By Robin Lord
Cape Cod Times
BREWSTER -- In her dusty rose running suit and knitted white vest, 95-year-old Margaret Walsh fits in with the surrounding color scheme of the Pleasant Bay Nursing and Rehabilitation Center in Brewster.
Good grooming is important to her, Mrs. Walsh says. And the condition of her home - any home - is no less important.
Although macular degeneration has drastically limited her vision, she still knows a wrinkle when she sees one. In fact, trying to smooth one on a bed in her West Harwich home was what landed her in Pleasant Bay. She had taken one too many falls as a result of her failing eyesight and loss of feeling in her legs, and she and her two sons decided it was no longer safe for her to live alone. She moved to the Brewster facility in 1997.
Mrs. Walsh has high standards, and she says they are met at Pleasant Bay. She credits owner-director Joshua Zuckerman with being as fussy as she is. "He makes sure things are immaculate," she says.
Making the transition from her own home to a nursing facility was easier, Mrs. Walsh says, because she felt comfortable right away.
Comfort is what Joan Insley and Doris Tenny like best about their nursing home environment. The two women became close friends when they moved into Pleasant Bay a few years ago. Besides finding each other, the friendly staff is the best part about the facility, they say.
"If feels like home," Ms. Insley says.
Activities with children
Making people feel at peace and secure is Zuckerman's goal. He designed the 133-bed facility with that in mind. Natural light floods most rooms. Views of gardens or the center's preschool playground meet your gaze from every window.
Zuckerman built the day-care and preschool center to accommodate his staff's children. He says he knew many of his employees would be young mothers, some of them single mothers, who would be more willing and able to work for his facility if their children were nearby.
Intergenerational activities between residents and the preschoolers are commonplace.
Visiting pets also are encouraged.
"Clearly, we're trying to change the image of skilled-nursing facilities," Zuckerman says. "The old idea of lonely old people warehoused in nursing homes is gone."
Zuckerman has made sure to maintain his facility as a model of the "new" nursing home. He has been able to dodge some of the problems that plague other nursing homes because he had the wherewithal to set up a facility that has attracted a larger-than-usual number of private-paying residents. That has allowed him to recoup more of what it actually costs to maintain a nursing home resident. The Medicaid reimbursement rate for those residents who cannot pay themselves is typically about $25 per day below cost on Cape Cod.
"We can be flexible because we're not owned by a corporation, so we're not as driven by a specific profit margin," he says.
Pleasant Bay also has a growing number of residents involved in the rehabilitation side of operations, where their stays are typically short enough to be paid in full by Medicare or their private insurance.
Zuckerman says he also has less trouble keeping qualified staff than the average nursing home. He says he has high expectations, because he wants to maintain the reputation of his facility, yet makes sure he treats the staff well. When his health-care provider recently raised his rates substantially, he chose to absorb it rather than pass it on to his staff, he says.
Zuckerman says nursing aides stay at Pleasant Bay an average of four to five years. Although the Massachusetts Extended Care Federation does not have turnover figures for certified nursing assistants, in an annual survey it conducts of nursing homes around the state, 54 percent of those on Cape Cod said their nursing assistants had been with them for more than one year.
The long-term-care section of his nursing home often has a waiting list. The average age of those residents is 90, he says. Those who come for short-term rehabilitation after an injury or surgery are generally younger and stay a much shorter period of time.
Bingo and singalongs
Daily activities at Pleasant Bay begin with breakfast in residents' bedrooms or the dining room. Afterward, residents are briefed on the day's news and quizzed on newspaper trivia questions or word games. Mrs. Walsh says she looks forward to the 2 p.m. daily activity, which could be bingo, musical entertainment or singalongs.
Mrs. Walsh joined a recent bus trip to a Yarmouth restaurant, and often takes part in some of the religious services brought into the home.
Ms. Tenny, 73, enjoys the craft sessions and often joins in the volleyball games. And Ms. Insley, who has trouble remembering her age, loves to look out the bay window in her room at the landscaped yard and Japanese-style garden beyond. Plants and her many ceramic figurines from home dress up the window seat.
Flowering shrubs and plants, which attract birds, were part of the overall landscape plan for the center. New York City landscape designer David Kamp, whose Dirtworks Inc. specializes in gardens for people with AIDS, Alzheimer's disease and other illnesses, created the garden plan.
Too many trees spaced too close together can look threatening to Alzheimer's patients, for instance, so Kamp made sure there were clear pathways. Tinted concrete walkways cut down on glare, and a gradual transition from sunlight to dappled light to shade helps those whose eyesight is fragile.
Residents' medical care is handled by Dr. Arthur Bickford and a nurse practitioner on his staff, who checks in on patients daily.
Mrs. Walsh says moving from her home to a nursing facility took some adjustments, but she knew it was time for her to make the move. She says she welcomes the security and comfort Pleasant Bay offers her at a time in her life when she is often uneasy about even visiting her sons, grandchildren and great-grandchildren because of all the activity.
"I told my sons, I want to be in a safe place where I get good attention and you know where I am."
Copyright, 2002, Cape Cod Times. All Rights Reserved.
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