Vocabulary: A Case to Drop "Home-like"
The word "home-like" has bothered me for a long time. It describes the type of environment that long term care communities must create for their residents.
The federal government mandates a home-like environment for skilled nursing participation in Medicare and Medicaid. A deficiency can occur under F-584 for lack of a safe/clean/comfortable/home-like environment. As a result, this violation also carries the distinction of sub-standard quality of care.
As defined in the SNF State Operations Manual:
A "homelike environment" is one that de-emphasizes the institutional character of the setting, to the extent possible, and allows the resident to use those personal belongings that support a homelike environment. A determination of "home-like" should include the resident's opinion of the living environment.
Clear as mud, and easy to objectively measure, right? To that end, allowing residents to bring their personal belongings qualifies. How generous of us.
I dislike the term "home-like" because it sounds like a cop-out. We can aim for something "similar but not exactly." It's as if we give ourselves a pass for falling short. We can set the bar low and still be in compliance.
A definition of home has been penned by fifth-grader Wynn, the winner of Habitat for Humanity essay on the meaning of home. He writes, "Home means an enjoyable, happy place where you can live, laugh and learn. Home is where one is loved, respected, and cared for."
Perhaps CMS could adopt this definition and base compliance on objective resident, family, and employee feedback? But, this is a subject for another day.
Research on factors influencing a sense of home in nursing homes reveals that psychological and social aspects are just as important as the physical space. Is this easy to do? Certainly not. Is it the ideal to strive towards, I believe so.
If you accept 5th grader Wynn's definition, then to create home means that we must provide a place that is happy rather than sort-of-happy. Above all, home means that we respect residents rather than something short of respected.
I submit that we want no less for ourselves. It may be near impossible to replicate the physical space of home. Nevertheless, stressing the importance of the emotional aspects of home puts us a step closer to having communities that are home vs. home-like.
In conclusion, consider a new perspective. People living in our community are:
- treated with respect and love
- having fun
- safe and cared about
- given opportunities that promote meaning and purpose in their lives
Julie has worked in Aging Services for over 30 years and has been a Licensed Nursing Home Administrator since 1990. She is a Certified Master Trainer with the AGE-u-cate Training Institute. Through her company Enlighten Eldercare, Julie provides training and educational programs on elder caregiving for family and professional caregivers. She is an instructor and the Interim Director of Gerontology at Northern Illinois University and lives in the Chicago Northwest Suburb of Mount Prospect, IL.