Steve Shields

Steve Shields’ journey from heading up a long-shore drilling operation in the Middle East to becoming a key player in the eldercare culture change movement began with the loss of his mother.

In the mid-80s, his mother had advanced Alzheimer’s and his father had Parkinson’s, two “headline diseases,” as he calls them. So, Shields went home to Kansas to help.

“The options available to them were dismal,” he remembers.

Shields saw his mother, a former dancer, deteriorate in a nursing home. He blamed the facility’s strict schedules and clinical feeling for her rapid decline.

One day she pirouetted down the hallway. A janitor knocked her down and injured her. The nursing home staff told Shields that his mother should not have been dancing in the first place. Shields gave some thought to it and then decided that his mother, and for that matter all of the other residents in the nursing home, should be dancing.

He transferred his mother to what was considered a better option, Meadlowlark Hills, a nursing home in Manhattan, Kansas, and took a job there. When she later died, he vowed to change the way nursing homes operate.

Since 1994, Shields has been CEO of Meadowlark Hills. In 2000, Shields and other Meadowlark personnel began conducting extensive research, gathering detailed input from residents, staff, architects and industry professionals on what would make Meadowlark Hills a better place to live. They transformed the 24-hour care center from its traditional institutional model into a new model based around homes where people live and thrive.

Complete transformation

Meadowlark Hills was a culture change pioneer. Advocates for culture change a decade ago were viewed as outsiders. But today the idea of smaller households with a consistent staff is firmly established as an alternative to traditional nursing homes.

Because of groups like Pioneer Network, the Green House project, PHI, and Meadowlark Hills, says Shields, the movement has become mainstream. These efforts have helped the household model grow from fewer than 30 small houses in America ten years ago to more than 800 today.

“It doesn’t need to have a brand name,” says Shields. “The vocabulary fits the local culture. In the long run, it’s been better for people to grapple with this and let it reflect local culture and local organizations. If there were 800 with a name like McDonald’s, the understanding of policymakers would be deeper and higher, but nonetheless, there are 800 where there was once none. “

At Meadowlark the use of clinical call lights, massive nursing stations, and metal meal carts was discontinued. Residents were given back their right to direct their own schedules and lives. The nursing home physical plant was redesigned to create the feeling of a true home. Since then, Meadowlark, with Shields at its helm, has become an international model of transformation in retirement communities.

“The rate of change is not going to slow,” says Shields, who speaks on the subject of culture change around the world. “It’s going to exponentially increase. We are now past the time when facilities are waiting to see if it’s a good move for them. Now is the time to actively plan for transformation or you’re not going to be here. By 2015, you’re gone.”

Meadowlark Hills is now a learning site for other organizations across the country, and Shields is an international consultant. Every week during the past decade, they have had visitors from around the globe “who want to begin their own journey,” he says.

Moving ahead

Shields’ staff recognized in the early ’90s that if others failed to move in the same direction, they wouldn’t sustain their own transformation.

“It takes constant vigilance to preserve and maintain and grow,” he says.

In addition to teaching other organizations how to make the changes, they have “penetrated” their area’s education system to ensure that their own area colleges and universities teach culture change.

“If we don’t, they are already tainted,” says Shields.

For instance, at Kansas State University, Meadowlark Hills has concurrently coordinated 20 different internships in various departments, including nursing, human resources, architecture, and landscape architecture, so that students in each area understand how their piece connects with the whole.

Shields says that smart decisions and further advancements in culture change can only help positively reform the health care system overall.

“I believe,” he says, “that elder services can really drive cost down in America. I think we can significantly drive down costs for the Medicare system,” by changing the focus from acute care to prevention and chronic disease management for eldercare and disability services.

He notes his excitement about the Obama administration’s recent nomination of  Kansas Governor Kathleen Sebelius as Secretary of Health and Human Services. “She’s a very competent individual,” he says. “Most importantly, she’s a very grounded, yet a practical visionary leader. I think she’s going to bring a great deal to the table at this critical time, at what appears to be the first allowable departure from the status quo not only in health insurance but in how we view health. I’m thrilled about it. . . . Whether she’s first or second pick, she’s the person for the job.”

As for his recommendations for future policy developments, Shields says policymakers should focus on reducing the number of nursing facilities and transforming those that remain into the household model. “Not only because it’s the only fiscally responsible way to deal with the problem,” he says, “but it’s also a wonderful solution that allows people their fundamental rights of driving their own lives despite the fact that they have 24-hour needs. They eat when they want and they sleep when they want and they make their own decisions.”

- Story by Dinah Cardin