On front lines of elder care, nun strives to meet challenges

For now, Teresian House Nursing Home in Albany is home to what its administrator calls the "Jack Benny/Eddie Cantor" generation.

But Sister Pauline Brecanier, O.Carm., knows that someday, fans of Tony Bennett and Patti Page will fill the beds -- and healthcare professionals have to plan now to meet the needs of that very different generation.

Sister Pauline has been administrator of Teresian House for 17 years, but her healthcare career spans more than five decades (see sidebar).

Changing needs

Sister Pauline smiled ruefully as she recalled the "medical model" of nursing homes popular in the 1950s, a model she strongly advocated at the time.

"Years ago, when we were designing nursing homes, we were putting labs in, X-rays, physical therapy," she explained. "We were very proud of those, but we kept them pretty much the same as hospitals."

Today's thinking has taken a 180-degree turn. Instead of being clinical and focused on technology, the Carmelite Sister tries to make Teresian House as homelike as possible, aiming at "quality of life as well as quality of care."

To that end, wings of the nursing home are designed like small neighborhoods, with carpeting, cozy decor and even pets. Homey kitchens where residents and their families can visit over a cup of tea are prominent.

"We're trying to replicate the environment [residents] had in their own home," said Sister Pauline. "Let's face it, the kitchen and dining room are where most of the activity in a family takes place."

Looking for solutions

Sister Pauline walks the halls of the 300-bed Teresian House as often as she can, getting to know as many residents and their families as possible so she can better meet their needs.

"It's a little more difficult" to develop personal relationships than it once was, she noted, because "the turnover is greater. People are not here that long; they come in here more terminal, with greater needs."

But Sister Pauline has two very personal reasons to strive for improvement: Her 98-year-old mother (known as "Memere B" to staff and friends) and her Carmelite mentor, 97-year-old Mother Bernadette, are residents.

"I want my mother to have the care I would want when I get older," the administrator said firmly.

Links to families

In many areas of care, the administrator believes Teresian House scores well. When a new resident moves in, she understands how traumatic and guilt-inducing it can be for the person's family, so it's become policy for a nurse's aide to call the family that first night and report whether the resident ate, socialized and slept well.

Not all reports can be positive; but when staff say someone couldn't sleep, said Sister Pauline, it's often like opening a tap for the family's feelings. Relatives admit the same thing happened at home and that they've had sleepless nights themselves while caring for their loved one. Turning that worry over to someone else is often a relief.

"They know we're here; we're watching them," she said, adding that she also started support groups for family members to ease their guilt.

Roomies

Residents at Teresian have private rooms, but couples' rooms adjoin so they can choose separate bedrooms or a shared bedroom and separate sitting room.

Sister Pauline remembered a time when administrators believed the elderly could have roommates because they "didn't know any different," having lived with family all their lives. But she objects to that theory. Most people, she said, have lived with spouses, not shared a bedroom with a total stranger.

Family members can check in on residents any time, since there are no restrictive "visiting hours." Guest rooms are available for relatives from out of town, and Teresian staff will even bring air mattresses into a dying resident's room if family members want to stay with them.

Frustrations

Of course, there's another end to the spectrum: the frustrations Sister Pauline deals with daily in her efforts to improve care. Number one on that list, she said, is the State Health Department, whose evaluations mean extensive paperwork rather than looking at the overall quality of residents' lives.

"They don't understand about quality of life. They think if it's all on paper, it's okay," Sister Pauline stated. "It's not realistic. They need to change how they perform their surveys."

Another thing New York State needs to change, according to the administrator, is the poor salaries paid to healthcare workers and the resulting high turnover in staff. At Teresian House, Sister Pauline started a staff retention program that includes free psychological counseling, an emergency fund for financial crises and a generous amount of paid leave.

But "we're not there yet," she said of the state's level of reimbursement to healthcare employees. "We won't be there till we give people the amount of money they need to live on without working two jobs."

Sister Pauline sees budget cuts as no excuse for poor care, however. "That's two different things," she cautioned. "What does hurt is that you can't give your employees a decent wage, but you can still give quality care without all the reimbursement."

What's ahead

Sister Pauline foresees a future when it will be crucial to find solutions for dementia, since people are living longer and are therefore more likely to develop the condition.

She also noted that since the children of today's elderly are very involved in their care, that next generation of nursing-home residents will demand a higher quality of care than ever before.

"I'm not satisfied," she said of her work to date. "There's still a long ways to go. It's a journey, and you're always on that journey, trying to meet needs."

No matter how much Sister Pauline accomplishes in advancing quality, homelike care for the elderly, she said there's one thing she can't give them: "I can't make them happy. The light in their eyes that you're looking for has got to come from family or friends. I keep hoping we can do something to put that light in their eyes."

(Call Teresian House at 456-2000.)

"One thing that bugs me is calling residents 'dear' or 'honey,'" Sister Pauline said. "It's very patronizing. If you're looking at being family, you don't build up that barrier. Residents want to be known by their names."

Any kind of patronizing is wrong, she added: "Mother Bernadette always taught us, 'You don't treat [residents] like children. Don't give them activities that are childish; give them something that's [appropriate] to their age.'"

When Sister Pauline entered the Carmelite Sisters for the Aged and Infirm (she celebrated her 50th jubilee this year), she said that nursing-home administration was "the furthest thing from my mind."

She worked in nursing, becoming a director of nurses before her order pegged her for administrative positions at St. Joseph's Manor in Connecticut and Noreen McKeen Residence in Florida.

There, her advocacy for the elderly became larger-scale: She served the 1971 White House Conference on Aging, the American Association of Homes and Services for the Aged, and the Connecticut Association of Non-Profit Facilities for the Aged. And she successfully pushed for sales tax legislation in Florida to benefit non-profit homes.

In New York, she has chaired commissions and planning committees to find solutions in long-term care and was appointed by Gov. George Pataki to the State Hospital Review and Planning Council. (KB)

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