The concept of aging often evokes the dismal image of an old-fashioned nursing home, with long, narrow, dimly-lit corridors that feel more like an institution than home.
But not at the new Merwick Care & Rehabilitation Center, where the family-owned Windsor Healthcare Communities has created a facility of mini-communities, where residents take advantage of 21st century concepts in senior care that allow them to treat their time in the facility as a next stage of life to enjoy.
Situated on the 171-acre up-and-coming healthcare campus off Route 1 in Plainsboro, with the centerpiece — new University Medical Center of Princeton at Plainsboro — being developed across the street, Merwick is the first state-of-the-art facility to have been drawn to Plainsboro, as envisioned by Princeton HealthCare System officials from the start of the endeavor.
Windsor Healthcare is run by the Jacobs family, led by President Hyman Jacobs and his son, Michael, vice president, and daughter, Batsheva Katz, vice president of quality initiatives. The family has incorporated many new trends in the industry into the design of the new facility, where they celebrated the ribbon-cutting and grand opening on January 11.
“You need to be able to build something from the ground up,” said Hyman Jacobs. “There are so many facilities out there that are 20 to 30 to 40 years old, and they are really not equipped to handle healthcare of the future.”
Part of planning for the future involved looking at current and past practices and bringing together a consortium of people for input — most importantly, their own staff, including the dietary, social services, and nursing departments.
“We asked them what they would like, what was their wish list,” said Jacobs. “These are the people who are on the ground every day, working with the residents. They know better than any architect; they know better than anyone else what is really needed to create an environment for our residents.”
From the design of its rooms — with 6 by 6-foot windows overlooking parks and foliage, where residents can control their own heating and cooling systems — down to the way the staff is trained, the Jacobs family wants to give their residents a much higher level of autonomy.
“We’re not looking for a long corridor,” said Jacobs of the design. “We’re looking for smaller neighborhoods because that’s where we believe the residents and patients would best interact without feeling like they are in an institution.”
The philosophy has worked well for the family in its prior facilities, but the new Merwick was the first opportunity for the family to literally start with a blank sheet of paper and map out how they would achieve the latest trends in skilled nursing.
The Jacobs family is from Long Island. Hyman Jacobs’ parents, who were immigrants from Europe, were in the import business. Jacobs attended Brooklyn College and Brooklyn Law School and became an attorney. In the early 1970s, he had also obtained his New York administrator’s license, but never used it until he got into healthcare.
It just happened that the first opportunity came in New Jersey, and Windsor Healthcare, based in Norwood, began expanding. This past year, the company acquired four of the St. Barnabas nursing homes, as the hospital decided to concentrate on acute/hospital care.
Merwick, the company’s 10th facility, replaces the former location, owned by Princeton HealthCare System, on Bayard Lane in downtown Princeton. The former location was over 60 years old, and when the time came for Princeton HealthCare to plan for its move to Plainsboro, it decided it was going to focus solely on acute care. “You see trends like this, where most of the hospitals are moving away from also owning nursing homes because the care is very different, the scope is different,” said Jacobs.
PHCS asked companies to submit their qualifications to be the ones to acquire and build the new facility. “Here, we had our first opportunity to bring everything that we learned and incorporate it into the new facility,” Jacobs said.
The family worked with another family-run company, Sweetwater Construction, to build the facility in 16 months. The new facility serves as a bridge between hospital and home for patients recovering from an illness or surgery. The 80-bed sub-acute rehabilitation wing — the Luxor Pavilion at Merwick — provides the level of rehabilitative care designed to safely and quickly get patients back home.
The center boasts state-of-the-art features, including a 3,500-square foot gym behind a two-story wall of glass, where orthopedic patients of all ages can work to rebuild their strength and stamina. It also features a 12-station dialysis center for both inpatient and outpatient treatment.
For the long-term care wing, with 120 beds, Windsor Healthcare officials say they “embrace the philosophy that the later stages of life should be treated as just that — new stages that can be rewarding and fulfilling while also being safe and comfortable.”
Hyman Jacobs’ son, Michael, handled the construction aspect of the project, and helped create the unique design for the facility. He said the architects for the project were able to do a good job in transforming the family’s ideas for a “de-institutionalized” atmosphere. “They came up with these little communities,” he said. “Some are 15 beds, some are 20 beds, and some are 18 beds.”
By doing this, patients with similar conditions — dementia, Alzheimer’s, and Traumatic Brain Injury (TBI), for example — can be grouped into one community, where the facility can focus on a program specifically for them.
“It also helped us create outside areas because if you have a very long, straight building, you’re limited as to what you can really do outside,” added Hyman Jacobs. “Because the building has various angles, we can create garden areas where the buildings meet. It will help in getting the residents to go out and be in an area where there are beautiful gardens.”
The family embraced many trends on the rise in the field, particularly as it relates to the residents’ living quarters. The rooms feature oversized 6×6-foot windows. None of the walls are straight; rather, they are canted, which means that they do not create a perfect square. In normal situations, the perfect square forces residents into looking at a wall or television.
With the new design, “the focus of the residents is really outside of that large window that was put in to give them the views of the garden or park or the Millstone River, or the wetlands,” said Michael Jacobs. “In the winter time, we can’t bring them outside, but at least we can let them focus on the outside.”
