically Jewish.
“Two hundred pages of report later, we found that we have some wonderful opportunities, as well as a need for more rehabilitation services; our reputation is strong, and there were places for us to really look forward toward growth,” Ms. Elliott added.
At the same time, they were confronted with a great piece of luck. The land just west of the property the foundation already owned came up for sale, and the foundation bought it. After a committee looked at possibilities and set priorities, it accepted a three-phase plan.
The Jewish Home at Rockleigh was built in 2001. That’s not a long time ago, but both technology and the underlying understanding of how to provide both rehabilitation and services to the elderly is dramatically different now. What was state of the art then no longer is so now. “The business of long-term care has changed,” Ms. Elliott said. “People are older, people are sicker, and the technology and knowledge base have changed.”
The plan is to build a new rehabilitation center on the existing building’s east end, toward Piermont Road. It will include an ambulance entrance, which the building now notably lacks; once it is built, patients will be spared having to be taken in through the main entrance, their privacy and dignity compromised. (Privacy and dignity are as important to the elderly as to the rest of us, Ms. Elliott and Ms. Cohen said.) On an even more practical level, they won’t have to be wheeled into the building exposed to the weather; there will be an overhang. Some of the changes are on that basic and practical and necessary a level.
Inside, the new building will have rooms for residents; the center provides both inpatient and outpatient therapy. Now, rehab patients are housed in the nursing home proper; the new building will free up those rooms.
The new center will offer not only such necessary but standard services as speech and occupational and physical therapy, but also new therapies, including warm water therapy. “We will be adding a large pool and two individual therapy pools,” Ms. Elliott said. The therapy pool, which patients can enter in specially designed wheelchairs that roll in a highly controlled way on underwater tracks, comes with cameras that can record underwater motions.
It will also include areas where patients can practice the kinds of mechanical skills they will have to relearn when they are back at home. “There will be skills practice areas set up like an apartment,” Ms. Elliott said; it will include a kitchen and bathroom.
The rehab center is not only for the elderly, she added; it is for anyone of any age who has to relearn the taken-for-granted skills of regular life.
Because of the way we as a society pay for health care, the rehab center provides not only rehabilitation to patients but also gives financial stability to the facility, and that stability is necessary if it is to flourish.
The plan is to break ground on the new rehab center by the end of next summer, and to open it by the summer of 2019.
Once that happens, the rehab patients who live in the nursing home will be able to move to there, and that will free up the space that will allow the next phase of the plan to begin.
“Phase 2 is transforming our large nursing units, with between 42 and 48 residents, to small houses,” Ms. Elliott said. It is these units — these small houses — that are at the heart of the new plan.
“We want these units to be home,” Ms. Elliott said.
The Jewish Home will use the Green House Project model. It’s a holistic understanding of eldercare that reconfigures space and reimagines the jobs of the people who work there. It places a living space in the center of a group of 10 or 12 private rooms, each with its own bathroom, run by a retrained staff whose members are assigned specifically to the unit and therefore naturally develop long-term relationships to the residents.
That circle of shared space, private space opening into it, and a dedicated staff will turn (and over the course of 20 years elsewhere has been proven to turn) what had been long institutional wings into a series of homes.
Residents will be placed using what Ms. Elliott and Ms. Cohen call the integration model. “The integration of people with different levels of cognitive ability works well,” Ms. Elliott said. Instead of warehousing people with dementia together, they will live in the houses, along with people with physical needs. “It is a different concept, and much more humane and more dignified,” she said. “This model shows that skills are preserved longer, both physically and cognitively. The outcomes are better.
“Even family visits are shown to go up,” she said. That’s because it seems more normal to the extended family, who feel more comfortable making more than the absolutely necessary appearances in the nursing home.
“Data shows that there is a lower incidence of incontinence, less weight loss, and even people who have been eating a modified diet are able to eat differently in this setting,” Ms. Cohen said. Part of that is the comfort that comes from the closeness the small group of residents is able to develop toward each other, and toward the staff. “There are only 12 residents, not 42,” she said. “So if someone, say, sees Mrs. Schwartz sitting uncomfortably in her chair, they’ll see it and tell someone because they know what she usually looks like.”
“When you walk around this building now, you see a lot of love,” Ms. Elliott said. “You see a lot of people who really care. But it’s hard to care the same way for 42 people that you do for 12, and it’s hard to get around these long hallways.”
She and Ms. Cohen had just returned from a visit to a nursing home that uses the small house model — it was the most recent of many such visits — and “you see everyone sitting around the table eating lunch together, and you see that they are family members. They are interacting in a way that feels like having your extended family around the table. It is very different from the old institutional/medical model.”
The Jewish Home at Rockleigh is notable for the light that streams into it; it’s full of big, unobstructed windows that almost seem to attract clear light and eliminate dark corners. That light will continue to illumine the small homes, Ms. Elliott and Ms. Cohen said.
Phase Three will involve new kinds of building; those plans are fairly vague for now.
Residents are funded in a variety of ways, both women said. “Many people who come for short-term rehab are covered either by Medicare or by private insurance. It’s rarely privately paid for. Long-term care can be privately paid, with long-term insurance or by Medicaid,” Ms. Elliott said.
