There is so much each home has to do to turn its systems around from the way they are institutionally geared to being individually geared. If homes are starting in that direction and know that they're not done, it seems like that's what they can say.

Ultimately, if people who live in a nursing home can live their lives as they would at home, but with the added benefit of caring support, then that home would be individualized in its care systems and practices.

OBRA actually gives pretty good language both in the Quality of Care section and in the Quality of Life section for the kinds of outcomes we should be seeing if homes are functioning in an individually-driven way.

I have a fear about moving too quickly to quantify and define something that is still developing and emerging because if we put parameters around it we may cut off the learning that is still underway.

It feels more useful now to capture experiences, practices, benefits and lessons from this development and spur on more. Windows of opportunity to innovate and change the norm are fragile and often short-lived. The rush to quantify could well lock things up and close off the innovation. And we still have so much to learn.

Sorry not to have something more definitive. A lot of state coalitions are grappling with this and I have a strong feeling about asking all of us to allow the unknowing the room it needs to take form rather than rushing to definition.

Take care,
Barbara

While Meadowlark did not go to a buffet style dining, we did convert to food prepared and served on site. What this has in common with buffet dining is that residents had the right returned to them to eat what they want when they want, which I assume would be components of your planned buffet dining lifestyle. Weight loss reduced by 92 percent in the first year and socialization dramatically improved during meals. Resident satisfaction with meals improved 67 percent.

Beyond that, it is difficult to gather data for something so elementary to our life satisfaction and quality. Its like wanting data to prove whether a dog is happier on a rope or free to roam. Somethings are just known and part of universal truth in the human condition.

Hope this helps.

Steve

1. Responses we have made to inquiries concerning compliance with the long-term care health and life safety code requirements in nursing homes that are changing their cultures and adopting new practices;

2. Summarizes questions and answers from a June, 2006 CMS Pic-Tel conference with leaders of the Green House Project (Attachment A); and

3. Provides information about an upcoming series of 4 CMS culture change satellite webcasts (Attachment B).