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.