At Hillsboro House, what works for residents also works for nursing home staff

Dec. 26--HILLSBOROUGH -- As a resident of Hillsboro House, Patricia Kienholz, 92, still strolls around the neighborhood on summer nights, meets friends for lunch downtown, and visits the local library weekly as she has for most of her adult life.

"This is as close as you can get to home," said Kienholz, who lived in neighboring Washington before moving into Hillsborough's skilled nursing facility -- the state's smallest with 35 beds. "I tend to be gregarious. It's a treat for me to wander about and chat with people. Being back in my own home would be isolating."

For 53 years, a stately yellow Victorian on School Street has been a collegial final haven for seniors who grew up here or in surrounding towns. Independent and owned by three generations of the Irwin family, Hillsboro House has garnered Medicare's top overall rating every year since 2008, reflecting rankings in staffing and patient health and safety -- which administrators attribute to teamwork in a close-knit environment where staff know and carefully watch residents for any small changes or signs of distress.

This, and ongoing communication with primary physicians at Hillsborough Deering Family Health, who visit weekly, has dropped the facility's re-hospitalizaton rate to 2 percent from nearly 20 percent, the state's average.

For decades, Hillsboro House has also received the lowest Medicaid reimbursement among nursing homes in a state that ranks near the bottom for compensating providers for the cost of caring for indigent patients on Medicaid, which comprise a majority of nursing home residents.

It's a senior community integrated into a small town, where neighbors help neighbors across generations, and where staff and patients have history in common. It's also an example of what aging-in-place can look like at the end of life -- and what works for residents and staff.

"Sometimes it's the 15 minutes you spend giving someone a backrub or chatting about a memory that means the world to them," said Jessica Edsall, director of nursing. "We know them right down to where they want their drink on their tray."

"The staff is sufficiently small enough that these relationships are real and substantive," said Andrew Irwin, owner and assistant director, who's worked here for 22 years.

During summer, one LNA invites residents to a barbecue at her home. At Halloween, day staff come back after hours to help residents pass out candy to trick-or-treaters and toss rings onto witches' hats and candy corn into cauldrons. "We're allowing people to continue what they value in their lives," Irwin said.

The nursing home's success and longevity are noteworthy, especially at a time when most are struggling financially and many are taking beds off-line because of a shortage of staff to provide direct care. Licensed nursing assistants are recruited by word of mouth or referred by current workers at Hillsboro House. Beds fill up from a waiting list or through transfer from rehabilitation or a hospital. Staff are either registered nurses or LNAs, including the cook who makes breakfast to order, so everyone is trained and licensed to help someone in distress, Irwin said.

The environment is intentionally seamless. Employees and residents eat lunch together, a home-cooked meal served in the wallpapered dining room. There is no segregation of patients with dementia. At 1 p.m., LNAs visit residents who aren't as social, spending an hour playing cards or cribbage or chatting while painting their nails.

"It's clean and wonderful and you have people," said Marian Eckland, 84, who is wheelchair bound. "It's just nice -- I can't tell you exactly why. The girls take care of us."

Staff tend to stay for years, grateful for easy shift coverage and flexibility that accommodates family obligations and emergencies, said Executive Director Heather Thyng.

A Hillsboro resident, Thyng brings her two school-age children to work in the morning before school starts, and sometimes her infant daughter. Laurie Dionne, an LNA there 10 years, works 7 a.m. to 3 p.m. then picks up her grandchildren after school so their mom, her daughter Tiffany, can work at Hillsboro House from 3 to 11 p.m. There two other mother-daughter LNA teams on staff.

Charles Santana, a Hillsborough musician and an LNA for 17 years, started at Hillsboro House earlier this year. The team spirit is "not something that's talked about, it comes naturally. This is a home environment."

This time of year, the wallpapered parlors with garland-strung windows, the fireplace decorated with pointsettias and ceramic reindeer, and overstuffed chairs with holiday-theme pillows resemble a Victorian Christmas. Grace Macheski, the LNA who cooks breakfast, distributes metal angels for residents to place on the tree. Moments later, Annemarie, an LNA in a red elf hat, dances a jig.

Wendell Grolljahn, 82, who's spent many Christmases here, points to a framed print above the fireplace of a girl hugging a St. Bernard. "That was my dog," he said. "And you had beagles, too," said Kristine Swingle, the day charge nurse. Grolljahn nods to Howard Humphrey, 76, his roommate sitting next to him on the couch. "We're two famous guys here. We always take the kids over to school (in the morning). I do everything with the kids now because I'm retired."

The corridor walls are decorated with photo montages of residents at various ages. "It's easy for us to forget that people had eight or nine decades of life they got here," Irwin said. "It's a reminder that people have had rich lives before we met them, and that's something that should still be appreciated."

Silver Linings is a continuing Union Leader/Sunday News report focusing on the issues of New Hampshire's aging population and seeking out solutions. Union Leader reporter Roberta Baker would like to hear from readers about issues related to aging. She can be reached at rbaker@unionleader.com or (603) 206-1514. See more at www.unionleader.com/aging. This series is funded through a grant from the Endowment for Health.

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