Leading with the New CMS Regulations: It’s in the Green House DNA!

By / Posted on October 17th, 2017

Many traditional nursing homes are scrambling to meet the new person-centered regulatory standards; however, it is business as usual for Green House homes.  What set’s Green House homes apart is the comprehensive transformation of the homes… physical design, organizational structure and philosophy of care are all changed to reflect elder-directed care. The three Core Values: Real Home, Empowered Staff & Meaningful life provide a guidepost for establishing operational practices.

CMS is placing a larger focus on use of non-pharmalogical interventions and staff having appropriate competencies and skills. Appropriate treatment and services for Elders living with dementia is also emphasized in the new regulations.

A key element of The Green House model is the use of specially trained versatile workers, whose responsibilities include food preparation and service, activities, light housekeeping, and laundry. The versatile workers are called Shahbaz, and are Certified Nursing Assistants who receive an additional 128 hours of education which encompasses all elements of their work including infection control procedures, culinary skills, dementia, communication skills and activities. Not only are staffed provided the training they need, but consistent staffing allows for Shahbazim to get to know their Elders, establish strong bonds of friendship. Being well-known supports allows for non-pharmalogical interventions to be effective.

 Residents Rights has become the largest section in the new CMS regulations.

Shahbazim understand that one of their fundamental roles is to nurture, sustain and protect the Elders in their care. Elders are in control, driving decisions in the home from menu choices to daily activities. Staff learn about how to provide Meaningful Life to elders in their care, including honoring their natural rhythms. Elders can sleep in and go to bed when they wish.

New regulations set new standards for care planning.

Elders can decide who attends and now must participate in setting goals. A nurse aide and a member of food services staff are required to attend care plan meetings. Again, this has always been part of the Green House model. Shahbazim lead the care plan meetings. Because they are consistently assigned to work in one home, they know their Elders well. Staff are coached on how to respect Elder’s wishes, while informing them of risks and benefits of proposed care. Ultimately, the Elder decides.

Grievances must be acted on quickly by staff and recommendations from Elders must now be considered. In a Green House home staff are talking to Elders daily, hearing their concerns and following up on their issues in “real time.”

Shahbazim are empowered and therefore can often make immediate changes to address Elder’s concerns, eliminating the need to go through a long chain of command to have issues heard and changes made.

CMS has put more emphasis on creating a “homelike” environment.

Green House takes it to another level providing “real home.” Every elder has a private bathroom and their own bathroom/shower. Elders can personalize their bedrooms, bringing in many items from home.

Meaningful Engagement is now a greater focus of new regulations.

Elders must be provided with a choice of activities that encourage both independence and interaction with the community. Activities in a Green House home include a combination of planned and spontaneous events, with a majority of activity occurring naturally and recorded as appropriate. Although the full-time activities director will act in a facilitative role, providing assessment and evaluation of activity preferences and individual engagement, assistance with activity programming, coaching and teaching; versatile workers within each home will have primary responsibility for leading meaningful and engaging activities on a daily basis. While anticipated activities can be scheduled, the spontaneity fostered in a Green House home means not all activities can be planned.  Some programs will occur naturally, such as folding laundry, a family visit, or assisting with the day’s meal.

The Green House team is proud of the work of our adopters and the strides we have made to lead the field, creating better lives and better jobs.  


Regulators and Providers Share Goals and Values

By / Posted on October 8th, 2015

The Green House Project works with organizations in over 30 states to innovate long term care in a way that meets or exceeds the highest level of the regulations.  Collaboration with state regulators is pivotal to the success of the movement and well being of elders. To build and deepen relationships with regulators, Senior Director of The Green House Project, Susan Frazier Ryan,  recently attended the Association of Health Facilitator State Agencies (AHFSA) conference in Charleston, South Carolina.  This conference is an important opportunity to engage in dialogue with state regulators of skilled nursing homes and ensure that there is a clear understanding of The Green House model.

“We believe that providers and regulators share the goal of creating the highest quality environments and experiences to serve people who require long term care, and help them ‘attain or maintain their highest practicable level of well being.’  In order to achieve the goal and move the field forward, it is imperative that providers and regulators do not work in silos, but rather build mutual respect for each other’s vital role,” Ms. Ryan states. The Green House Project supports organizations to partner with regulators and create real homes where people live meaningful lives.

 


Joint Provider Surveyor Training: Building Vital Relationships

By / Posted on April 2nd, 2015

Susan-Frazier_8924A mutual goal of providers and regulators is for elders to experience high-quality lives, enjoying choice, freedom and dignity. The Green House Project understands this, and supports dialogue and education to build strong relationships among all stakeholders. The Joint Provider Surveyor Training, recently held in Grand Rapids, Michigan, provided an opportunity to spread our message about the importance of partnership, and its necessity to achieve positive outcomes for the future of aging.

As Senior Director of The Green House Project, I joined Renee Cunningham, Director of Nursing for Kalkaska Memorial Health Center, to present the latest research on The Green House model. Renee shared her organization’s journey to adopt The Green House trademark, and the value that they believe it will bring to help them achieve their goal of opening two Green House homes in 2015.

The Green House Project partners with state regulators to understand the specific regulations of each state, and educates them about The Green House model. Since the Omnibus Budget Reconciliation Act (OBRA) of 1987 was enacted, mandating that nursing homes “…help each resident attain or maintain the highest practicable well-being…” (CMS 1987), person-centered thinking has been inscribed in long-term care policy. The Centers for Medicare and Medicaid Services (CMS) continue to advance this agenda through regulations and interpretive guidelines that mandate person-centered approaches. It is essential to bring regulators and providers together for vital collaboration. Building those relationships at the policy and advocacy level are essential to achieving meaningful life at the individual level.