so seniors can "age in place"
The concept deinstitutionalizes care in a facility heavy with green features
by JOHN FOYSTON. THE OREGONIAN. 05.28.2008.

TIGARD -- Elite Care at Fanno Creek opened this month, bringing a new kind of elder care to Tigard, an innovative blend of high technology and old-fashioned extended family ties that keeps residents involved and active and allows them to "age in place."

"We want people to have a sense of belonging," said Bill Reed, who developed Elite Care with his wife and business partner, Lydia Lundberg. "We want them to have influence over their surroundings, and we want them to have purpose."

Elite Care does that through what it calls relationship-based care. It is best understood by looking past the many sustainable and green features of the new Craftsman-style buildings just finished on Southwest Grant Avenue. Which is not to discount their triple-pane windows or thick insulation; the rainwater captured in tanks to flush toilets and irrigate; the "fly-by-wire" light switches that go not to fixtures but to a computer that decides the intensity and color of light based on the time of day.

There are geothermal heat loops in the ground, heating panels and photovoltaic cells on the roof, and reverse-osmosis filters to strip chemicals from potable water. Miles of wire and electronic sensors monitor real-time energy use, water flow and the location of every caregiver and resident. High-tech -- but like the best technology, the systems are transparent.

Working in service

They work behind the scenes and in service of the people living out their last years as functioning, contributing members of a community.

"They're definitely about person-directed care and creating a home," said Joanne Rader, "not a homelike setting, but a home -- there's a real difference."

Rader is a long-term care nurse and an advocate working in Oregon (as part of Making Oregon Vital for Elders) and at the national level with the nonprofit Pioneer Network in Rochester, N.Y. Both organizations work to effect a broad, grass-roots culture change in elder care, a change marked by a shift away from institutional settings.

Elite Care is one of many organizations that are part of that culture change, Rader said: "They're honoring the individual, knowing the person, allowing decision making to happen at the bedside between resident and caregiver, and they're honoring home."

The spacious, open, sky-lit kitchens in the two houses at Elite Care Fanno Creek are perfect examples, places where people gather as chefs preside over L-shaped islands.

"The kitchen is the heart of any home," Reed said. "Here the kitchens are open and the chef is part of the entertainment and the relationship. In most care facilities, the kitchen is behind closed doors and people eat in dining rooms -- that tells people that they aren't home."

Many elder-care facilities seem to go out of their way to tell clients they are not home, with designs that include long, windowless hallways and rows of blank doors, and by the segregation of people based on how well they function. You'll find none of that at the new place in Tigard or at Oatfield Estates in Milwaukie. That is Elite Care's first facility, one that's received national attention for innovative use of technology.

Extended families

Elite Care Fanno Creek has no blind halls. Instead, bright, spacious suites radiate like spokes around the central kitchen or, on the third floor, the communal living room. Each of the two houses is home to 12 to 15 residents, and each functions like an extended family, Reed said, where residents look out for one another and are involved.

The only long hallway has a row of windows over a long stainless-steel covered potting table, where residents can garden -- there are greenhouses inside and out, and garden boxes ring a second-story walkway. Residents will grow vegetables and herbs for the kitchens, and the Milwaukie site even had a market day recently.

Involving residents in growing food, and monitoring and fine-tuning their energy use, allows them to influence and act upon their world. That is especially the case in weekly home meetings, when residents will talk with staff about how the houses are run and suggest new activities.

"Resident-directed care and a high ratio of caregivers to residents are some of the ways that we deinstitutionalize long-term care," said Ellen Liu Kellor, an elder-living specialist with Elite Care.

A network of sensors that tracks the location of every resident and caregiver by their badges seems vaguely Orwellian, but it allows people who function at different levels to remain together even as their faculties diminish. These promise to be families that stay together.

"The integrated population is very different from the segregation model, where people are constantly uprooted and put in different living situations as they age and their abilities change," she said. "Here, people can age in place and remain a part of their extended family, and the partnership between technology and human relationships is what makes that community possible."

This story was originally appeared in The Oregonian