MIDWAY — At first glance, Homeplace at Midway certainly doesn't look like a senior care center.
With touches of Craftsman design on one cottage and French County on another, the collection of structures looks more diverse than the standard subdivision and nothing like the standard nursing home.
"The design is certainly noteworthy because it is so radically different," said Keith Knapp, president of Christian Care Communities, the non-profit building Homeplace.
But Homeplace is notable for several other reasons, too, he said. First, it represents an equally radical departure in how older people live together in assisted living and nursing home environments. Second, the Midway community has been working for 16 years to make it happen.
The Midway Nursing Home Task Force has met monthly all of that time, said long-time member Helen Rentch.
"We thought it would be a real simple thing," said Rentch, 68, who works part-time as a nurse. "We thought it might take three years."
Instead, she said, "we constantly met barriers."
The idea hatched in 1998 seemed pretty simple. There were people getting older in Midway and they needed assisted living or nursing home care so they didn't have to move away.
At the time, there was only nursing home in Woodford County, Taylor Manor, and it was privately run and didn't take Medicare or Medicaid, Rentch said. People were having to seek nursing home care outside of the county. In one case, a family had to settle a loved one in far away Pike County.
But the simple problem ended up having a rather complicated solution. First, the state initially was not allowing the addition of any new nursing home beds. Second, and what would prove to be the bigger challenge, the financial model for the nursing home industry said 60 beds was the minimum number for a facility to make business sense.
Early on, the task force worked with Christian Care Communities. At the time, however, Christian Care couldn't figure out a way to make a smaller facility financially viable.
The state would only approve 23 beds for the Midway facility, said Knapp. That required what he called "a work around." In this case it was a $2 million fund-raising campaign.
It allowed Christian Care to lower the cost per square foot to a point that Homeplace could be affordable and sustainable. And, he said, it helped the community feel even more involved in the process of creating a nursing home in Midway.
Also, starting in 2006, Knapp and the task force decided to implement the Green House Project model, created by Dr. Bill Thomas. With it, nursing home care is reinvented from institutionalized facilities to close-knit communities of residents and caregivers.
Since 2003, dozens of organizations have adopted the model across the country. Homeplace will be the first Green House model nursing facility in Kentucky.
Christian Care and the Midway task force began working together in 2006 to create $13 million Homeplace at Midway, which will have a total of 47 beds: 23 for short-term and long-term care; 12 assisted living beds, 12 memory/personal care beds.
A home-like environment
The goal of the Green House project model is to create individual cottages with a home-like environment where groups of 10 to 12 seniors live together. The residents and staff work as a team to create house rules, even menus. The same small number of staff members stay with the same group of residents. The physical space is reflective of a family home with a large, communal dining table and living room space and individual rooms.
While that may sound like a simple concept, in reality it involves rethinking everything about how geriatric care is delivered, Knapp said. The current nursing home model is similar to the medical model of a hospital. Much of it, Knapp said, is designed for the ease of the care provider, not the comfort of the person who is receiving the care. And in most states, including Kentucky, the state regulations dictating how care homes operate reflect that medical model.
Creating something different at the Homeplace involved coordinating efforts of nine different agencies across two different state cabinets, Knapp said.
Even some seemingly common sense things were challenging. For example, a first step in creating a more home-like atmosphere involved eliminating the wide, pervasive hallways that make a nursing home building feel institutional. But state fire codes required hallways to be at least eight feet wide so two hospital beds could be wheeled through side-by-side. It also set a minimum requirement of how far each room could be from a fire exit.
Christian Care Communities and regulators had to be willing to talk about "why do the rules exist," Knapp said. And eventually the groups were able to find a way to keep residents safe and offer a place that feels like home. While there were many challenges, "none of them were insurmountable," he said, adding that it helped that by the time work began on earnest on Homeplace, the Green House project model had been successful in other places.
Midway's Homeplace is under construction and scheduled to open in the spring and both Rentch and the Christian Care Community team are palpably excited.
A team effort
Tonya Cox, Homeplace executive director, has visited other Green House project model facilities to learn how to properly use staff and integrate residents and employees into a team. Each of the 42 people who will make up the staff will also receive 120 hours of special training.
Everything from plants to pets to what's on the menu for dinner will be a collaborative effort between staff and residents, she said. The same staff members who provide routine medical care will also help with the cleaning and cooking in the cottages. A mix of new employees and volunteers from other Christian Care facilities will work at Homeplace.
As the community becomes established, new residents will be paired with a fellow housemate as a mentor to help them understand how things work, she said.
Most senior citizens don't want to give up their autonomy and choices, she said. And the Green House model helps them "have meaningful and productive lives and be involved" in how things work in their home day to day, she added.
Part of the community
But the model extends beyond the walls of the cottages, Cox said. It is important that Homeplace at Midway be a part of the community. There are plans to have Midway College students do internships at Homeplace and to create opportunities for Homeplace residents to attend classes at the college, which is just across the street.
The Homeplace campus also includes walking trails and, in a later phase, will include patio homes for people such as Rentch who are looking to downsize but who are not yet ready for assisted living.
Plus, there is a meeting room that Cox hopes will regularly serve both residents and the whole Midway community.
"I am so convinced that this is the way to go," said Knapp, that if the Homeplace is successful the Green House model could be used in other Christian Care homes in Kentucky.
And, finally, it fills the need identified by the task force 16 years ago: folks from Midway and Woodford County who love their community don't have to leave.