Bill Thomas, Aging is “Life’s Most Dangerous Game”

By / Posted on April 28th, 2015

IMG_0076In his Age of Disruption Tour, Dr. Bill Thomas promises a wide ranging discussion about society’s perspective on aging and what he calls, “life’s most dangerous game.” Nearly 300 people turned out to beautiful Nelson Hall at Elim Park Baptist Home in Cheshire, Connecticut to hear Dr. Thomas, joined by musician Nate Richardson.

As people entered, they were greeted by the sound of drumming and a blackboard with where people completed the phrase “as I age I dare to….” Everyone was encouraged inscribe their “dare” on their own personal shaker, and to contribute their own rhythm to the drumming.
Combining music, story-telling and multi-media, the performance seeks to debunk our pre-occupation and romance with the perfection of youth. As Dr. Thomas, demonstrates with a teenage picture of himself, braces and all, the reality is often not quite as rosy as the ideal. The romantic notion of youth is perpetuated with an anti-aging fantasy, which can be seen in the myriad products and services that claim to reverse the effects of aging.

Dr. Thomas proposes an alternative. Age takes things away, but it also offers new gifts. While today’s society emphasizes the losses, we can choose to see aging rather as the transcendence of youth. As we age what we’re good at changes, and we move beyond the cares and priorities that consumed us when we were younger.

IMG_0063

The key for a successful older life is to be able to discover “re-imagination”. Youth is about imagination and possibilities. Then people surrender their many dreams, and narrow their focus. They trade possibility for competence. As they become defined by their competence, they are afraid to try new things because, they’re afraid of looking foolish. In order to age well, we must let go of this fear, and regain some of those dreams, or find new ones.

Re-imagination is about creating opportunities to learn and grow. It’s about giving up competence for possibility. Take risks, because you never know what you might find. And taking these risks is life’s most dangerous game.


The Skilled Nursing Development Opportunity – Aspiring to Something More

By / Posted on July 31st, 2014

I read with interest a recent article in Senior Housing News- Developers See Opportunity as Old Nursing Homes Become Obsolete. It’s great to see not only that people recognize that the stock of 40+ year old nursing homes is not going to cut it, but to hear the sentiment that the replacement of old nursing homes is an opportunity. But when we think about replacing nursing homes, what are the key considerations? Are we making the most of this opportunity by re-thinking them, or are we simply sprucing up the same institutional approach?

For nursing home providers considering a significant renovation, the article makes the point to do your homework. “Given the relative aging of the post-acute care facilities, some providers are finding that it’s more cost-effective to develop new facilities rather than redesign multiple decades-old properties.”

Also think about the long-term value of your renovation investment – a renovated facility will look good today compared to what’s available, but how will it look against the competition in 20 years? How will it fare as consumer demands continue to evolve?

What I love about the nursing home model discussed in this article is that it’s designed to be a community gathering place. Most current designs and locations segregate their older population from everyone else. This is bad for everybody – Elders don’t get to interact with anyone other than other older people. And younger people don’t have the opportunity to appreciate Elders and to benefit from everything they have to offer. Creating a space that is inviting to the surrounding community, families and friends is a great idea.

On the other hand, I got the sense that at their heart, these facilities are potentially the same old institutional nursing home in a prettier box. In addition to community space, this design will have examination rooms, because that’s what physicians want. As I hear providers embrace the “hospitality” model, with cafes, wireless and flat screen TVs, I wonder if anyone has asked Elders what they want.

I’m also wondering about how these new nursing homes will actually work. Will the design make it easier for people to get around or will it still have long hallways filled with workers hurrying from place to place (albeit on nice carpet)? Will the culture put people first, or will it simply be the same institutional approach? Will the people who work there develop real relationships with the Elders who live there? Is it designed to maintain dignity and create meaningful lives?

There’s no doubt that these new nursing homes will be a huge upgrade over what’s currently available to most people. They’ll be more attractive, and more comfortable than facilities built in the 1960’s, but will the experience really be that different?

