Recently, for work reasons, I toured Rosewood on Broadway, a nursing home where I had spent nearly 15 years on daily visits with anywhere from one to three of my elders at a time.

Physically, Rosewood has changed a great deal since my mother, the last of my elders, died. Now, through tears of remembrance, I view this beautifully remodeled nursing home. When it was time to choose a nursing home, I'd have loved to have this beautiful physical setting for my elders, but they had what to me is most important, wonderful staff. These same people work today in new surroundings. We hug and tear up as we greet one another. I look around, amazed. "Beautiful. Simply beautiful," seem to be the only words available to me.

Nursing Homes Strive for Person-Centered Care

Most nursing homes in recent memory were built around the old military model of efficiency. Much like older hospitals, nursing homes had narrow hallways and small double rooms. When Rosewood was first built in the late 50s, the only people to have private bathrooms were those in private rooms. The rest shared hall bathrooms. Later, during the '70s I believe, came private bathrooms, a huge step forward.

In the early '90s, my neighbor Joe, who had broken his hip, needed nursing home care. He was my first elder responsibility, as he had no family in the area. I knew little about nursing homes, but I chose Rosewood for Joe because I could continue to visit him daily. I was also aware that my community had a good reputation for nursing homes - as nursing homes went.

From Joe's time onward, I had elders with nursing needs, and Rosewood's wonderful staff cared for them. I was always part of the care team and visited nearly every day, making the lives of my elders as unique as possible in a nursing home setting. As I grew to know the staff and administrators, I could to sense their awareness of the movement toward person-centered care.

Gradually, more plants, and even pets, became part of the scene. A large aquarium was donated by a grateful family and I could see the effect watching the colorful fish had on many of the elders. The home provided garden plots for those who wanted them, or let them put flowers in high planters that could be reached from their wheelchairs. The grounds were beautiful and part of person-centered care. They had photo centers and unique display cases to showcase their elders' accomplishments.

Now, the remodeling has turned narrow hallways into open areas where nurses can view call lights and monitor residents without appearing to do so. Shared rooms are large and so well designed they may as well be private. The old three-meals-a-day routine has been replaced by choices of when and what to eat. My mom would have loved this change.

Nursing Homes Adjust to Residents from Different Generations

Nursing homes must adjust to more generations. People may live to be older, but that doesn't mean everyone is healthier. Thus nursing homes are experiencing what I call a "culture clash."

The generation that researchers term the "very old," those over 80 and more likely to be in a nursing home environment, are those who grew up during the great depression. They are apt to be conservative in their outlook, more frail because of their age, and have a preference for "farm meals," country stores and polkas or big band music.

Because health issues also affect people in their 60s and 70s, however, a quick look around a nursing home will soon remind you that there is a generation here that maybe would prefer rock and roll, gourmet coffee and computers rather than the old pot-bellied stove atmosphere. Already we are seeing the old standby bingo for entertainment joined by Wii bowling and other hi-tech entertainment. Large plasma TV screens reflect the modern view. Boomers are becoming part of the nursing home population, and with them is coming change.

Technical Advances Provide a Safer Environment

Advances in technology have provided nursing homes with monitoring devices to alert staff when a resident is attempting something that could be dangerous, which includes anything from standing up without assistance to trying to enter a stairwell.

Much of the technology is more subtle now than in the past, which helps create a calm, more home-like atmosphere. Instead of hospital beeps and blaring microphones, quiet pagers and ear pieces allow communication to be less disturbing to residents. Cameras can be used when necessary and monitored by a computer, medical records and doctor's orders are computerized, beds can be rigged with alarms that are quiet to the elder, but still alert the staff if someone needs help.

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When used improperly used, just like drugs, technology can be misused to replace human care if watchful, caring people aren't monitoring its use. Human hands are still the primary care need. But used well, technology can be a boon to the safety of elders.

Good nursing homes are totally different from the model of the '50s, which was to keep people safe and quiet until they died. Now, well-run centers provide hands-on human touch, lots of activities and care directed toward the individual. Are there still some of the old-style homes around? Yes, far too many.

Activists in the form of the Pioneer Network, families of those in nursing homes and Boomers who one day may be in a nursing home, are all working toward the day when of the old "warehouse" model of nursing home is wiped off the planet. It's going to be awhile before that happens, but culture change in nursing homes is evident in most areas, and homes that don't catch up will, hopefully, find themselves out of business.