Anyone who has ever sat in a wheelchair for an extended period of time knows they can be uncomfortable. Imagine sitting in one all day long.
That’s the scenario Ed Maschmann posed to the nurses back in 1963 when Cedarcrest Manor was just opening. It was “an experiment” for the staff.
“Boy, did that teach all of us,” said Maschmann. “Nurses said by 10 a.m., ‘I’d have given anything to get out of that chair . . . or just to get up, to stretch.’
“That taught us a lot . . . get ’em up out of the wheelchairs if they can!”
Back then, 50 years ago, that was a novel approach to nursing home care, said Maschmann, who founded Cedarcrest Manor along with Louis B. Eckelkamp, of the Bank of Washington, and Cal Bogart, a local builder who found the property.
Today, as Cedarcrest Manor celebrates its 50th anniversary on July 1, the nursing home is once again at the forefront of a changing industry.
Earlier this year it began a four-year federal grant study through the University of Missouri-Columbia that involves having a nurse practitioner on staff to help care for the residents and also train and teach the staff new techniques on how to decrease rehospitalization for long-term residents.
Read more about that here.
And Cedarcrest is part of the national trend to provide residents more choices, especially in two key areas — food and activities.
“We’re changing our way of thinking,” said Leslie Hughes, assistant director of nursing, who has worked at Cedarcrest since 1984.
“Before long-term care was all about routine and schedule. Now Baby Boomers are coming in, and times have changed . . . So we’re really trying to expand meal choices . . . it’s short-order cooking . . . almost like a restaurant.”
It’s more work, Hughes admits, but it makes the residents happier, “because they feel more in control and can make their own decision.”
Maschmann approves. That is the atmosphere he cultivated at Cedarcrest all those years ago.
First Nursing Home in Washington
Back in the early 1960s, Maschmann, who had served as a Marine in World War II and saw combat duty in the Pacific theater, was working in insurance and real estate when he decided to make a change and open a nursing home in Washington. He had a family member living in a nursing home and was disappointed both in the quality of care and the home itself.
“It was just an old home,” Maschmann recalled, “but they were all old then. There were no new (nursing) homes. They were all converted houses, things like that.
“I thought there’s got to be something better than that available.”
So Maschmann began researching the idea. He spent one full year doing nothing but visiting other nursing homes — across Missouri and Illinois — to see the best practices that were available at the time.
“I liked the elderly,” he commented. “They were always so interesting, had good stories.
“I thought it would be fun working with them, listening to the history of our country and seeing if there wasn’t something better out there to give them rather than just have them look out the window all day long.”
Most nursing homes prior to the 1960s didn’t offer activities, Maschmann said.
“They were even called dumping grounds for the elderly. That’s about what it amounted to.
“The doctors weren’t interested in caring for the elderly. There were no medical schools training doctors for geriatrics.”
Armed with the knowledge he needed to establish his nursing home, Maschmann next went about tackling his next obstacle — funding.
“The minimum cash required to submit a proposal to this state was $80,000 — more than I had accumulated in 39 years,” he said.
He made a list of people he thought would be interested in establishing a Washington nursing home, and who also could afford to be a part of it financially. Eckelkamp was at the top of the list.
“Thank God he was as excited about a nursing home in Washington as I was,” said Maschmann.
‘This Is Our Spot’
In touring other established nursing homes, Maschmann paid attention to what the residents liked and did not like. He talked to them to find out what they wanted.
One of his questions was always, “What would you prefer, city or country?” The overwhelming response was for the city, “where there’s some action,” Maschmann recalled, noting one resident even said, “If you’ve seen one tree, you’ve seen them all.”
So when Bogart called him up one day to show him the Jordon property he had just purchased on Fifth Street between Elm and Cedar streets, Maschmann went along. When Bogart opened the door and Maschmann saw the first floor had been flooded from a bathtub on the third floor, he realized the house was ruined and the location was perfect for his planned nursing home.
“I said, ‘This is our spot,’ ” Maschmann recalled. “It was just what we were looking for!”
The property was “at the crest of Cedar Street,” so the owners named it just that.
“When the neighbors found out about our plans, we were warned not to even think about cutting down the two centery-old tulip trees in the front,” said Maschmann. “We listened to them too, and the trees are still there.”
