Jan Braun (center) pours wine for residents before their meal at Meadowview House at Shorehaven in Oconomowoc, which has a more home-like atmosphere now. Credit: Gary Porter

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Gerri Bussey loves to sleep in, and she does so nearly every day. She loves a big breakfast. Once a week she takes a bubble bath in style with a glass of wine.

The vivacious 79-year-old isn't on holiday. She's been living at an Oconomowoc nursing home, Shorehaven, rehabilitating from a fall that happened a few months ago.

Far from the traditional nursing home with sterile hallways and fluorescent lights, Shorehaven is one of a new breed popping up in the state, and a sign that life for Wisconsin's most vulnerable residents is transforming.

Built in 2005 according to the "household model," Shorehaven mimics home, down to the smell of coffee and bacon in the morning. There's even a dog, Haley, who scampers about freely.

"I'm enjoying life," Bussey said on a recent afternoon. "And it's nice to know there are people around me going through the same thing, and you know you're not alone in this world."

There aren't many homelike nursing homes in the state, perhaps fewer than 10% or 15% of all nursing homes, according to Terry McLaughlin, chairman of Community Living Solutions, an Appleton-based firm that designs and builds housing for seniors.

But there's widespread consensus that it's the way forward.

The new architecture draws people out of their rooms. The settings are intimate in scale and sensory rich, ideally with sunlight no matter where you are. There are spaces for socializing and quieter spots for contemplation.

"When you walk into a facility today, it's something very much like your home. The difference is night and day," McLaughlin said.

Most of the state's nursing facilities are aging structures built decades ago in the 1980s or earlier. Inspired by Civil War hospitals that clustered as many injured patients as possible around a nurse's station, their signature is long hallways flanked with rooms. It's a cold environment with block walls, industrial lighting, no common spaces.

While this may have been OK with the generation that fought in World War II, nursing homes are trying to keep up with a new, more demanding group of consumers. Those who are starting to use long-term care have more wealth and resources than their parents and like to get value for their money, said Scott Townsley, a principal at CliftonLarsonAllen, a national senior living consulting firm.

"There are already seniors saying, 'Don't put me in one of those,'" said LaVrene Norton, president of Action Pact, a consulting firm that specializes in implementing the household model. "That's pressing us to find viable solutions where it's more like home, more vibrant, and more part of the community."

But money for renovations is scarce, drained by some of the lowest Medicaid reimbursements in the nation. A recent national report ranked Wisconsin nursing homes as having the third highest "Medicaid deficit," with facilities absorbing $330 million in costs for caring for Medicaid patients. Nearly two-thirds of nursing home residents in the state are on Medicaid.

Nursing homes in Wisconsin that can afford new buildings overwhelmingly choose home-based environments. The state Department of Health Services offers an incentive for using modern designs, and out of the 15 construction projects in the state since 2011, 14 were based on the small-home trend.

Even places that can't rebuild are tearing up their hospital-style corridors as much as possible. Lynn Vogt, administrator at St. Anne's Salvatorian in Milwaukee, said she doesn't have $6 million lying around to rebuild the 1966 nursing home she runs. What she can do is knock down walls to create lounges, sun rooms and other common spaces. There are plans to pave the halls with carpet tiles, convert shared rooms into private ones, and update lighting, furniture and finishes for a residential feel.

"The benefit will be very much to the quality of life for the residents. We need to address what consumer expectations are," Vogt said.

Transforming people's daily lives isn't just about bricks and sticks. There's also a corresponding institutional culture that nursing homes are trying to change, no matter what kind of building they're in.

Nursing home residents have had little control over their lives and little privacy. They often share rooms, wake up at set times and eat meals from trays like clockwork. Even into the 1990s leather restraints strapped people into wheelchairs.

"It's the only two groups of people who aren't free: prisoners and residents who live in nursing homes," Action Pact's Norton said. "It truly is an odd thing, and it wouldn't have lasted this long except the people are so frail they can't fight back."

The movement to give nursing home residents more freedom and choice is widely called person-directed care. Many facilities have figured out ways to let residents sleep and eat when they want, but they also need to create a better sense of community and home.

"For so many years, institutional nursing homes were looking to be efficient and not get close to the people they were caring for. Well, now we've gone back, and we want them to be more like family," said Wanda Plachecki, chair of the Wisconsin Coalition for Person Directed Care.

Lorna Gartzke, administrator at Shorehaven, has shaken up the institutional culture there since moving to the new building. She slashed vertical hierarchies and dissolved independent departments such as food service, housekeeping and maintenance. Everyone reorganized into households, which worked around the residents as they set the pace and routines of their own lives.

"When you're in a house and need to take care of people, you do everything. You share roles," Gartzke said.

Gartzke said the differences are stunning. In the old building, there was an unpleasant smell, more residents yelled and acted out, and the number of people who had to wear monitors, because there was a risk they'd flee from the nursing home, was seven times higher. All this has changed. Because it's more like home, people don't run away.

Some research has supported the idea that residents do better in homelike environments. Studies of Green House homes, a small-home model designed for 10 to 12 residents that has spread around the country over the past decade, have found lower rates of depression and more emotional well-being.

Three Green Houses are under construction for the Milwaukee Veterans Affairs campus, with the first to open in July.

The small-home movement has taken hold as the number of nursing home beds in the state plummets amid fiscal pressures and less restrictive living arrangements, such as assisted living have risen.

Nursing facilities in Wisconsin have lost a quarter of their capacity since 2001, when there were more than 48,000 beds, compared with about 36,000 today. They serve a population that's older and more frail than ever before.

"Long-term care has come a long way, but it has a long way to go," Gartzke said. "These are the people who made our world. So they deserve this."