nless you're independently wealthy, it's almost impossible in this country to get graduated levels of care as a senior citizen."

Ten months into her new position as director of the Netherlands Union's innovative Vredenoord home for the elderly, Paula Koeweiden has mastered both the macro and micro issues of church-sponsored senior care in a rapidly changing regulatory environment.

"The large majority of Adventist members in Holland can't afford the 4,500 to 5,000 euros (US$5,400-6,000) a month that some private nursing homes are charging," she notes. "Most have only a basic state pension, and maybe a small company pension. Without a facility like this that is also friendly to their faith, many would have to spend their last years in an overburdened state nursing center."

Koeweiden, formerly the treasurer of the Netherlands Union, became director of Vredenoord in January 2004 as the elder-care facility experienced a significant financial and personnel crisis. Vredenoord again has a full census (and a waiting list of more than 40), offering 100 apartments with graduated levels of care, and some 45 apartments for assisted living. An 8.5-million euro (US$10 million) expansion and renovation was just completed this summer, and has aided significantly in rebuilding the patient census.

The director has purposefully "learned the ropes," working in each department of the facility until she understands the tasks and challenges employees face. Weekly group meetings with the residents have become useful problem-solving opportunities, and both resident and employee morale has climbed dramatically.

"The key ingredient in what we've all done to turn this place around is transparency," she adds. "In personnel meetings, with constituents, it means telling all the situation--what we're doing, what the problems are--keeping them informed. And they've clearly responded positively to that way of doing business."

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