Later, Maschmann and Eckelkamp bought out Bogart’s share of the building.
The staff at Cedarcrest agreed that the group knew what they were doing when they picked a location. The residents enjoy being in the center of town on a busy street.
“They like to traffic watch,” said Hughes. “They can tell you who runs the stop sign.”
“And the parades that come by — the Fair parade, Christmas parade, homecoming . . .
“We’re very fortunate to have an outdoor space like this. Not every (facility) has that.”
The reaction to Cedarcrest was positive, Maschmann recalled. Everyone said, “Finally, we’re going to have our own nursing home.”
According to photos of the open house tours that appeared in The Missourian back in 1963, over 2,000 people turned out to see the new facility.
“We had a waiting list before we opened,” said Maschmann. “That’s how anxious people were to get in.
“But we wanted to grow slowly so we could give excellent care from day one. Three residents were admitted July 3 . . . did they get the service!”
An editorial that appeared in The Missourian on June 20, 1963,
“ . . . this will be one of the most valuable assets in this community,” it reads. “In the matter of importance, it will easily compare to any of the industries we have in Washington.
“We have talked about a nursing home in this community for many, many years — just as we did about a hospital before we got one. Many elderly people have hoped and prayed for one. They all prefer to stay near home, especially in their declining years, but there was no such home here to serve them.
“They had to go elsewhere, and that was not always good for them. They eventually lost practically all touch with the community in which their greatest interests rested.”
‘Stretch Those Legs a Little Bit’
Cedarcrest was different than many nursing homes of the day because it offered physical activities, like field trips and social outings, as well as games like shuffleboard and encouraging those who could walk short distances to do so every once in a while.
“We used to make the ones who could, walk to their table in the dining room, leave their wheelchair in the hallway,” said Maschmann, recalling how that was frowned upon by the state regulators who came to visit.
“We were trying to make them healthy, to stretch those legs a little bit . . . They needed that,” he remarked.
Physical therapy was in its infancy, at the time, Maschmann said, but he and the staff took the approach of treating residents how they would like to be treated, or how they would want their own relatives treated.
“ . . . to get the maximum out of their life that is left,” said Maschmann.
“At first you’d have to push them — Come on down for exercises . . . ‘No, not today’ . . . or it’s time for your bath . . . ‘I had one yesterday’ . . . well, no, you didn’t. That sort of thing. They wanted so often, ‘just leave me alone, let me relax.’ ”
But it wasn’t long before they found they liked the encouragement, he said. And their families did too.
While Cedarcrest was being built, Maschmann and Eckelkamp worked out a back-up plan in case the nursing home fell flat — they would convert the building into a hotel. So they outfitted each room with individual plumbing.
“We never needed it though,” said Maschmann with a smile.
In the beginning, the building was designed to accommodate “59 guests in 30 rooms,” according to news stories in The Missourian at the time. Over the years, the facility was expanded twice, in 1969 to 120 beds and in 1975 to 184 beds.
In 1963, the daily rate was $6/day with an extra charge of $50/month for residents who needed extra care.
“At first, most of our residents were private pay, approximately 95 percent,” Maschmann noted. “The county picked up the tab for the indigent. A little later, the state picked up a portion for the county’s share. Then it was the state and federal, then Medicaid (state).
Today Cedarcrest is licensed for 177 beds, but a more comfortable number is around 120, said Carol Stolte, business office manager, who has been with Cedarcrest for 40 years.
All of the semi-private rooms have been renovated and converted to private, she noted.
The type of residents Cedarcrest admits also has changed. In addition to the traditional long-term residents, the facility now offers a rehab-to-home program for short-term stays.
“We may admit and discharge 30 patients each month for people recovering from procedures like knee and hip replacement surgery,” said Stolte.
“You can only have so many days in the hospital and then you need to go to rehab.”
Credit Staff for Success
Maschmann is quick to credit much of Cedarcrest’s success to the facility’s first head of nursing, Mrs. Elizabeth Stock, RN, of Gray Summit, who came with years of experience at a facility in St. Louis.
“She was a strict taskmaster, who insisted on the best, not second first, nursing care,” said Maschmann.
