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The Green House Project Blog

Toni Lynn Davis: Best Fifty Women in Business in New Jersey

An innovator is described as a person who introduces new methods, ideas, or products.  That definition truly describes Toni Lynn Davis, the President and CEO at Green Hill Inc.  She has spent her career implementing new and innovative practices to improve the lives of Elders in New Jersey.  The first Green House homes were opened under her leadership in that state, and she has been a champion for culture change in aging services for many years.  So, it’s not surprising that NJBIZ selected Toni as one of the Best Fifty Women in Business in New Jersey.  The awards ceremony was held in late March and was a special evening for those being honored.

Click here to read about Toni’s story in the awards ceremony official program (see page 11).  In addition to her very successful work at Green Hill, Toni serves the State of New Jersey as a policy expert in the area of Elder-first long-term care as a board member of Leading Age New Jersey.  She volunteers countless hours and resources to long-term care providers across the state who desire to redefine the long-term care model in their institutions.  She also serves as a member of the Steering Committee for the Green House Peer Network, helping to shape the policies and vision for this group of adopters.  She is very involved in volunteer community programs, providing holiday gifts to seniors in need.  Toni has also led the effort for intergenerational programming—including student and senior roundtable 8 minute mixers, plays from the local high school, intergenerational Valentines dances and special choral concerts.  Lastly, she is a real advocate for women.  Toni serves as a coach and mentor to a large number of women who work in the Elder healthcare industry.  She works with Rutgers University as mentor for student interns and is currently mentoring Assisted Living administrators in developing a new community in Newark for low income and Medicaid Elders.

It should be noted that Toni was promoted to Executive Director/President of Green Hill Inc. during a period of financial loss and low occupancy.  Staff morale was extremely low.  She established a system of staff empowerment, created roundtables of discussion and opened communications.  Toni moved the organization from a top down hierarchy to a cross lateral structure which created a creative problem solving atmosphere.  In a period of four years, Toni overcame a $2.7 million financial loss and put the organization solidly in the black.  The morale of staff as well as the Elders completely turned around.

Toni:  We applaud your life long work with Elders and anxiously await to see what innovations you have in mind in the future!  Congratulations on your award!


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Investing in Staff Retention: Can You Afford Not To?

None of us would argue that staff turnover creates a host of problems for organizations.  Staff retention is vital from a quality perspective, but what about the economic impact it plays for a health care provider?

The issue is explored by the Director of THE GREEN HOUSE® Project, David Farrell and PHI Strategic Advisor, Steven Dawson, in the Spring/Summer 2014 publication of the Indiana Health Care Association “Insight”.

High turnover of your direct care workers can mean reduced quality of care, increased stress for the staff, inefficiencies across many levels, the constant need to recruit and train—which lead to some very high dollar issues.

While some nursing home providers say it is “inevitable”, when they sit down and truly calculate those costs they are shocked so see their annual turnover costs!  In the article Farrell and Dawson discuss investing in proven retention strategies.

Click here to read the full article and let us know how turnover has affected your organization!


Are you curious about staff turnover in a Green House home?

The Green House model gives Elders four times more contact and reduces staff turnover.  A Green House home is created from the ground up to foster the same feeling and experience you get from living in a real home.  Each home is designed for 10-12 Elders keeping it flexible and maintaining a warm feel.  The comfort of private rooms and bathrooms are combined with the family-like atmosphere of open common spaces.

The innovative organizational structure in the Green House model is based upon “the conviction that we need a new framework around which to organize the experience of those who protect, sustain, and nurture our Elders.”  The structure challenges the traditional nursing home hierarchy to create environments that empower elders and those who are closest to them.


Click here to see why The Green House model is the proven and preferred option for creating sustainable culture change.


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Talk about The Green House Project during National Nursing Home Week® 2014

Are you interested in spreading the word about the Green House model and bringing Green House homes to your community? You’re invited to join Green House adopters and enthusiasts across the country during National Nursing Home Week from May 11-17 to educate your local communities and policymakers about The Green House difference.

This year, the American Health Care Association is using the Hawaiian theme, “Living the Aloha Spirit,” for National Nursing Home Week. According to their website, the aloha spirit means that “… the people of Hawaii are encouraged to treat others with deep care, respect and humility, leading to individuals creating a better world.” The Green House model’s core values of Meaningful Life, Empowered Staff, and Real Home, align closely with this year’s theme and we are excited to invite communities across the country to see the difference that our model offers.

Want to get involved next month? Here’s how:

- Write an op-ed in your local paper in support of the Green House model & share with us!

- If you’re already an adopter, invite local policymakers to “see the difference” by visiting your Green House home during that week and sharing photos with us

- Help us launch a “Get Connected” campaign and share your National Nursing Home Week stories and photos using social media and connecting with us on Facebook and Twitter using #EldersRule

Need a template to get started? Visit our Support the Movement page and use our policymaker site visit letter and editorial sample and share these tools with your friends and colleagues. Contact Meaghan McMahon at (mmcmahon@capitalimpact.org) with your questions or to share success stories, photos and editorial letters.