If you ask people where they want to spend their last years, they’ll tell you “home.” When Elders are admitted into institutional skilled nursing facilities, they want to go “home.” If an Elder is in long term care, being physically at home is no longer an option. So what can “home” mean in that context? First off, I’m pretty confident it doesn’t mean something that looks like a hotel. I think it means a place that is comfortable and is familiar, and allows them to continue to live their lives as they would if they were living independently. It means having opportunities to make the choices we all expect as adults – when to get up, when to have meals and what to eat, how we spend our time. It means being able to do the things that make life meaningful, and to be respected and known as individuals.

So when we invest in new skilled nursing development, don’t redesign something based on today’s nursing homes. Start with the mission and important values. Think about a design that will work better for Elders and the people who work there. Let’s not squander the opportunity to create something new. Let’s aspire to something better than more attractive institutions.


For-Profit Provider Shares The Benefits of Choosing The Green House Model

By / Posted on July 29th, 2014

“Why would you do anything else?”

That was the question posed by John Ponthie, Member of Summit Health Resources, a for-profit skilled nursing provider in Arkansas, who has embraced The Green House model on two campuses, and is about to start development of a third. He believes that the differentiation, risk mitigation, long term financial benefits, and culture change support from The Green House Project make the decision a “marriage of passion and economics.”

I recently had the opportunity to visit John’s beautiful campus in Magnolia, Arkansas along with a for-profit group looking to develop Green House homes in Missouri. After a tour and a delicious Arkansas barbecue with Elders and the staff, we sat down to learn why a for-profit operator would build Green House homes.

John’s Green House homes are located in a rural area of Arkansas where Medicaid is the biggest payer source, and his private pay rate is $15 less per day than Medicaid. He didn’t want to have to spend “his whole life attracting residents.” The decision to build Green House homes has been rewarded with occupancy rates in the high 90% range compared to a state average of 70%.

Risk mitigation was another reason for developing Green House homes. After careful consideration, he concluded that occupancy was his most significant risk. After a big investment in this business, he didn’t want another organization with a newer building or a better concept, to “trump” him. Green House homes are the pinnacle of skilled nursing innovation, and so highly differentiated from the competition, he believed that the model and its benefits protected the business from new entrants.

But what about the costs of Green House homes versus traditional skilled nursing facilities or other models? The team at Summit Health Resources focused on ways to manage development costs without cutting corners, keeping capital costs low. The key is finding someone who really knows construction, according to John. “Most people don’t know construction. And you have to come up with a design that makes sense.” The incremental cost of Green House homes, when amortized over 20 or 30 years, and taking into account the benefits, “is a no-brainer.”

According to John, The Green House culture and organizational change are the “magic.” The Green House Project helped create a culture focused on caring for Elders, and providing them with a meaningful life. Families spend more time with their loved ones, and are extremely involved with the activities in the home.

For the staff, the benefits are enormous. They are empowered to do their best for Elders. They feel a sense of pride, and that they are a part of something special. “Their commitment goes way beyond their job description,” according to John. In addition to having very satisfied employees, he’s been rewarded with very low turnover.

It was great to see the “magic” created in Magnolia first hand, and to hear John’s story. It’s truly a case of “doing good, while doing well!”


Assessing the Financial Viability of The Green House Model: Slaying the Urban Myth

By / Posted on June 20th, 2014

Take any urban myth, such as the popular one about alligators living in the sewers;  people talk about it, but nobody has seen it.  The urban myth about Green House homes is that they are not financially viable because they are too expensive to build, and too expensive to run.  But when you really look at it, the facts don’t support the myth, according to Scott Townsley, Principal, CliftonLarsonAllen, LLP, in a presentation at LeadingAge of Pennsylvania.

Public perception of nursing homes continues to be negative.  Despite that, occupancy remains pretty high.  Nursing homes have benefited from Certificates of Need, which peg nursing home bed supply to demand.  Nursing homes have never had to worry about marketing a product that the public didn’t want – demand is guaranteed.

Over the next 10-15 years, utilization will decrease, according to Townsley, meaning that supply will outstrip demand.  Consumers will have more choice and nursing homes will have to compete to keep rooms filled.  To succeed, something will need to change.   And Green House homes represent one of the biggest innovations – and opportunities – for operators.  Research shows that consumers will drive farther and pay more for Green House homes compared to traditional nursing homes.

The Green House model is not just about doing good – you can do well.  In addition to deep culture change, person-centered care, a unique residential environment, and better quality of life, Green House homes also generate better outcomes, improve payor mix and increase occupancy.

