BETHANY, MO. - Crestview in Bethany, Mo., has become a model, offering residents the freedom to sleep late, eat what they choose and go out for the afternoon. And the approach is saving money.

Here is what Eric Haider says people dislike most about nursing homes: losing their privacy and losing control over their lives.

Here is what he did about it: He gave those qualities of life back.

At Crestview, the rural Missouri home that Haider runs, residents use their own furniture. They get up when they choose. They eat when they want. They have pets and bird feeders and gardens. They go shopping and bowling and fishing and even Ferris wheel riding.

Haider's "person-centered" approach doesn't cost more -- it saves money. The home is one of 40 that operate on the lowest Medicaid rate in the state -- $85 per resident per day.

Yet Crestview is winning national acclaim and consistently posts near-perfect scores on state inspectors' tests.

"If I can do it at this price, how come the home a half-mile from here -- at $99 a day -- can't?" Haider asks.

Crestview has cut costs without cutting corners. Residents don't need costly disposable briefs, for example, because aides keep track of when to take each one to the bathroom. Less food gets wasted because residents have more meal choices. High-salaried middle managers aren't needed because nurse's aides have more authority.

Best of all, the home's 130 beds stay full, which provides a stable stream of funding. A new wing with 44 private rooms -- all spoken for -- is under construction. Crestview has a waiting list of 80 people, an anomaly in a state where nursing homes average 76 percent occupancy.

Those results have fueled demand for Haider to make presentations to operators and inspectors across the country. He has visited more than 30 states and will speak to an international group in Australia next year. He happily admits he's on a crusade to overhaul the nursing home industry.

"Instead of covering up, shoving everything under the carpet, let's fix the problems," he said during a tour of his facility. "Then people will be proud to say, 'I'm 85 years old, I'm going to a nursing home.'"

"Give them what they want"

Regulators say his methods are simple.

"He mainly tries to find out what the residents want and figure out how he can give them what they want," said Marilyn Fischer, a state official who oversees nursing home inspectors in the northwestern region. "It just makes an awful lot of sense."

Two-person rooms in the newest wing seem semiprivate because of a partial dividing wall. Instead of sharing, each resident gets a door, bay window, sink, television and thermostat.

Handmade quilts, family photos, easy chairs and knickknacks lend a homey feel.

Colleen Parman, 71, collects chicken figurines and was delighted when Haider bought her a five-shelf display unit. "It makes you feel like you're somebody," said Parman, who lived in two other nursing homes before moving to Crestview.

Jim Hulen, 73, was bedfast, coiled in a fetal position when he arrived at Crestview. Now he's walking and active in Bible study and music sessions. He also goes shopping. "It's good to get out of Dodge," he said. "I've made friends."

Breaking the mold

Haider began looking for new ways to do things about 12 years ago, when he ran a nursing home in Kansas. A woman there had eye problems and complained that her room was too bright. At home, she had a blue bulb. So Haider bought her one. "She was happy," he recalls. But the home got cited by the state inspector for breaking a regulation on lighting.

"We fought about it a long, long time. I think I said, 'Take my license, I won't change the lightbulb.'"

Haider has been experimenting ever since. He and his wife, Margie, moved to her native northwest Missouri 10 years ago to take over the former "county poor farm" with its burnt-orange-painted walls, four-person rooms and lack of staff communication between shifts. The home was in trouble with state inspectors because of residents' pressure sores and infections.

The Haiders decided: If they could turn Crestview around, any home could do it.

Controlling administrative costs

Eric Haider, 49, is executive director and Margie Haider, 44, is director of nursing at the nonprofit facility about 21 miles from the Iowa state line.

It's a long way from Haider's roots in a region of India that became part of Pakistan. He came to the United States when he was about 5. The family moved around the country, living in Eureka in the 1970s. Haider earned a bachelor's degree in biology in 1980 from Missouri Western State College in St. Joseph.

Like most nursing homes, Crestview draws more than half its operating revenue from Medicaid, the state-federal program for low-income residents. But unlike most operators, Haider isn't complaining about his rate, even though at $85 a day it falls well below the state's $97.27 average. He simply spends less on the front office.

Crestview eliminated most middle-management jobs, such as assistant director of nursing. A nurse's aide is in charge of scheduling staff members, ordering supplies and billing Medicare. That means Haider gets those tasks done for about $9 an hour instead of $18 an hour.

Overall, administrative costs at Crestview last year ran $11.61 a day per resident, compared with a median of $18.90 for all facilities in Missouri, said Kevin Morey, who audits nursing homes for BKD LLP in Kansas City.

Morey attributes the difference, in part, to the fact that Crestview pays no fee to a management company or home office, as most nursing home chains do.

Such "related party" payments sometimes involve questionable expenses and can divert profits from patient care.

Creative organization and teamwork

Crestview's spending on direct-care staff is by no means extravagant. Cost reports filed with the state show that Crestview runs at about the state median -- roughly three hours of care a day for each resident.

But the staff is organized in an unusual way.

Most homes have a traditional chain of command with nurse's aides doing the menial tasks and nurses and administrators calling the shots.

