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Non-Traditional Nursing Homes

State policy changes could create more

Hernandez said the relationships she and her coworkers develop with Sagecrest residents means small problems are noticed before they become serious medical issues. She said the assistants have the nurses' respect, and their observations are taken seriously.

"If you see something wrong, you tell the nurse. You can see the signs right away."

Nursing assistant Juanita Martin has worked in nursing homes for more than 30 years. Sagecrest, she said, "is totally different. When I walked in here, I felt like crying. I was that impressed."

The Green House Project is a nonprofit that advocates for culture change in nursing homes. It creates a template for deinstitutionalized, homelike care. Some other long-term care facilities use a similar approach, emphasizing individual care, personal surroundings and smaller communities, but not all are part of the Green House Project.

Funding is a barrier

A barrier to the creation of more Green House facilities in Texas is money. Sagecrest costs $195 a day plus charges for medicine and personal care items. Texas Medicaid reimbursement for the Sagecrest Green House homes is about $106 a day.

"Two-thirds of Texas residents in nursing homes get help from Medicaid," said Amanda Fredriksen, AARP Texas advocacy manager, and rates largely determine "what Texas nursing homes look like."

AARP Texas is asking state officials to adopt policies or legislation that would ease the financial restraints and encourage developers to construct more Green House facilities.

For instance, Fredriksen said, the state could create a special Medicaid reimbursement rate for Green House homes and could give priority to developers of these homes when allocating new Medicaid beds.

"The state supports a culture change" in institutional care that would allow more Green House homes in Texas, said Chris Traylor, commissioner of the Texas Department of Aging and Disability Services.

State Rep. Elliott Naishtat (D-Austin), who chairs the Joint Legislative Committee on Aging, agrees that "the model is worth exploring" and said his committee will study it before the 2013 legislative session opens.

Tracy Sutton Schorn is a writer living in Lockhart, Texas.

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