Some people might have a hard time bonding with the residents of Mission Nursing Home, a skilled nursing facility for men who have struggled with addiction, alcoholism and mental illness. The residents of the Plymouth-based program have lived hard lives, and it shows — in their behaviors and in the myriad and complex health problems they all face. Even the most dedicated staff members say that working with them can be tough.
Just ask Donna Evjen, Mission Nursing Home’s director of nursing.
“These guys do have quite a few negative behaviors associated with drug use and mental illness,” she said. “They are very manipulative. They have their outbursts. Some are very sexually inappropriate with our female staff. But we do a very good job with the behavior management here. We have to.”
Even taking all those complicating factors into account, Evjen said she’s not the only staff member who feels a close connection to the nursing home’s residents. She said that staff members make a point of getting to know each resident as an individual human being: As they learn more about each man’s difficult life history, they build a deeper understanding of his humanity. This approach makes for a rewarding work experience that’s unfortunately unique in many long-term care facilities, Evjen said. And for her at least, it makes for a job that’s hard to leave.
‘I came back’
“I first came here in 2012,” Evjen explained. “In 2016, I left for a position at another facility as a transitional-care unit director. But I missed Mission and my patients and my work here so bad that I came back in 2017. I missed the setting. I missed the fact that these patients don’t have a lot of family involvement. We become their family and they become ours.”
Jim Steinhagen, Missions Inc. CEO, said that the nursing home, which is tucked away in a quiet corner of Missions Inc.’s peaceful lakeside campus, fills an important role in the state’s range of nursing facilities.
“It serves a very clear purpose in the skilled nursing business in that the population we work with there is probably too challenging to live in most nursing homes,” he said. “They are men that come in with behavioral challenges, that have been discharged from other facilities because of those behavior problems. They come to us and we’re very good at dealing with complex behavioral issues that other facilities can’t — or don’t — want to.”
Providing a welcoming home for men who are not welcome in other nursing facilities is important work, Evjen said.
“You start to understand that this place serves a really good purpose. It is rewarding. You realize that you’ve made a positive impact on the lives of people who have been struggling most of their lives.”
Despite their rough exteriors, the home’s residents are, Evjen said, “mostly just normal guys who’ve struggled.” And even though many are younger by as much as two decades than most nursing home residents (the average age at Mission Nursing Home is 66), the vast majority — because many residents have comorbid conditions related to their lifelong histories of addiction and mental illness — will live their final days at the facility, she said.
Listening to residents, learning to accommodate their needs, helping to make their lives more satisfying can feel like a privilege.
“Once you start breaking down the walls, you establish a trusting relationship and the negatives behaviors stop,” Evjen said. “You feel like you are serving a good purpose, and it becomes like one big, happy family. It is rewarding in that aspect.”
‘A very unique nursing home’
In many ways, Mission Nursing Home is different from a typical nursing facility. The first difference is the most obvious: Unlike most senior care homes, which, thanks to their longer life expectancy, are usually mostly populated by women, this program houses men only.
That distinction stems in part from Missions Inc.’s history, Steinhagen explained.
“When it was founded in 1895 we were called Union City Mission,” he said. “Leaders from the city of Minneapolis and local religious groups got together to address the issue of alcoholism and homelessness for men who were coming back from working up North in the mines and farming.”
In the early days, the program was run like a farm, and the residents — all men — worked there and tried to live a life of sobriety. But many of the men were in bad health.
“As more residents came to the farm, there was a need for additional services,” Steinhagen said. “They were seeing individuals with long histories of alcohol and drug addiction and their bodies were just breaking down.”
Union City Mission leaders decided to create a space for respite care, Steinhagen explained, to give people time out from their farming duties and to get well. But not every resident got better: “Some individuals continued to age and have more complex and acute needs as they aged. What became clear to the leadership was they needed to develop a more complex system of care.”