In most cases, the urban myth about Green House homes is based on nothing more than rumors or a cursory review.

For example, in a strategy review and financial analysis performed by CliftonLarsonAllen for a struggling provider, they looked at the impact of incremental strategy improvements vs. conversion to Green House homes.  With the incremental approach, the organization was out of business by 2019.  By building Green House homes and improving occupancy and payor mix, and getting a higher private pay rate – typical results with the Green House model – the organization will turn around and ultimately thrive.

St. Johns Homes near Rochester, New York demonstrates the financial impact of Green House homes.  Susan Frazier presented a case study comparing St. Johns traditional nursing home to their recently developed Green House homes.  The Green House homes are generating improvements in occupancy and payor mix, with exemplary survey results, at operating costs that are 30% lower PPD than the legacy nursing home.

Don’t fall for the urban myth about Green House homes.  With 152 Green House homes in operation, and another 150 under development, the facts tell a different story.


7th Eden Alternative International Conference: Green House Staffers Present on a Wide Variety of Culture Change Issues

By / Posted on May 5th, 2014

The Eden Alternative is celebrating 20 years in 2014!  So, the conference last week was time for a celebration and a chance for thought leaders and partners from across the country to share their knowledge and experience with conference participants.  Below are highlights from just a few of the sessions led by Green House team members.

Bringing Eden Alternative Principles to Hospice: Treading New Ground

Person-centered care can be a powerful differentiator in competitive hospice markets.  The Eden Alternative Philosophy can help hospices deal with financial realities like the increased focus on efficiency dictated by Medicare reimbursement cuts, as well as the employee stress and dissatisfaction caused by these changes.   It’s also an important way for hospice organizations to demonstrate to staff that they remain focused on their clients and mission, despite the economic challenges.

That was the message from the session entitled: “Bringing Eden Alternative Principles to Hospice: Treading New Ground” presented by Project Guide, Claire Lucas, of The Green House Project.  While the basic concepts remain consistent across the care continuum, there are unique challenges incorporating person-centered care in the surprisingly medically focused hospice environment.  One challenge is that Elders are located remotely.  Another is the short duration of typical hospice care, with most ranging from just a few days to two weeks.

The Eden Alternative philosophy encourages hospice providers to enrich their visits, and add more value.  Focusing on simple pleasures, activities and hobbies, and reminiscing are a few ways to keep the focus on the person.  Other ways to enhance home hospice visits include aromatherapy, comfort touch and music.

Well-being and the Empowered Workforce: Respect, Relationships, and Growth

The key to empowered staff is coaching leadership according to Project Guide, Marla DeVries and Director, Susan Frazier of the Green House Project staff.
Empowered Staff is the “human architecture” of the Green House home explained Frazier.

In the Green House model, the CNA role is replaced by a versatile worker, called a Shahbaz .  They are part of a self-managed work team – a team that is respected for its proximity and deep knowing of Elders.  A central component of an empowered workforce is coaching leadership, creating empowerment conditions and always “educating, educating, educating.”  “While traditionally a leader is focused on managing people,” said DeVries, “coaching leaders must embrace people.”

With an empowered workforce, the focus is no longer about care-giving, but about care partnership – how staff works together.  Clinical support team staff members do not come in to deliver a solution, but to support staff and to work as a coaching partner.  While working as a mentor and an educator, a coaching leader must balance support and accountability with team members.

A Community-based Green House Approach: Development Goals, Opportunities and Outcomes

There are unique benefits available to providers and developers teaming up to provide healthcare via decentralized community-based approach.

Using the nation’s first community-based Green House project as a case study, Susan Frazier and SWBR Architect, Rob Simonetti, expressed that incorporating senior living options like Green House homes into residential developments is a win-win.  Elders benefit because they’re not segregated from the community, living in a real home, with a normalized environment and routine, and being part of a real community.

Incorporating Green House homes into developments also benefits the developer.   It enhances community support and helps them achieve construction efficiencies.  It’s also a significant market differentiator – the Green House model is very attractive and seen as a positive addition to a development.  “Green House homes make it easier for developers to sell market rate housing,” according to Simonetti.  Part of the attraction is buyers who are anticipating a future need, either for themselves or a loved one.