The young architect was furious.
Visually impaired and confined to a wheelchair without the use of one side of her body, she was quartered in a poorly
lit room ill-designed for her needs. With everything from towel racks to light switches out of reach, she was at the mercy
of others to bathe, dress and feed her. She endured the humilities of being assisted on the toilet and, for her bath,
elevated five feet above the floor by a mechanical lift that swung her around and lowered her like a sack of potatoes into a
tub of water.
After three days, she got out of her wheelchair and confronted the man who had put her there: Steve Shields, Executive
Director of the Meadowlark Hills nursing home in Manhattan, Kansas.
"We are going to fix this," she vowed to him in a low, emphatic voice.
She was intensely angry, not at Shields, but from her new-found awareness of the cold, unnatural surroundings in which
many seniors live.
Her mood told Shields that his plan had succeeded: the architect who would help design Meadowlark Hills' new facility had
been emotionally sensitized to the urgent need for a complete culture change in the home's environment.
It was a pre-condition to signing the contract, Shields had told the partners of the prospective architectural firm. One
of you must be admitted as a resident to Meadowlark Hills.
There was a moment of silence, the senior partner looked at the junior partner, and the latter subsequently was seated into
a wheel chair, told not to use the left side of her body, and fitted with Vaseline-smeared glasses. For the next 72 hours, she
was treated like any other Meadowlark Hills resident.
"We should have done it for only 24 hours, because I think we almost impaired her mental health," says Shields. "To know
that it affected [her] so emotionally after only 72 hours, you realize what institutionalization does to our most vulnerable
people who are truly dependent."
Fixing how we treat elders in these environments, says Shields, is a moral imperative that must involve everyone, not just
nursing homes. To that end, he and his crew are involving everyone within reach in creating a livable, nurturing environment
for elders and staff at Meadowlark Hills.
About five years ago the facility, a nonprofit, ecumenically-sponsored retirement community, realized the need to expand to
meet the community's growing need for assisted care. With expansion came the opportunity for redefining the home's values,
says Shields, "and a much stronger drive to elevate the place of elders in our community."
A strategic plan was developed, architects engaged, demographic and financial feasibility studies performed and focus groups
organized.
"Our residents really drove the decisions," he says. "This wasn't something we just took off and ran with."
Wharton Manor, another local nursing home, was brought into the planning process, resulting in its eventual merger with
Meadowlark Hills, a move Shields calls the most strategically critical part of the expansion plan.
He took the plan to the local community. "Help us," he asked, "or we'll have to keep doing the same old things."
The community responded with gifts of $3 million. Another $27 million was raised by underwriting a bond issue.
The essence of the planners' vision involves replacing the facility's institutional unit with households where elders, 15 to
a household, feel at home and in charge of their lives.
"What we think is unique about what we've done environmentally is to go through piece by piece and pull out everything we
could that was institutional," says Shields. "Stainless steel tray transport racks, med carts, the visibility of lifts in the
hallways, peeping wonder guard alarms.. I mean, everywhere you look we've made something completely unnatural about aging."
Various units of the new structure were designed by those most attuned to the needs: bathrooms by the residents and nursing
assistants, kitchens by the kitchen staff and assisted-living apartments by the residents and focus groups.
The architect put to work the insights she gained as a temporary resident in designing the health unit. She maximized
independence for the residents with the way she placed towel racks, toilet paper and other items impacting elders in their
daily lives that most people don't notice. By strategically placing lights and adding huge windows in each room, she brightened
the environment and gave residents a connection to the outside world with a beautiful view of the surrounding foothills.
Some of the households have been completed and residents from Meadowlark Hills and Wharton Manor are moving in. The focus
now, says Shields, is to create a culture within the new homes that stimulates self actualization on the part of residents who
live there, and that makes the household "a place to continue growth, not a place to come to die."
His suggestions for other homes seeking culture change?
First, "dare to do it," he says. "We have a tendency in our industry to ponder too long. Start taking action.. articulate
the vision that is unique to your place."
Second, bring the broader community into it. "We lead too secluded of a life in long-term care. We've got to get out there
and bring resources, spirit, energy and support into the [nursing home] community. Get out there," he concluded.
