An Intergenerational Model of Care for Long-Term Care Facilities

An interview with Charlene Boyd, administrator, Providence Mount St Vincent, Seattle, WA.

As medical advancements and technology lengthen the average person’s lifespan, the population of older adults is increasing exponentially. As of 2014, older adults represented 14.5% of the US population and are expected to grow to be 21.7% of the population by 2040.¹ In order to adequately plan for and manage this influx, the care for this population will need to advance and grow along with it.

To meet this challenge, some in the long-term care (LTC) field are reinventing the concept of geriatric nursing facilities, choosing to view nursing facilities as sites of opportunity. Media outlets have recently showcased the efforts of Providence Mount St Vincent, a nursing facility in Seattle, WA, owned and operated by Providence Health & Services, which is dedicated to providing a refreshingly different experience for older adults in need of increased levels of daily care.^2,3 The facility includes assisted-living apartments; skilled nursing “neighborhoods” (as they are called); a transitional care unit for patients just discharged from the hospital but in need of several weeks of nursing care and rehabilitation; and a licensed child care center, the Intergenerational Learning Center (ILC), which allows for intergenerational interactions to take place in the facility for the mutual benefit of the older residents and children. 

Over the past year, Providence Mount St Vincent has received widespread international attention and recognition as the result of being the subject of a forthcoming documentary called “Present Perfect” by filmmaker Evan Briggs. The trailer released for this documentary has been seen by millions of viewers all over the world.

To gain more insight on how this facility is advancing the delivery of LTC and the way society views nursing facilities, Annals of Long-Term Care: Clinical Care and Aging spoke with Charlene Boyd, who serves as the administrator of Providence Mount St Vincent. In 2003, she received the Catholic Health Association of the United States’ Midcareer Award for her leadership. Ms Boyd is also the co-founder of the Pioneer Network, a national organization dedicated to making fundamental changes in values and practices in nursing homes. 

Can you tell us about Providence Mount St Vincent and describe your professional and personal experience with the Intergenerational Learning Center (ILC)?

I have been with Providence Mount St Vincent for over 35 years, where I started out as an occupational therapist. From there, I moved to public relations and fund-raising and helped to establish the Providence Mount St Vincent Foundation, which is the fund-raising affiliate for “The Mount,” as we informally say. I’ve been administrator since 1991.

In the late 1980s and into the 1990s, Providence Mount St Vincent experienced philosophical changes as well as physical changes. While The Mount always had an excellent reputation dating back to the 1920s, we felt our residents needed several things to improve the quality of their lives: more independence, more choice in how they spent their days, and more joy in their lives. As a result, we adopted a philosophy of care focusing on the resident. The resident had—and has—the power to decide what he or she wanted to do. In addition, one of our staff members needed child care, so we explored the idea of having a child care center located within our building that would be open to the community as well as employees. And, in 1991, we opened the ILC with one class and 12 children, including my oldest son, who was one of the first babies. Today, the ILC has six classes and 125 children ranging in age from 6 months to 5 years. 

Was the idea for the center a completely organic idea or had there been scientific studies done that reported on the beneficial influence of children in nursing homes?

We had heard there were some long-term care facilities (LTCFs) with child care programs, and, in fact, we visited one in Washington state. But we decided that not only did we want to have a child care center, we wanted to structure it so that residents and children would be engaged in every possible way. We discovered that some facilities had child care centers on campus, but they didn’t offer any engagement. We wanted to take it a step further. We were committed to providing opportunities for the residents and the children to be together in a variety of activities such as art, music, exercise, and storytelling, especially among our skilled-nursing residents. In addition, we wanted to provide some opportunities for one-on-one visits. Sometimes, there is no special agenda except the joy of these two generations sharing time together.

At the time we were creating the ILC, we were not aware of any scientific studies, probably because it was so rare for nursing homes to have child care programs. Most of our success has been based on qualitative information from our residents, their families, and the families of the children. 

Can you talk more about how the older adult and childcare areas overlap? They are in the same facility, but what types of rooms or areas are near each other and which are totally removed? Are there some separate, isolated buildings for older adults?

Within The Mount, our child care center is located in two areas: the first floor, which contains the main child care center including an outdoor playground, and one classroom located on the third floor centered between two skilled-nursing “neighborhoods,” as we call them. 

The ILC is open 5 days per week, from 6:00 AM to 6:00 PM. Every day, there are scheduled visits for children and residents. For example, every Tuesday morning at 10:00 AM, one teacher brings some of the babies to the resident lounge to visit residents living in the assisted-living apartments. Every Wednesday morning at 10:00 AM, there is an intergenerational art class. And so on. There are approximately 36 visits by the children every week. Our teacher-child ratio is greater than the average, so that a teacher may take a group of children on a visit while the other teachers stay in the classroom with the other children. 

