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Sunday, October 24, 1999

Facilities Tend To Be Smaller

By Thomas J. Cole
Journal Investigative Reporter
HARROGATE, England -- The Adam is in many ways an example of how British nursing homes generally differ from homes in the United States.
The Adam wasn't built to be a nursing home; it is a converted Victorian home on a quiet, tree-lined street in this northern England town.
The Adam provides 24-hour nursing care to its residents but doesn't offer the wide range of medical services found in most U.S. homes.
The average nursing home in the United States has more than 100 residents. The average in Britain is less than 40; the Adam has just 23.
"I like to think we're more of a family than a place of work," Teresa Baxter, the home's deputy matron and a registered nurse, said while giving a tour of The Adam.
But the character of the British nursing-home industry has been changing in recent years with the growth in the number of for-profit homes.
Small, converted homes are viewed as inefficient by some for-profit operators, including Sun Healthcare Group of Albuquerque. They have moved to increase profits by building large homes.
The average size of a British nursing home was 37 beds in 1998, up from 25 in 1986, according to a survey by market analyst Laing & Buisson of London.
Homes owned by major for-profit providers had an average of 50 beds in 1998, compared to 34 for homes run by major nonprofit operators.
Joan Morton, who heads the nursing-home inspection unit for the North Yorkshire Health Authority, is concerned about the trend toward the U.S. model of large, purpose-built homes.
"Ours are very homey, much more homey," Morton said in an interview in her Harrogate office.
Sun, through its subsidiary Ashbourne, runs a home in Harrogate that is a former boys preparatory school. Grosvenor House has 50 residents.
"I prefer it to the purpose-built," Julia Yeomans, the home's administration manager. "This is the residents' home. You want it to feel like it."
Ginny Jenkins, director of the nonprofit group Action on Elder Abuse, said she toured some nursing homes in Philadelphia.
"There was nothing to make it a home and not a mini-hospital," Jenkins said.
The British nursing-home industry does have some things in common with its U.S. counterpart.
As in the United States, the nursing assistants who do most of the work in British homes earn about the same as workers in fast-food restaurants. And British homes, like those in the United States, have problems with staff turnover.
The British nursing-home industry, like its U.S. counterpart, gets most of its money from the government. It pays for nursing-home care for those who can't, much like the Medicaid program in the United States.
The Adam has a mix of public- and private-pay residents.
The front yard of The Adam is a flower garden. The grand entry hall is carpeted, as are the rooms. There is no smell of antiseptics or human waste.
"We're very conscious of that," Baxter said. "If it smells, you question the care, don't you?"
The Adam is a for-profit home but isn't part of a chain.
Bert Moss, 86, has been living in the home for 31/2 years with some government assistance.
Moss had a few complaints about the food and the restrictions on his trips away from the home. But, he said, "The staff are very good."
Moss, who served in North Africa during World War II and retired as a school maintenance worker, has lost both legs to diabetes.
He tries to get out of the home every day for exercise, taking his wheelchair around a nearby park. Last year he parachuted from an airplane to help raise money for a sea-rescue organization.