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The Green House Project has partnered with the Robert Wood Johnson Foundation’s THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care. Supported by the Robert Wood Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes. Each quarter, a member of the THRIVE team will contribute a blog post to the Green House Project website.

Early findings from the THRIVE research collaborative were published in The February 2014 Gerontologist supplement, Transforming Nursing Home Culture: Evidence for Practice and Policy, a themed issue providing evidence to inform practice and policy related to culture change.  The full articles can be accessed at http://gerontologist.oxfordjournals.org/content/54/Suppl_1.toc and are summarized here.

A paper entitled “A “Recipe” for Culture Change? Findings from the THRIVE Survey of culture change Adopters” provided information from a survey that assessed which components of culture change – and in what combinations – have been adopted by nursing homes.  The survey was completed by 164 nursing homes that had already adopted culture change.  Results showed that adopted components of culture change varied across the type of nursing home model (i.e., small house, household, traditional unit).  As one example, respondents from small houses reported a significantly higher rate of direct care workers preparing meals (79%), but these were some of the least adopted practices for other adopters (22% of households and 13% of traditional units).  Results also showed that some traditional environments have been able to implement certain culture change components without large capital investments.  For instance, respondents reported similar rates of practices related to educational support and quality improvement regardless the nursing home model.  Taken together, these findings suggest that although practices do vary by model, some components of culture change are attainable for homes that have fewer resources to invest in large-scale renovations or reorganization.

A paper entitled “Who are the Innovators? Nursing Homes Implementing Culture Change” focused on the organizational factors associated with culture change implementation.  Using a sophisticated analytic process, information from 16,835 nursing homes was used to determine which resident, facility, and state characteristics related to a nursing home later being identified by experts as having implemented culture change.   These characteristics included being nonprofit, larger in size, and with fewer Medicaid and Medicare residents. Implementers also had better baseline quality with fewer health-related survey deficiencies and greater licensed practical nurse and nurse aide staffing. These findings suggest that nursing homes are in a better position to implement culture change if they start out with more resources and fewer challenges.   In a related article entitled “Culture Change and Nursing Home Quality of Care”, analyses examined how culture change implementation related to later nursing home quality.  This study found that nursing homes identified as culture change adopters later had fewer health-related survey deficiencies, but there was no improvement in the MDS-based metrics of quality.  These finding may suggest that culture change improves nursing home processes of care, and/or that surveyors recognized the homes’ culture change efforts in their ratings.  The lack of impact on MDS outcomes may suggest that either the early focus of such efforts has not been on clinical outcomes, or that because nursing homes adopting culture change already had better outcomes, there was less room for improvement.

Finally, a paper entitled “Developing the Green House Nursing Care Team: Variations on Development and Implementation” explored the roles of the nurse and the Shahbazim in the Green House model, focusing on how variations in the nursing team related to clinical care practices. Data were collected through observations and interviews with nurses, Shahbazim, Guides, and Directors of Nursing, and found that implementation of the nursing role within the Green House model varied both within and across sites.  Four nursing model types were identified: Traditional (nurse manages both care and non-care activities); Parallel (nurse manages care, Shahbaz manage non-care activities); Integrated (nurse and Shahbaz collaboratively manage care and non-care activities); and Visitor (Shahbaz manage care and non-care activities, with input from nurse as requested).  Care processes, Shahbaz skill development, and worker stress varied across each model, and although the Integrated model presents considerable challenges in terms of clarifying boundaries, it seemed to offer the greatest benefits in the areas addressed in this study.  

The THRIVE team will be expanding upon these and other findings in 2014, and will be sharing those with you and others via conference presentations, webinars, blog posts, and more journal articles.  As always, we invite your feedback about the best ways to keep you informed of the latest findings.

Questions about THRIVE can be directed to Lauren Cohen (lauren_cohen@unc.edu or 919-843-8874).


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Episcopal Homes of Minnesota: Despite Harsh Winter, Major Construction Progress has Occurred for Six Green House Homes

While we are all anxiously waiting for spring to truly arrive this year, none could be wishing for that more than the construction workers on the project for the Episcopal Homes of Minnesota!  Warmer weather and fewer snow storms will be welcomed with open arms!  Despite the tough winter season, major progress has been made on the $45 million dollar project.

Midway Village will provide a variety of living options for Elders including skilled nursing services in The Green House homes.  Ten Elders will live in each of the six homes which is being called “Episcopal Church Home – The Gardens”.  Not only will Elders enjoy their own bedroom, bath, home cooking, a hearth and balcony or terrace…they will also be able to enjoy the laughter of children each day.  A day care center will be part of Midway Village.  It’s something the organization has wanted to do for years, but they never had the space to provide the services.  The center will be available to staff and neighborhood infants and toddlers.  A truly wonderful inter-generational experience for all!

Another important aspect to the project includes light rail service that will pass right in front of the project…making transportation more convenient for Elders, staff and families.

The Green House homes are slated to open in February of 2015 and will be the first skilled nursing Green House homes in Minnesota.


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