It is not surprising that the new plan will cost money. “We anticipate that this will be a $30 million project, and as we have done in the past we are going to the community to ask them to invest their financial resources in this project, and in the future of elder care in this area,” Ms. Cohen said. “And in their own care.
“We have been very successful so far. We have been conducting a campaign, starting just a little over a year ago, and so far we have a little over $12.3 million in commitments.” Now, the Jewish Home is reaching out to the community, and Ms. Elliott and Ms. Cohen are sure it will come through.
“We are well on our way,” Ms. Elliott said.
Eli Ungar of Englewood is the chairman of the Jewish Home Family.
“I think that given their druthers, almost everyone would choose to [stay] in their own home, with the stuff they have filled it with for decades,” Mr. Ungar said. “With their possessions, their pieces of history, their shared memories. But for some people, the reality is that living independently simply is impossible.
“Nursing homes all over the world have experimented with different ways of providing care to people in the settings they most prefer. The Jewish Home at Rockleigh is wonderful now, in many respects, but we have seen and learned that there are in some aspects even better ways to provide for our seniors. One such example is the Green House model.”
The Jewish Home was built just before advances in understanding were made, he said. “A lot of these new understandings were incubated and tested and evolved over the last 10 years. When the home opened, it was a superb example of what was known and understood then. Today we know more and understand better and can learn from the excellent work of others. To ignore this knowledge would be to ignore the best interests of seniors, who rely on us to create the best possible setting for them.
“It is not an easy understanding, or an inexpensive one,” he continued. “But having seen what it looks like, to see how elderly people can experience joy again in everyday living in such settings, our conclusion wasn’t that we should try to do this. It was that it is an imperative that we try to do this.”
But will understanding continue to evolve, so that every decade or so will see the demand for wholesale and expensive changes? No, Mr. Ungar said. Instead, our understanding that elderly people need more agency in their lives, just as the rest of us do, and that joy is available to them, just as it is to the rest of us, is a philosophical reorientation that’s now reflected in this new way of caring for them once they no longer can care for themselves. The model may need to be tweaked, but he thinks that it will not have to be changed fundamentally.
“Underlying the real estate change is a more fundamental cultural change,” he said. “It moves the senior to the center of the universe, in terms of decision-making and the myriad decisions that go into a seemingly typical day. I think that this model will evolve as the decision-maker is no longer a nursing home administrator or a well-intentioned family member but the person, him or herself.”
Carol Silberstein of Tenafly will be the Jewish Home’s next president.
Her mother, Ruth Krongold, is 97 years old and lives at the Jewish Home at Rockleigh. Ms. Silberstein, a lawyer with a local practice, visits her mother ever other day.
“I see so much,” she said. “I see the struggle to maintain whatever dignity and independence you can.
“I have to call the current setup dormitory style, with the long hallways. They did a really nice job at the time, but I see how the small houses would lead to a much closer community.
“I see the loneliness. There are single rooms now, and that is great” — and the small houses will retain single rooms for all residents — “but she is all the way at the end of the hall.” Ms. Silberstein often visits her mother at mealtime, and she talks to other residents as well; over the years, she has developed relationships with many of them. The small house model, which would keep a consistent group of residents together, would make that kind of relationship building easier.
It also would help the staff, she said. “The aides are hard working people. It’s a hard job. But they cannot sit at the table with the residents. There is no room for them. This new concept would allow that.”
It also would allow aides to spend more time with residents because they would spend less time going from one end of a long unit to the other.
The more she sees, the more excited Ms. Silberstein is about the small house plan. “Carol is really visionary,” she said about Ms. Elliott. “We need a visionary person. I love working with her.”
Carl Epstein of Teaneck was one of the founders of the Jewish Home, and he is looking forward to the changes.
“My approach is a little different from the professionals,” he said. “They talk about the wonderful new things, how different it will be, all the benefits that go with it. But I take it from a more emotional standpoint. From the why of why we do this.
“We have a beautiful facility now. Why do we want to do this?
“Because we are Jewish, and being Jewish comes with certain obligations that flow directly from our millennia of tradition, and from the requirements about what we should be doing, and how if we fail to do these things we would be negligent. We would not be fulfilling the spirit of what the Torah tells us we have to do.
“The Torah is very specific. It is interesting that of the 10 Commandments, the first four deal with the relationship between God and humanity, and the fifth is ‘honor thy father and mother.’ The interpretation is that you honor all fathers and mothers.
“We have a very specific obligation to care for our elders.”
To be absolutely practical, it is necessary to come up with a facility that will be able to pay its bills. “We must create a financial model that avoids the bane of all nonprofit nursing homes, which is worrying every Thursday morning about how to meet payroll. We are aware of that problem, and so we put everything into one package. In order to maintain what we have, we have to be cutting edge. We have to be way ahead of everybody.”
“Everything that we are planning to do is in keeping with those Jewish imperatives,” Mr. Epstein said. “If we don’t have the state-of-the-art capabilities, if we can provide quality of life, respect their dignity and self-esteem and we don’t do it, we are failing in our mission and our obligation as a Jewish community.”
Mr. Epstein, like Ms. Silberstein, Mr. Ungar, Ms. Elliott, and Ms. Cohen, is certain that the Jewish Home at Rockleigh will live up to its mission and obligation as part of the Jewish community to provide the best possible care to its residents and rehab patients, and to enrich their lives.