Residents have the option of participating in the visits. If they do not want to join in, that is their choice. Residents are always welcome to come to the ILC to visit or just observe. The third floor classroom has large windows within the doors, so often some residents in wheelchairs like to come to the doors and watch the children. They are welcome to come into the classroom if they would like, and many do.

How do you train your staff to excel in this unique setting?

In a handout we created last year, it says we “train the entire program staff on intergenerational culture and interactions that will maximize enjoyment for all and provide unique opportunities for the children to learn from their older friends.” Our staff receive training during employee orientation and through ongoing training and education with these goals in mind. The Mount also has a culturally diverse employee population representing over 50 countries. We believe the diversity of our employee population serves as an advantage with regard to how different cultures care for older adults and children.

On the website and in the ILC handout there are scheduled and “spontaneous” activities and interactions mentioned. Can you describe some of the interactions that take place? How do the spontaneous interactions come about? 

As mentioned earlier, we have 36 planned visits each week for the residents and children to be together. And often, we have the pleasure of witnessing spontaneous activities that are often planned but seem to be spontaneous. For example, once per week the older children come to the cafeteria for 30 minutes with their teachers. We never know who will be there. The teachers usually have some type of project planned such as puzzles or art projects. Residents seem to naturally “migrate” toward the children to visit and see what they are doing. And, of course, the children invite them to join in and share the activity. 

Another example is when a teacher is taking a group of children to visit some residents. They typically are stopped along the way by other residents for a chat. Who can resist a wagon with babies? And as I mentioned before, residents are welcome to stop by the ILC any time for a visit or a hug or just to observe the children. 

What effects from interacting with the children have you observed in the elderly residents? Is there a notable positive impact on their mood? Their appearance? Their physical ailments? Their mental abilities? 

We observe many positive benefits in our residents. When the children arrive for a visit, one notices a physical change—the residents seem to be more alert, smiling, present, and happy. Residents often say the children remind them of when their own children were little, and they share great memories of their families. Even with residents who have dementia or Alzheimer’s disease (AD), they often seem to connect with their past as a mother or father, and you can see joy on their faces. I’ve witnessed a resident with advanced AD and very little communication skills actually speak in coherent sentences when she’s holding a baby. Those maternal instincts never go away. 

What are the biggest challenges of integrating child and older adult care centers? What problems have arisen in The Mount’s history, and how were they addressed?

When we first introduced the idea of establishing a child care center within our building, some of our staff members and residents were hesitant. It was unheard of. Were the children going to make the residents ill? Would there be kids running up and down the hallways? The answer was no, of course. But once the staff saw how well the residents responded to the children and how happier the residents were, all of the doubts disappeared. 

Space continues to be a challenge. The waiting list to get into the ILC is extremely long—over 2 years. Also, as a non-profit organization, the budget can often be challenging. Through fees paid by the parents, the ILC meets all of its direct overhead costs. However, our fund-raising affiliate, the Providence Mount St Vincent Foundation, raises funds every year to pay for the art teacher and music teacher. In addition, the Foundation raises funds to help the ILC provide a higher teacher-child ratio, so that a teacher can take a group of children from a class to go visit residents while the other teachers can stay in the classroom with the remaining children. Without the support of our Foundation, it would be difficult to provide the intergenerational programs and allow for higher staffing.  

Why do you think this model has not been adopted in more LTCFs? 

I think this model has not been adopted more because of a number of key issues: budget, space, and licensing. We have over 35 teachers on staff and that’s a large expense to The Mount, as we provide excellent benefits for our employees. Our child care center is licensed, so there is constant monitoring, surveys, inspections, etc. And the space must be adjusted for infants and children, from restrooms to eating areas to the playground to nap time. 

While there are challenges, we believe the positives certainly outweigh the challenges. The vibrancy of our young families here at The Mount has enriched the lives of our residents many times over. The joy that the children bring to our residents is priceless, and we are very happy to continue in our commitment to provide this unique program and service. 

More information on the The Mount and its ILC can be found online at bit.ly/2f0Y4WF. 

1. Administration on Aging. Aging statistics. AoA website. http://www.acl.gov. Accessed November 15, 2016.

2. Jansen TR. The preschool inside a nursing home. The Atlantic. January 20, 2016. http://www.theatlantic.com/education/archive/2016/01/the-preschool-inside-a-nursing-home/424827/. Accessed November 15, 2016. 

3. Shaw Brown G. Seattle Preschool in a Nursing Home ‘Transforms’ Elderly Residents. ABC News. June 16, 2015. http://abcnews.go.com/Lifestyle/seattle-preschool-nursing-home-transforms-elderly-residents/story?id=31803817. Accessed November 15, 2016.