“We became one of the first nursing homes to train our nurses aides to become certified, which gave them additional pride in their profession,” said Maschmann.
The first doctors who served as medical director were Dr. Ben Eisenmann, from New Haven, along with Dr. John Post and Dr. John Ryan. They split the duties until state regulation required there be a single medical director, said Maschmann.
Later Dr. David Brunworth was medical director for many years, and today Dr. Jessica Van Bibber of Mercy Clinic serves as medical director.
The current administrator is Dana Bailey, who has been with Cedarcrest since 1980. She was hired as a part-time dietary aide while she was going to school and then developed an interest in nursing.
She progressed from a nurse aide to LPN to RN to assistant director of nursing and then director.
She has been administrator for the last 13 years.
Like Bailey, many of the staff at Cedarcrest have been working there for two, three, even four decades.
“We have a lot of professional nurses who have been here 10-plus years,” said Hughes.
Stolte was still in high school when she started as a nurse aide in 1973. Back then state regulations allowed nurse aides to start at age 16.
“My salary was $1.65/hour,” she said, smiling.
Hughes, who was hired in 1984, began in the dietary department. From there she moved to be a nurse aide, then a floor nurse and later into management.
Her starting salary was $3.35/hour and when she became an LPN, the top pay was $6.50/hour.
Family is the word many staff members used to describe working at Cedarcrest. The staff feels like family and the residents too.
“We can all do any job here,” said Stolte. “It’s never, ‘No, that’s not my job.’ ”
“We can work in the laundry. We can work in dietary. We can fix the toilet . . . ,” Hughes chimed in. “We can do all kinds of stuff . . . wallpaper, paint . . . ”
Competition Has Been Good
For a long time after Cedarcrest opened, it was the only nursing home in Washington. In 1989, MDI Limited out of Monticello, Ill., which had bought Cedarcrest in 1980 with North American Heath Care as the managing company, built a second facility, Grandview Healthcare Center.
In the years since, other nursing homes have followed in the area, and all of the competition has been good, said Maschmann.
“Each one is trying to outdo the other,” he remarked, noting the residents are reaping all of the benefits.
Several years ago, Cedarcrest’s current owners, the investment firm Omega, completed a major renovation of the facility, installing new carpet, painting all of the walls, updating the decor . . .
A palliative or end-of-life care room also was added. The room has a wall separating a family area where relatives can spend time away from the resident’s bed. The armchairs also pull out to beds in case relatives end up staying long hours.
New activities have been added too. That’s part of the cultural shift going on in the industry, said Hughes.
Activities new include things like going to the movies, shopping, dining out, trips to the casinos . . .
“Don’t get me wrong —you can never have enough bingo,” Hughes remarked. “But we’re trying other things, different kinds of crafts.”
Cedarcrest has a van with a mechanical lift that it uses to transport residents for these outings. The van can accommodate two wheelchairs and several walkers.
“Sometimes we have to make several trips,” noted Stolte. “Like for the recent Trail Day. They spent the whole day coming and going.”
Cooking is another activity that has been opened to the residents. There is a kitchen area that therapy uses to help residents who will be returning home, but the long-term residents also can go there to help cook the dessert they’re going to have or all kinds of options, said Hughes.
The musical guests who come in to perform also are always popular, said Stolte, especially the Elvis impersonators.
‘It Wasn’t a Job, We Loved the Work’
Maschmann retired as administrator in 1995, many years after he had sold the business.
It was hard to retire, but it was time, both for him to begin slowing down and for new ideas to come into the nursing home.
In the years since Maschmann left Cedarcrest, the facility has had good years and bad, including a period in the late ’90s where the managing company’s poor leadership ended up with the home being placed in receivership by the state for a year.
Today Cedarcrest is managed by Health Systems Inc., which Maschmann and the current staff feel is doing a good job.
Maschmann, who is still able to live on his own, continues to visit Cedarcrest to see both the staff — many of whom were there when he was — and the residents.
Reflecting on the 50th anniversary, Maschmann is struck by “how we were able to make this thing work. We made it work by nothing more than positive thinking,” he said. “Believing this was going to work made it work.
“It wasn’t a job — we loved the work. It’s not like punching a machine all day long. You could see results,” he remarked.