Overland Park ? Kansas nursing homes are in trouble.

“I’d say that in 10 years, a third of them will be gone; that means 10 a year will go under,” said John Grace, executive director of Kansas Homes and Services for the Aging, a state association for nonprofit nursing homes.

Since the onset of assisted living facilities, the state’s nursing home census has been in steady decline.

“Nobody wants to live in a nursing home. We all know that,” Grace said.

Also, Kansas Medicaid payments are among the lowest in the nation. And half of the state’s 350 for-profit and nonprofit nursing homes were built before 1970, a time when cramped, semiprivate rooms were the norm.

“The industry is in chaos,” Grace said. “It’s in confusion, in frustration, in fear. It has to change. It can’t go on like it is.”

Giving them what they want

Grace is part of the Pioneer Network, a grassroots movement dedicated to changing both the nation’s nursing-home culture and its attitudes toward aging. The group is wrapping up a four-day conference today in Overland Park.

“This is incredible,” said David Slack, senior vice president at Lancaster Pollard, a Lawrence-based investment company that helps finance hospitals and nursing homes. “Five years ago, there would have been 20 or 30 people here. Today, there are 811 registered.”

Much of the movement is tied to the simple premise of giving people what they want: an environment that’s more homelike, less institutional.

‘All about home’

At Meadowlark Hills nursing home in Manhattan, Kan., for example, residents live in 12-bed houses, each house equipped with its own kitchen and dining room. Staff and residents eat together.

Unlike most nursing homes, Meadowlark Hills lets each resident decide when to get out of bed, bathe and eat. They are not expected to follow someone else’s regimen. They spend their days doing what they want rather than what someone else tells them to do.

Each house has a doorbell and a porch. Visitors aren’t free to wander in and out; instead, they’re expected to ring the doorbell like they would at another person’s house.

“It’s all about ‘home’; that’s all it is,” said Meadowlark Hills executive director Steve Shields, who’s become a key player in the movement.

Too simple to accept

For many, the concept is too simple to accept, especially in an industry mired in regulation.

“We’ve had people from 42 states and 14 countries come in for tours,” Shields said, “And it never ceases to amaze me; they’ll stand there and say, ‘Wow, a real front door, a doorbell. How’d you do that?'”

He said Meadowlark Hills’ switch to a homelike environment had not affected the home’s financial solvency.

“We have about the same amount of money coming in and going out,” he said. “But that’s not the point. The residents love it; that’s the point.”

Grace said about three-fourths of the state’s nonprofit nursing homes were in various stages of creating 12-to-14-bed homelike facilities.

“Everybody’s trying to figure out what to do,” he said. “They know they have to change.”

Deb Casement, director of staff development at Renaissance Gardens retirement center in Brooksby Village, Mass., is ready for change.

“It’s the right thing to do,” said Casement, who grew up in Cherryvale, Kan.