Nursing Home of the Future: Mamaroneck's Sarah Neuman Pioneering Resident-Centered Care

Although few would plan for the years after retirement to be spent in a nursing home, unforeseen illness and declining mobility could render dreams of traveling the country by RV or perfecting a golf swing unlikely. 

According to a 2004 report compiled by the Centers for Disease Control (CDC), 27 percent of Americans over the age of 65—1.3 million—were residing in nursing homes.  What’s more, the Census Bureau predicts that the population of people 65 and over will more than double to 86.7 million in 2050 from 36.3 million in 2004, a number that reveals the potential rise in health issues as a result of an aging population whose life span has become increasingly higher than in previous years.

But with many elderly people stubbornly resisting the transition to a nursing home—stereotypes of loneliness, isolation and stifled independence abounding—is there any alternative other than home health care for people requiring day to day care?

Based on the teachings of Dr. Bill Thomas, a geriatrician whose Eden Alternative philosophy teaches that “aging should be a continued state of development and growth, rather than a period of decline,” the Sarah Neuman nursing home in Mamaroneck plans to build a free standing set of buildings modeled after Thomas’ Green House project, which will address what Thomas says are the basic problems affecting nursing home residents: loneliness, boredom and helplessness.

In a poignant quote from a National Public Radio (NPR) interview in 2005, Thomas said, "I believe that in the nursing home every year, thousands and thousands of people die of a broken heart. They die not so much because their organs fail, but because their grip on life has failed."

“The initiative is an outgrowth of our cultural change,” said Lisa Feiner, chair of the Sara Neuman board, continuing, “This is our first push toward resident-centered care and an effort to create smaller communities where residents and staff would have continuity to move together.”

The $15 million project will include the construction of a two-story main Green House building that will house 24 residents (12 on each floor), on the corner of Rockland and Palmer Avenues.  The current front entrance reception area and walkway to the nursing home will eventually be knocked down when construction begins, and the existing offices relocated.  The project is slated to begin mid-2014 and will take several years for completion.

Part of the $15 million project will also include the renovation of the Pavilion—a three-story building which was built in the ‘70s for assisted living—into five small houses modeled in both architecture and quality of care, after the main Green House.  The renovations will begin later this year. 

“There will be some shared rooms in each house—our footprint doesn’t allow us to expand,” explained Feiner.

The concept is quite revolutionary. The Green House model does not resemble the institutional hallways of a typical nursing home, but, instead, strives to look like the comfortable homes where elderly residents previously lived.

Any and all patients will be accepted into the Green House for long term care regardless of the severity of their conditions, which represents a departure from traditional assisted living facilites where critically ill patients are often designated to more institutional setting.  

“I think that is really a big change,” said Feiner.

Each resident will have a private room. The building will be constructed with many windows and an emphasis on natural light, with common areas including a front porch, outdoor garden, kitchen, dining room, fireplace with a hearth, living room and other areas where residents can spread out. 

Additionally, with a 2:1 ratio between shahbazim—primary caregivers—and residents, there will be an emphasis on individual care.  According to Feiner, shahbazim will have nursing backgrounds as well as culinary training, and, in a further departure from tradition, will not dress in nurses’s whites.

And, much like its name implies, the Green House will adhere to principals of environmental sustainability.  As Jeanette Cohen, marketing manager and community liaison for Jewish Home Lifecare explained, environmentally friendly feature include a roof that collects stormwater; porous pavement in the garden and a sifter in storm drains to help clean water before it drains into the sewer system.

“We’re trying to get some level of LEED certification,” said Cohen, about the Leadership in Environmental and Energy Design designation. 

Nationwide, the Green House currently has 134 locations, with an additional 106 in development now. Two of those 106 are in New York: Sarah Neuman and a 20- story stand alone house on W. 97th Street in Manhattan, which will be part of Jewish Home Lifecare, the parent organization of Sarah Neuman.

“It’s nice to be at the forefront,” said Feiner. 

Although the Legacy, or original, nursing home will remain the same for now, Feiner said that the long-term goal for Sarah Neuman is to move toward the small house model when funds are available. 

But will the new model cost more to operate?

According to Feiner, the answer is no. Green House is expected to be “cost-neutral,” with operating expenses on par with what they are currently.

Approximately 10-15 percent of residents pay out of pocket for the nursing home, with the remainder covered by Medicare and Medicaid reimbursements. A large percentage of Sarah Neuman’s current residents are from the surrounding area, with a few from Greenwich and White Plains; the average age is 87.

Sarah Neuman is fundraising for a portion of the $15 million capital cost for construction, but has funding at the moment to proceed with renovations on the Pavilion.

So far, plans have been modified to incorporate several changes based on community feedback on the project, said Feiner. These changes have included changing the main entrance to a driveway off Palmer Avenue, modifying a parking area to add 11 additional spots and making sure that lights were facing downward and properly screened with landscaping. 

With Sarah Neuman piloting the new project, it’s possible that the model of nursing homes could be radically different going forward.

“It’s just a natural outgrowth of how we want to treat elders in the future and how we’d want to be treated,” said Feiner.