Leaving to Go Back: Al Power and the St. John’s Home Green House Project

By / Posted on June 6th, 2013

When Al Power was in med school and specializing in geriatrics, he would visit his grandmother in a nursing home. During one these visits, he noticed the nameplate on her door; the last name, “Power” had an “s” at the end of it.

“It was a note to me,” he said. “Of how anonymous she was.”

To Al, such anonymity wasn’t an issue unique to that particular nursing home — it was in the corners of every traditional nursing home. It is evident whenever elders are pushed into an institutional setting and away from their families. Away from the libraries. Away from neighbors. Away from the coffee shops. And away from the streets they know.

In other words, away from the community.

Al Power and The Green House Project are bringing elders back to a space where they know the greater community and the community knows them. It is a space that allows for growth, both for the people who serve elders and the elders themselves.

Eventually, Al left geriatric medicine, but he didn’t leave behind his passion for serving elders — not by a long shot. Even before he had left his practice he had already started working with St. John’s Home in Rochester, New York, and had learned about a new movement to revolutionize elder care embodied and supported by The Green House Project.

The Green House vision was the perfect marriage of the physical and operational change along with the philosophical change we really needed to move elder care forward,” explained Al.

“We talk about trying to create independence,” he continued. “But so many of our systems create dependence, make people shut down and feel incapable. I realized how a normalized environment can really liberate those people.”

Now Al Power and the team at St. Johns are focused on normalization. His goal is to maintain the same kind of life for elders in nursing homes as the one they had before they arrived. To do that, St. John’s took the real home concept of the Green House model one step further.

While many Green House adopters had built smaller, person-centric homes to replace the larger institutional-type buildings on their campuses, Al and his team wanted to build their new homes in existing residential neighborhoods. They wanted to bring elders out of isolation, back into multi-generational communities, where they could go to the local gym and the library and walk down the same sidewalk as other people.

Many nursing home executives try to save costs by having a central campus as a base of operations. St. John’s, in effect, wanted the exact opposite; they wanted to decentralize.

Although individual licensing of resident Green House homes proved to be an obstacle with the Centers for Medicare and Medicaid Services, the Green House Project helped resolve conflicts, brought everyone together, and helped St. John’s succeed in desegregating elders from the rest of the community.

In 2012, St. John’s became the first Green House adopter in the nation to locate individual Green House homes in the community. They built two houses, eleven miles away from their campus, in multi-generational, diverse neighborhoods. And it worked.

“When we saw the results,” said Al. “We were even more convinced that it was the way forward.”

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Al Power and everyone on the planning team knew that the St. John’s Home Green House Project would have success stories; they just didn’t know the stories would already be written before the homes even opened.

In preparation for opening day, the St. John’s staff invited family members, elders, and

people from the community to come have lunch. At one table, there was an elder, who Al recognized, sitting with his family. Al also knew that the man needed help from people to lift him up from one chair to another at his traditional nursing home.

Al ended up joining the man for lunch. When they finished their meal, the staff brought over the elder’s wheelchair. But before they could assist him, the man got up and got into the chair — by himself.

When one of the staff asked him how he did it, he said. “I don’t know, I guess over there I’m supposed to be sick.”

Al and the entire team at St. John’s have learned to expect more of the elders they serve. And by raising the bar for long-term services and supports in the community, they are inspiring providers everywhere to expect more of themselves.