A 104-bed facility
In 1964, the organization, then known as Missions Inc., launched a nursing facility for residents in the program’s former chapel. Two decades later, in 1994, Missions Inc. tore down the chapel and opened the 104-bed facility that is in use today. The larger facility meant that beds could be made available for people outside of the Missions Inc. system.
“It went from non-skilled respite care to a skilled nursing and respite home,” Steinhagen said. “What they realized was that on the continuum of needs, these men required additional care and were reaching a point where it would be easiest to provide that level of care as part of that organization.”
Not all senior facilities provide skilled nursing care, Evjen said. Unlike assisted living programs, for instance, which require nursing staff to provide medication supervision or adjustments, skilled nursing facilities must employ a nursing staff with higher levels of expertise.
“We need licensed staff,” she explained, “an RN or an LPN. Most of our residents need therapy to maintain their current levels. Some have G-tubes, IVs or tracheostomies. That requires a different level of training.”
All-male nursing homes are rare, said Frances Stevenson, Missions Inc. programs communications associate. “My understanding is we are the only all-men skilled nursing home in the state,” she said. “That really sets us apart.”
Steinhagen thinks the program is even more rare than that. “This is a very unique nursing home,” he said. “It serves a really defined population. Male gender is required. Typically they’re on Medicaid or Medicare. They are lower socioeconomic status. It’s the only nursing facility that works with all males in the state and the only one we know of in the country.”
Evjen said that many staff members pride themselves on welcoming challenging residents and helping them improve their behaviors in order to find a more satisfying life.
“We take a lot of the patients that nobody else will, some due to mental illness or sexual behaviors with staff or female residents,” Evjen said. “We have experience in this, we understand it, and we know how to work with this kind of population.”
Some of that patience and understanding for residents comes from personal history, Evjen said. “We have a few of our nurses either have a family member or themselves have been through some type of struggle with addiction.”
The same can be said about many employees across all of Missions Inc.’s programs, Stevenson added. “There are quite a few people who work here who are recovered addicts themselves. It is a pretty common thing among our employees. The residents like that. They can relate to the employees. It makes for a deeper understanding.”
No matter what their personal history with addiction, all nursing home staff get special training to help them better understand the patient population, Evjen said.
“We have a very extensive onboarding program. We make sure they are very well educated about what we do here before they start on the units. We want them to know what they are getting in to so they are not shocked by anything they see once they start working here.”
Meeting residents’ needs
With an eye to meeting the unique needs of residents, the Missions Inc. Nursing Home offers a range of services and activities, Evjen said.
“We have lots of different interventions. We try to keep residents occupied with male-oriented activities, things they can do with their hands, like building bird feeders or a mock bowling activity.” Pre-COVID lockdowns, musicians would regularly visit the facility; when the lockdown was in full force in the spring, some played outside so residents could listen through the windows.
There are also group conversation sessions, Evjen said, including a weekly sports conversation group, a men’s group and a “mock AA meeting.” Because so many of the residents are long-time smokers, the home also offers an indoor smoking room.
“Many of the gentlemen with a chemical history are smokers,” Evjen said. “They are allowed to go in the smoking room for certain hours every day. It keeps them calm. There is a large big-screen TV in there and a coffee bar.”
To help residents focus on their mental health, there are weekly visits from a psychiatrist and a psychologist. “We have psychiatry and psychology coming in every week,” Evjen said. They are closely monitored. Some are mediated for anxiety and depression. They haven’t aged very well.”
Most residents at the home are estranged from their families, and many have been homeless at some point in their lives, Evjen said. And their long histories of drug addiction and mental illness mean that the home also has an active Assertive Community Treatment (ACT) program through the state of Minnesota.
The ACT staff, Evjen explained, “Come in once a week and visit with residents. They do one-on-one meetings with clients and help with behavior modifications and monitoring their psychiatric medications.”
