Ten thousand Americans turn 65 every day, and will continue to do so for the next 19 years, according to a study by the Pew Research Center. By 2030 in New York City, one in five residents will be over 65.
“There can be no more ‘business as usual’ when it comes to aging,” Audrey S. Weiner, president and CEO of Jewish Home Lifecare, says in an interview. “The numbers are too high, the stakes are too great, and the lives are too sacred.”
By the end of this year, Jewish Home Lifecare is slated to break ground on a new 20-story facility on the Upper West Side, to replace its nursing home on 106th Street. To be called The Living Center of Manhattan, it is based on a radically innovative model of elder care called Green House, in which a larger facility is organized into smaller units that operate like households. Decisions are guided not by the needs of the institution as a whole, but by the needs of the elders within a particular unit.
The project, at 97th Street between Amsterdam and Columbus avenues, represents several firsts. It’s the first high-rise Green House project in a major U.S. city, and the first to include a unit designated for elders from the LGBT community. With an estimated cost of more than $285 million, this is the single largest eldercare capital project in New York. And Jewish Home Lifecare officials have worked collaboratively with the union, SEIU (Service Employees International Union) 1199 United Healthcare Workers East, to reorganize the staffing plan, job descriptions and the general culture change regarding how things are done.
According to plans, they will establish 22 houses, as the small units are called, each with 12 residents. Wiener describes the houses as “a cross between a kibbutz, a commune and a college dormitory.” Each unit includes an open kitchen area, a large communal table and a central living area with lots of light and 12 private rooms, each with its own bathroom — without the feel of a hospital or typical nursing home. There are no long hallways with hard linoleum floors in shades of hospital green (the facility is carpeted), no lineup of patients in wheelchairs waiting for transport to a meal or activity (meals are served in the unit and residents decide when and what they’d like to eat; they also decide about how they want to spend their time), and staff members, now empowered, are never too busy to pay special attention to each elder.
“It all comes down to autonomy. No matter how old or young, that desire to make choices — even if they’re not the best choices — is so important,” Susan Frazier, chief operating officer of Green House, tells The Jewish Week. “We’re trying to create an environment where the elders can grow, thrive, live a life that has meaning and purpose.” Founded in 2003 by William Thomas, Green House now partners with organizations in 25 states and with 153 facilities; it serves than 2,500 elders, and also has potential projects in development in eight additional states. Green House is supported by the Robert Wood Johnson Foundation.
In an article in a new book edited by Weiner and Judah L. Ronch, “Models and Pathways for Person-Centered Elder Care,” Thomas describes the “urgent need to change aging.” In Green House facilities, specialized workers are called shahbazim (named for the Persian word that means royal falcon, an image that evokes courage and strength — Thomas likened them to “midwives of elderhood”). The individual, a shahbaz, is a direct care worker trained as a CNA (certified nursing assistant), food services worker, activities catalyst, light housekeeper, and member of the self-managed team that communicates with medical and other staff.
At The Living Center, these staffers, members of 1199, will be called adirim, after the Hebrew word for noble. As Weiner says, “This is noble work.”
In addition to those staffing the LGBT unit, all staff members will receive special training from SAGE (Services and Advocacy for GLBT elders), a national organization headquartered in New York. Catherine Thurston, senior director for programs at SAGE tells The Jewish Week that she knows of partners of LGBT elders — a rapidly growing population — who are so nervous that their loved one might be victimized that they pretend to be the sister or cousin rather than the partner.
LGBT elders can choose between living in the specialized household or to be integrated with other residents. There will be no separate units for those with dementia; rather, they will live among others, cared for by the staff members who will follow a philosophy of care called “comfort first.” For all the elders who move in, Weiner sees this as their final home.
“We want them ultimately to have a good death, with the people who’ve known and loved them, whether staff people or the other elders, and their families,” she says.
The facility can accommodate 414 elders; 150 beds are available in five state-of-the-art post-acute rehabilitation units for short stays. Two of the houses will be for elders who keep kosher, and one of the rehab units will also be kosher.
Weiner says Jewish Home Lifecare hopes to open at the end of 2017 or early in 2018. To date, it has raised $40 million in a capital campaign and has to raise an additional $25 million. The rest of the $285 million budget will be met through a mortgage (JHL is working with HUD on mortgage and financing issues), and from a land deal the organization made with developer Joseph Chetrit. An owner of Park West Village, where the building will stand, he offered Jewish Home Lifecare a decades-old parking lot to build on (and a payment) in exchange for the 106th Street building. At first, Weiner explains, JHL thought it would sell half of the 106th Street space and build on the other half, but this deal gave it a square space that would accommodate the kind of building it wanted from an architectural perspective, and would make building less difficult; they would not have to move residents out during construction.
Weiner says that the operating costs will be the same or lower than those of a traditional nursing home. Based on current market conditions, the organization has budgeted $650 a day. “We don’t know what market conditions will be three years from now, but the prices will be market competitive,” Weiner says. JHL will continue to accept Medicare, Medicaid, private pay and applicable insurance.
The residents now at 106th Street will have priority in reserving space in the new building, which will also include a synagogue (a full-time rabbi is on staff), Judaica library, spa, café and a roof garden for herbs and vegetables. Weiner recognizes that most New Yorkers want to age like New Yorkers, with close connections to the city they love.
There has been some pushback from the Park West Village community about the building, which is to be constructed next door to Public School 163. Jewish Home Lifecare is now completing a draft environmental impact statement, and Weiner is committed to working with the community — there will be no deliveries to the building during school hours. Public hearings are scheduled this week.
Jewish Home Lifecare’s history dates back to 1848, when Hannah Leo and the women of Congregation B’nai Jeshurun began making house calls on poor Jewish women. Almost 167 years later, the organization operates several facilities in the Bronx, Manhattan and Westchester, with assisted living, independent living, day programs, homecare and a research institute, among its programs. It employs more than 3,500 people — all of whom will receive SAGE training about dealing with LGBT elders.
Thurston of SAGE says that a common question that comes up is, “I treat everyone the same. Why do I need training?” She responds that the challenges that LGBT seniors experience in life before getting to a home or senior center make them less likely to be open and authentic.
“A nursing home is still a nursing home,” she says. “You have to shake up the whole philosophy, which is what Jewish Home Lifecare is doing.”
In her book, Weiner writes about the process of working with staff, residents, trustees, families and management to imagine how they might do things differently. At one meeting, they served trustees and managers meals on trays, complete with bibs. In the new facility, elders will eat at their communal table, in dignity, at home.