A point-by-point comparison makes the differences starkly clear.  No endless halls, shared bedrooms and isolation. Gone is institutional thinking in favor of true caring.
Areas of Difference Traditional Nursing Home Skilled Nursing and Rehab Neighborhood
SIZE 120-plus beds, divided into 20 to 40 bed units. 10 elders and rehab guests
PHILOSOPHY Focus on medical services for frail patients. Focus is on home and living to fullest. It is a home for people who just happen to require medical services.
ORGANIZATION Steep bureaucracy where nurses control all unit activity. Direct care staff are empowered with nurses visiting the home to provide skilled services.
DECISION MAKING Made by the organization. Placed as close to the elders as possible. House councils plan menus, activities and routines.
ACCESS Space belongs to the institution. Elders often given limited access to spaces. Space belongs to the elders, access to all areas of the house.
OUTDOOR SPACE Often challenging to access, especially without assistance. Easily accessible, fenced, shaded and in full view of the hearth and kitchen, allowing staff observation.
LIVING AREAS Most commonly double bedrooms and shared baths. Lounges and dining rooms often at end of long corridors. Private rooms with private baths. A central hearth is adjacent to the open kitchen and dining area with short distances to walk.
KITCHEN Off limits to elders and visitors. Elders and visitors have access and may participate in cooking.
NURSES STATION In center of most units. None. Medication and supply cabinets in each room for nurse visits.
DINING Large dining rooms with many elders. One dining table for home-style meals.
STAFFING Departmental. Tasks are divided among several people. Average 75 percent turnover rate. Elder assistants (can) take care of all tasks needed, such as direct care, laundry, housekeeping and cooking. Average 10 percent turnover rate.
VISITORS Limited ability to participate. May take part in meals, meal preparation and activities. Elders often host family celebrations.