Conceptualization and development of the Household/Neighborhood Model for skilled nursing facilities: A case study

The conceptualization of the Household/Neighborhood Model for skilled nursing facilities began in 1987 at Evergreen Retirement Community in Oshkosh, WI, USA in the search for the “perfect” nursing home. Being able to see perfection required being freed from the mental constraints of regulations, reimbursement systems, and existing staff training programs so that visionary thinking was possible. Conceptualization was followed by a pilot project to test various aspects of the vision. The result was (1) a management philosophy built on Continuous Quality Improvement, (2) a team-based organization structure, (3) cross-functional staff roles, (4) social-model activity programming, and (5) a residential style physical setting that won strong support from the State of Wisconsin. With this support, we had the opportunity to open in 1997 the first full-scale model of a Household/Neighborhood in the United States based upon providing “resident and relationship centered services and care”. The model was validated through a year-long evaluative research study. In 2004 we opened a second full-scale model incorporating significant improvements identified through experience. The opportunity to further develop the model has been provided through its adoption in China by China Senior Care, which will open their first facility in 2014.