Crestview turns that model on its head, involving nurse's aides in solving problems instead of just emptying bedpans.

Staff members are assigned to teams -- one for each of the home's four wings. The 20-person teams include nurses, aides, housekeepers, activities staff members, maintenance workers and kitchen help. Each team works with the same group of residents each day.

A nurse's aide heads each team and is in charge of "quality of life" issues. Those can range from helping residents decorate their rooms to answering a family member's question about why grandma's dentures are missing. That frees nurses to deal with medical problems.

It sounds corny, but everyone works together. Laundry workers attend staff meetings alongside medical technicians. All chip in with information needed for the lengthy reports nurses must file on each resident's condition.

No staff member walks by a blinking call light without finding out what the resident needs.

Eat what you want

Rules give way to personal preferences. Some residents arrive wearing disposable briefs, simply because staff members in their former nursing homes found it more convenient. One wheelchair-bound woman told team leader Sissy Springer that she "felt like a baby." Springer said the diaper wasn't needed if the resident could tell aides when she needed a bathroom. Only three residents use diapers now, down from 53 four years ago.

Other Crestview creeds: Sleep as long as you want. Take a shower -- or refuse it. Eat when you want. Steam tables, with three meat and four vegetable choices, stay open at least 2 1/2 hours for each meal.

On Wednesday mornings, residents help cook breakfast, using electric skillets and waffle irons to concoct treats such as chocolate chip pancakes or waffles. They eat in five dining rooms, organized by care level.

Hot dogs, cereal, fresh fruit, ice cream and other snacks are available anytime.

Haider says most homes fight residents' habits, trying to change their lifestyles after 85 years. He says residents of those homes tend to "fight and fight, until they give up. They decide, 'I'm going to sit in this chair, put my head down and pray that I die.'"

With his model, "rather than fight, now they're helping. She's awake, she's hungry, she wants to eat. So all the food goes into her body, not the wastebasket," Haider says.

The number of residents on expensive food supplements has dropped to 12 from about 55.

Haider admits he's had a few busts. Candlelight dinners are out, since a napkin caught fire.

Bernice Coon, a diabetic, appreciates the home's flexibility. "Anytime you want any food they don't have, you just tell them and they'll fix it," she said.

Coon, 87, moved to the nursing home last year from the home's assisted-living units after suffering a stroke. Her husband died a few months later. Now, one of the bright spots in her day is provided by the home's big gray cat, Sassy, who naps on a special pad in Coon's bay window. The home has five cats and two dogs, as well as bunnies, chickens and a rooster outside in the courtyard.

"You get to have fun"

Every work group at Crestview plans a weekly activity. Laundry workers read to residents. The maintenance staff hands out remote-control cars for residents to race down the hallways.

There have even been water gun fights. Once, a resident turned his call light on, then soaked the responding aide.

"You get to have fun with them," said team leader Linda Cook, who worked at another facility in the area before joining the Crestview staff. "It's more homelike here. It's not like just doing your job."

For instance, one man on her hall wanted to make a strawberry cheesecake, so the staff took him grocery shopping, then helped him assemble the dessert. "Now he wants to make apple butter," Cook said.

This stands out even more when you consider that Cook oversees the "heavy care" hall, where all 24 residents need help with daily tasks such as eating and toileting. That didn't stop Cook from taking a vanload this summer to the Northwest Missouri Fair, where they rode the Ferris wheel and bumper cars.

Fischer, the regional inspection chief, said that while Crestview takes risks, staff members "know their residents pretty well and they know what would be safe for them." She sees a big payoff, because having fun "makes them feel better, eat better, take less anti-depressants."

Residents have jobs, such as making toast or putting silverware in bags. They get name tags showing their duties. Bill Geyer, 87, wears a tag that says "agriculturist."

Geyer, who suffers from Alzheimer's, helped plan a backyard flower garden.

Peggy Elliston, 70, posed one of the more challenging requests. She was upset that she had been forced to leave her cat, Snowball, behind at her farmhouse. Haider agreed to fetch the cat, but Snowball turned out to be hostile, scratching staff members. So workers built a three-room, heated house for Snowball in the courtyard outside Elliston's window. "I don't know what the heck I'd do without her," Elliston says. "She's a lot of company to me."

Lining up for jobs

Residents aren't the only satisfied ones. While most homes have sky-high staff turnover and can't recruit aides fast enough, Crestview has dozens of people on a waiting list for jobs. The home employs 160 people. Employees get $1,000 bonuses on the anniversary of their employment.

Staff coordinator Charles Turpin says pay isn't the main draw. Jobs at other nursing homes and nearby hog farms pay better than Crestview, where nurse's aides start at $6.60 an hour. But Crestview offers something else: "You get a lot of reward out of it," he says, "because people thank you."

Other homes, including some in the St. Louis area, are trying parts of Haider's model, especially the expanded meal times and 24-hour snacks.

"Eric is a breath of fresh air," said Michael Roth, administrator of Alexian Brothers, Sherbrooke Village, in St. Louis County. "I think what he's doing is the right thing for all of us to be doing."