The Villas at Killearn Lakes vision: What are we striving for?
Christopher P. Mulrooney, M.P.S., Ph.D.
Partner and Chairman of the Board
As with anything innovative, it is difficult to articulate in a few words what’s different about Villas at Killearn Lakes. Frankly, there are many things that are unique about this approach to assisted living and memory care, and only over time will those differences be clearly seen. For now, though, I’ll do my best to use words to paint the picture.
It’s probably best to start with our actual vision statement: To advance culture change and the small house movement through innovative philosophy, architecture, staffing patterns and service delivery that result in the provision of high quality personal care services.
Immediately, this statement begs explanation, since many of the words and phrases are not used in typical conversations about assisted living. For instance, what is meant by culture change? “Culture change is the common name for a global initiative focused on transforming care, as we know it, for Elders and individuals living with different physical, developmental, intellectual, and psychological abilities” (The Eden Alternative, 2012). It’s clear from this definition that those of us who subscribe to it, believe that the status quo in our field isn’t good enough. Something has to change. And my colleagues and I believe that what has to change is the very culture of aging services delivery.
Let’s face it: by and large our society has a negative view of growing older, and still struggles (though less so, with increased advocacy efforts) to acknowledge that differing abilities don’t equate with strength vs. weakness. We often overlook or don’t even recognize how physical and/or cognitive challenges enable us to rob someone of his or her personhood. And worse yet, as children of aging parents, we are often the most egregious of these thieves.
There is often no place where this is as evident as in congregate care environments, such as nursing homes, assisted living facilities, or other similar settings where increasing needs and increasing age intersect. Regulations intended to protect vulnerable citizens, along with well-meaning, but poorly trained staff, have often created a culture that is focused primarily on minimizing risk, preserving the power deferential in favor of management, and marketing to guilty family members through well-placed decorations and lovely chandeliers. Even in the best of circumstances, such environments are devoid of any meaningful engagement, and have a tendency to infantilize or over-protect those who have raised us, fought for us, built our economy for us, and spent 80, 90, or 100-plus years sacrificing for us. Can’t we do better for them?
Scott (2015) reminds us to “Think about the people that live in our communities. They are waiting all day long. Waiting for the next meal, waiting for the next scheduled event. What’s the opposite? Engagement. Excitement. Involvement! That’s what we need to be seeing. People that are excited to be alive. And what excites people? A chance to use their wisdom, their life experience, their talents, their potential. When we don’t get to do these things we feel useless. And who wants to feel useless?”
As The Eden Alternative (2012) puts it: “As human beings, we are inclined to pay more attention to the negative rather than the positive, to see the limitations rather than the possibilities. Our language and our societal perceptions reinforce the view that aging and/or living with physical, developmental, intellectual, or psychological challenges equals decline or disability. Well-being, as a frame of reference, requires us to focus on the strengths, possibilities, dreams, and goals of each individual. Doing so, we define quality of life in terms of what each individual can do and what they have to offer their communities.” Villas at Killearn Lakes is about this re-framing from disease to well-being, both within its walls and outside of them.
A large part of this re-framing is in the design of our neighborhood. The “small house” movement is about providing personal care services in more reasonably sized environments – real houses, rather than “facilities.” No matter how lovely the chandeliers in those facilities are, we believe that most of us would rather stay at home as we age and receive any needed services through home care. In a sense, that’s what Villas at Killearn Lakes is – home care, but with the home added in. Sometimes it’s impractical to stay in the house or apartment where one has lived for many years. If care needs necessitate a move, that’s hard enough that it doesn’t need to be exacerbated by having to accommodate oneself to institutional rules. We believe it’s degrading to be told what time to get up, what time to eat, and that the kitchen is off-limits. Each “villa” at Villas at Killearn Lakes will be a gracious home to 12 persons, who will share a Great Room, kitchen, dining area, and the use of a private spa area. Each person will also have their own private bedroom, bathroom, and barrier-free shower.
No matter how innovative our architectural design will be, the heart of culture change is in staff- resident relations. The innovative philosophy, staffing patterns & service delivery mentioned in our vision is best understood in terms of “person-directed care.” “Person-directed care is structured around the unique needs, preferences, and desires of the individual in question. Through this approach, decisions and actions around care honor the voices and choices of care recipients and those working most closely with them” (The Eden Alternative, 2012).
Misiorksi and Rader (2005) have done a good job of describing how Person-directed care differs from traditional care models by depicting this continuum. It moves from a model where the organization makes most of the decisions to one where the residents make most of the decisions:
Creating a Person-directed culture involves daily attention to key themes, and that’s more comprehensive than this short article could cover. The four core values that guide our efforts are the best way to outline them briefly. These values are:
Mutuality – My own research (Mulrooney, 1997) and the experience of those in this field has shown that care partners across a variety of long-term care settings are driven most by a need for affiliation – the maintaining of close, meaningful relationships. This is often satisfied in long-term care through resident relationships. And the reality is that residents in these settings lose their identity when no one engages with them on a deep-enough level to know who they truly are, what strengths and gifts they possess, and how those gifts can continue to be used and valued despite physical and cognitive challenges. Mutual relationships that are more reciprocal in nature form care partnerships that engage both residents and staff in ways that create well-being for both. At Villas at Killearn Lakes, this value will be lived out through consistent staffing patterns, decision-making at levels closest to the resident, strengths-based (rather than deficit-based) resident service plans, and “house rules” generated by residents and staff together.