The goal is to allow the “communities” to have their own courtyards, provided by the natural angles created by the building’s setup, and residents can go outside as much as they would like.
Another important feature, said Jacobs’ daughter, Batsheva Katz, is the toe-to-toe bed alignment. “It’s not as it is in the traditional nursing home, with the beds side by side,” she explained. “It’s more for privacy, and there is a wall in between, so even if you’re in a semi-private room, you still have the privacy of having your own space, which is very important to most people.”
In the sub-acute unit, residents have showers in their own rooms. “It creates a level of dignity to not have to go down the hall” to shower, she explained.
Wi-Fi access is available throughout the building, said Michael Jacobs. “If someone just had surgery, and they’re active and running a business, every room on the short-term rehab site has a work station. They can bring their laptops, and they can work there.”
Every room also had its own heating and cooling controls, so residents can set their own temperatures. Another innovative feature is that every bed has its own electronic heat curtain. “At night, if they’re cold, they can put on a timer, and it blankets them with warm air over their bed,” explained Michael Jacobs. “We said, ‘What do we want when it’s time for us to go to a facility? I’m always cold, so we’ll put that in.’”
In the semi-private rooms, there are television speakers placed above each person’s bed, so that residents do not have to fight over the volume on the television.
“The residents should be autonomous,” said Katz. “They should have more control over their environment and be able to live their lives the way they want to.”
What the family does not like about older facilities is the practice of bringing food to residents via carts that are pushed down the hallways. Although tray-less food service is already a hot trend in newer nursing homes, the family took it a step further.
“What we did was we built a tunnel from the kitchen to the resident wings,” said Michael Jacobs. “Food goes into the tunnel, up the elevators, and to the residents, so it never has to go through common hallways.” Food is also brought up in bulk, instead of in trays, and served to the residents.
Windsor Healthcare’s facilities also follow the philosophies of the Eden Alternative, an international not-for-profit organization dedicated to transforming care environments that promote quality of life for all involved, according to its website. Katz said the approach focuses on transforming the culture in the facility, beginning with the staff.
“We go facility-by-facility and train staff,” said Katz. “It’s about person-centered care, which really gives the resident a much higher level of autonomy. When do they want breakfast? What newspapers do they read? How do they want to spend their time? It’s about developing relationships.”
This philosophy does not create a culture in which staff members are assigned a number of beds, moving from person to person without really forming a relationship. “You should know the person, you should know where they’re coming from,” said Katz.
Part of that requires paying attention to patients to be able to relate information to the patients’ doctors, which studies have also shown leads to a decrease in medicine and prescription rates, said Katz.
“If a caretaker sees a patient gets acid reflux when she eats something tomato-based, she’ll know it’s due to food,” explained Katz. “A doctor coming in won’t see that and will say, ‘Let’s prescribe something.’ They found that by addressing needs, you use a lot less medication.”
Hyman Jacobs said that staff members are taught to watch for signs for the patient and communicate with the doctor. “If they feel that they’re going to be heard, we’re empowering them to do more than just follow orders,” he said. “It’s how a caregiver is treated that makes a difference in how they will treat the people they are caring for.”
“Sometimes you have employees on the front line who know better than doctors,” Hyman Jacobs added. “If they can’t be heard, it’s a terrible waste.”
The facility also features a concierge, who takes care of everything from facilitating trips to the doctor for residents to ensuring a resident will have his or her favorite newspaper or cup of coffee. “If your parent likes peanut butter and jelly with tuna fish on it, that person is going to make sure your parent gets it,” said Michael Jacobs.
Some of the company’s other facilities feature social groups, like traveling drama clubs in which residents put on plays. “We try to just view this as another stage in life,” said Katz. “What can you do at this stage? The sky’s the limit.”
In fact, the family is so confident in its facilities that they say they would feel comfortable sending their own members — or themselves — to the facilities. Katz’s father-in-law recently had a stroke and was first sent to the Rusk Institute of Rehabilitation Medicine, affiliated with New York University, but later re-located to one of Windsor’s facilities.
“He advanced further in the month he was by us than the month he was at Rusk,” said Katz.
When asked if any of them would consider treatment or becoming residents later on at Merwick, Michael Jacobs replied: “It better be this one.”
Hyman Jacobs said his family has acquired a lot of experience from building its first facility and hopes to build more throughout New Jersey.
As President Obama’s healthcare legislation has changed healthcare around the country, Hyman Jacobs said there has not been an impact on Merwick or Windsor Healthcare yet. But “we’re always concerned about any possible cutbacks in reimbursement for facilities,” Jacobs said. “As of now, it has not really affected us to any degree.”
Hyman Jacobs said he believes the company provides a very important service to patients at this stage in their lives. “As long as a person can stay in their homes, that’s the best,” he said. “But if it comes to a point where they do need care, the nursing home, at this point, is probably the best, most efficient way of providing that care.”
Hyman Jacobs’ own parents are elderly. His father is in his late 90s, and his mother is in her late 80s. “Looking at them and seeing how they are — and thanking God every day that they are well — really gave me a mandate that if I’m in this business, I’m going to do it right,” he said.