The Gazebo Program
For a select group of residents, one of the Mission Nursing Home’s most unique offerings is the Gazebo Program. Though the home’s focus is on sobriety, a small number of residents have been approved by a physician to drink a prescribed amount of alcohol each day. This takes place in the late afternoon in a gazebo behind the nursing home.
“It’s a mini happy hour,” Evjen explained. “It’s a highly regimented program. They get one or two beers or two pre-dosed, pre-packaged shots. It is supervised and doctor-approved.” To qualify for the Gazebo Program, Evjen said, residents have to be approved by a physician or their guardian: “They can’t be on mood-altering narcotics. They must eat all their meals and keep up on their cares.”
The program is controversial in some quarters, Steinhagen said, but it is considered a harm-reduction model and has been successful for many participants.
“This program was put in place as the need was identified,” he said. “These men in the program all have histories of alcoholism.”
In past years, before the Gazebo Program was established, Steinhagen explained, residents would leave the facility, get drunk and then cause trouble in the community: “What we realized was that abstinence wasn’t a realistic goal for the majority of this population. What could be done to reduce the harm and the effects on the community? That’s where the Gazebo Program came in. It is very successful in achieving what it was intended to achieve: to keep the men on site and not leaving and becoming a public nuisance.”
The Gazebo Program has been a lifesaver for many residents, Evjen added.
“It’s huge. They live for it. That is that their big highlight of the day.”
After lunch, she said, participants must take a Breathalyzer test. They also can’t have had any falls over the last 24 hours. Once they pass those hurdles, approved residents can spend a few hours relaxing in the gazebo. “They play music and sit and socialize,” Evjen said. “After it is over, they do a post-gazebo assessment. They have to walk normally, talk normally, count backward from 10 and turn their bottles back in to us. Then they go on their way.”
The COVID-19 pandemic has been particularly fatal to residents of the state’s long-term care facilities. Though Mission Nursing Home had one resident die of COVID complications in April, it so far has had no other fatalities from the virus.
The resident’s death, followed by two residents and four staff members who were asymptomatic but tested positive for COVID, prompted the nursing home to go into lockdown that month, closing to new admissions and visitors. The residents who tested positive were isolated and put into 14-day quarantine. The staff members quarantined at home for 14 days. All were negative for COVID-19 on retest and have recovered with no negative side effects, Evjen said.
“We’ve been very diligent with our practices,” Evjen said. “We’ve been very fortunate to have no other deaths from COVID. I think that this has something to do with the fact that we started closing down prior to the statewide mandates.”
Steinhagen said that he is pleased with this record. “The nursing home has done a fantastic job of preventing the virus form coming into the building and being part of the environment,” he said.
Though the home can accommodate 104 residents in shared rooms, in recent years it has tended to average around 70 or 80 residents. After admissions were closed in April, a few residents who were already on hospice died, and census in the home was down to just 58 residents.
As COVID restrictions have eased in Minnesota, the home is now welcoming new admissions. Evjen said she and her staff have their precautions in place and feel ready for the challenge.
“I’m not real concerned about COVID,” she said. “We’re very diligent with our infection control. We require two negative tests before they come in. Then they go into quarantine for 14 days. We test them again on day 4, 7 and 14. They stay in isolation until their test is negative.” She said she and her staff are ready to take on more residents: “Our goal is to be full at 90.”
Though Steinhagen admits that, “Personally I am nervous about it,” he knows that it is important for the home to begin accepting residents again: “We’re continuing to have in place the protocols that have allowed us to be as successful as we’ve been so far at keeping the virus out of the facility. I’m hoping we will continue that success into the future.”
No matter what the next few months hold for Mission Nursing Home, Steinhagen said that he continues to be humbled by the level of loving care that staff provide for residents. He thinks it’s that very care that has kept residents safe and the home virus-free.
“What strikes me all the time is the degree of passion, compassion, commitment that the staff there have to these men,” Steinhagen said. “What they do is very humbling and I’d have a hard time doing it myself. Staff see their work as a mission. I never cease to be impressed with the good work they do.”