Personhood – Judith Carboni (1990) writes, “Elderly residents in [long-term care] face non-personhood: identity becomes murky because they no longer have a special bond with a place that held a significant, personal meaning.” Profound and frightening, this statement only begins to address what we hold dear about the concept of personhood at Villas at Killearn Lakes. Our philosophy and values are rooted in the belief that each of us is created in God’s image, that our identity is sacred because it first belongs to Him, and that a life lived long should not and cannot be reduced to a “less-than” status simply because it’s measured against the standards of our society rather than the image of its Creator. We will live out this value by helping residents engage in ways that are meaningful to them personally, and not primarily through group activities that appeal to the masses; and by addressing the whole-person needs of those we serve, including attention to each individual’s spiritual, emotional, and psychological well-being, as well as their physical wellness.
Choice – Anything less than “…to be respected for one’s ability to decide for oneself, control one’s life and absorb the costs and benefits of one’s own choices,” as The Eden Alternative (2012) describes autonomy, sets up a “…condition which allows or invites sympathy, pity or invasive paternalism…If people are only able to choose between courses of action that are ‘good for them’ or ‘pre-selected,’ then the true dimension of autonomy is greatly diminished.” At Villas at Killearn Lakes, this core value will be operationalized through daily life in one’s own home – not an environment that is “home-like,” but home. This means residents choose how they will live each day, with as little assistance as is necessary for them to preserve an autonomous quality of life that each of us desires at our core, and as much assistance as is necessary to maintain wellness as each person defines it.
Quality – It is hard to imagine a health care organization these days with a vision, mission, or values statement that doesn’t include reference to quality. As consumers, we all want to receive services from health care providers who strive for high standards and quality outcomes. But what does this really mean? Quality has to be measurable for it to be meaningful. Villas at Killearn Lakes subscribes to the model that well-being and its seven primary domains: identity, growth, autonomy, security, connectedness, meaning, and joy, are the most appropriate way to measure quality in an assisted living environment (The Eden Alternative, 2012). These domains are interwoven into our four core values and will be studied regularly in our continual quality improvement process.
Ultimately, what we’re striving for at Villas at Killearn Lakes, is to help combat the ageism that pervades long-term care services and our society, in general. Progress is being made on this front every day, and we are excited to be a part of it. For instance, as reported recently in an aging network newsletter, new research is demonstrating that persons with dementia are capable of leading small group activities for other persons with cognitive loss. Srajner et al. (2014) found that residents leading groups “…were able elicit high levels of positive engagement and affect in their fellow residents with dementia. Not only that, but the results were obtained across a wide range of dementia levels. The implications of this research are significant. Residents helping residents: not only does this provide a new meaningful collective social identity for residents with dementia, but it also flies in the face of the ‘ageism’ that persists against seniors.” Such efforts at working from a strengths-based perspective in assisted living and memory care is what we espouse. The emphasis on “assisted living” should be on the living part of that phrase. Life is a gift that is no less precious when we need a little help to live it to the fullest.
Do we expect it to be easy to accomplish this vision? No, but nothing of value ever is. A vision is an ideal state, something for which an individual or an organization continually strives. While we don’t expect to eradicate the challenges of growing older, we do hope to share them and ease the burden of them just a bit. A vision is a journey more than a destination. And the journey is richer when we share it with others. We consider it a great privilege that we will soon be sharing that journey with those who entrust us with this opportunity at Villas at Killearn Lakes.
Dr. Mulrooney is an Assistant Dean and member of the Geriatrics faculty at the Florida State University College of Medicine. He is a gerontologist and organizational psychologist, and has been advocating for and applying his passion toward culture change in aging services and long-term care since he felt called to the field at age 15. Since then, he has served in roles from care partner to CEO.
Carboni, J.D. (1990). Homelessness among the institutionalized elderly. Journal of Gerontological Nursing, 16(7):32-37.
Misiorski, S. and Rader, J. (2005). Continuum of Person-Directed Culture. Unpublishedconceptual model distributed at the Pioneer Institutes.
Mulrooney, C.P. (1997). The Person- and Relationship-Centered Caregiving Trait and Other Characteristics of Outstanding Nursing Assistants in Long-Term Care Settings. Unpublished doctoral dissertation. Boston University.
Scott, D.B. (2015). Ideas to Inspire. Kinnelon, NJ: Denise B. Scott, LLC.
Skrajner, M. J., Haberman, J. L., Camp, C. J., Tusick, M., Frentiu, C., & Gorzelle, G. (2014). Effects of using nursing home residents to serve as group activity leaders: Lessons from the RAP project. Dementia, 13(2), 274-285.
The Eden Alternative (2012). The Eden Alternative Domains of Well-Being: Revolutionizing the Experience of Home by Bringing Well-Being to Life. Rochester, NY: The Eden Alternative, Inc.