By Rachel Scher McLean / Posted on July 27th, 2017
Next week, visionary leaders will come together at the 2017 Pioneer Network Conference. The theme, ‘Be The Future’, is a powerful charge to change the way society views aging, and create a better world for elders and those who work closest to them. The goal of this conference is to showcase innovative thought and best practices in the long-term care culture change movement. The Green House model is featured throughout the conference, and the national initiative is leading two sessions, one on the value of short term rehabilitation with a Green House home, and one on Best Life for elders living with dementia.
Short term rehabilitation presents an opportunity to position an organization for the future. The small house model provides a consumer-driven experience that leads to positive outcomes. During the education session, The Green House Project will highlight The Woodlands of John Knox Village, an organization who has captured their market by utilizing The Green House model for short term rehabilitation. They will share how they achieve positive outcomes using functional rehabilitation in the home, establish credibility with key stakeholders, and positively impact their bottom line.
As the population of the United States ages, the prevalence of Alzheimer’s and related dementia is growing. Dementia was estimated to cost the United States more than $236 billion in 2016. To address this challenge, The Green House Project has developed Best Life, an initiative that aims to connect elders with life and community through the philosophical, architectural, and organizational elements of The Green House model. It requires dedicated teams, extensive knowledge of the types of dementia, and a fervent belief in the unique ability of every individual to enjoy a meaningful life.
The Green House Project is a proud leader of what is possible in long term care. This conference is a time to connect with like-minded visionaries. As the paradigm shifts to view elders as creative, resourceful and whole, their potential is unlocked, and we all benefit.
By Anne Ellett / Posted on June 26th, 2017
Anne Ellett is a certified Nurse Practitioner (NP) with more than 20 years of experience in elder living and memory care, and served as Sr. Vice President with Silverado Senior Living, an award-winning Assisted Living company specializing in dementia care. Currently, Anne is owner/CEO of Memory Care Support, LLC, a consulting agency working with senior housing professionals as they develop state-of-the-art health and wellness and memory care programs.
The Green House Project recognizes that providing a life affirming, dignified environment for elders living with dementia (ELWD) is imperative, especially given that over 80% of people living in long term care have some form of cognitive change. Supporting these elders to thrive is a multifaceted process, and involves culture change. Best Life is a new initiative, designed to support Green House teams, by building on the core values of Real Home, Meaningful Life and Empowered Staff, and providing enhanced education that focus on principles such as:
- Power of Normal – normalizing programs and environments
- Integration with greater community
- Celebrating retained abilities
- Dignity of Risk
- Age-appropriate interactions
- Elder-directed, relationship-rich living
I had the pleasure of delivering this guided process of implementation at The Woodlands at John Knox Village (JKV) in Pompano Beach, Fl. JKV is a wonderful location incorporating independent living, assisted living, a nursing community and 12 Green House homes onto one campus! Their 12 homes have barely been open a few months but the leadership at JKV has the desire to strive for excellence in helping those with dementia thrive. Educator, Dolores Hughes said, “We feel equipped with tools to implement immediately, and also challenged to see people living with dementia in a new way. Best Life is an eye-opening experience.”
BEST LIFE supports elders living with dementia (ELWD) to have choice and dignity, while living in the least restrictive environment possible. Often, restrictions are due to our own perceptions of the capabilities and interests of ELWD. Typically, we are trained to see the diagnosis first rather than the whole person, which can limit the experiences and choices we offer to the ELWD. For example, as a nurse, I was trained to label “patients” by their diagnosis, i.e., the hip fracture in Room ###, or the patient with Alzheimer’s in Room ##.
When we use labels to identify someone, that prevents us from seeing the whole person and instead we focus on their loss of abilities, “they’re not able to ______ (fill in the blank) because they are living with dementia, they would not be interested in doing ______ (fill in the blank) because they are living with dementia.” In BEST LIFE, we learn to look beyond losses and inabilities toward retained capabilities and emerging talents.
As professionals, it’s important to examine our own training in the traditional model which emphasizes the diagnosis rather than the person. Are we limiting the experiences we offer to ELWD? For example, are we restricting them, perhaps from our own bias and belief that we need to segregate ELWD for their own safety? New research shows that there is value in offering ELWD frequent experiences with the larger community and with younger generations.
BEST LIFE has three areas of focus: Culture, Meaningful Engagements, and Health and Well-being. An entire day is devoted to each of these topics, looking both at our own biases and misperceptions of ELWD, and also examining new research from around the globe on new techniques that are beneficial and increase choice and dignity for ELWD.
During the BEST LIFE workshop at JKV, one of the most poignant experiences was when the participants shared what they would want the shahbazim to know about them if they were living with dementia. Aside from details such as their favorite foods or activities, the participants overwhelmingly requested that they be enabled to continue to have fun and laughter, and opportunities to try new things, and also to continue to contribute and “give back”.
There are already stories of elders connecting with life in new ways, as a result of this new focus on retained abilities and strengths. There is an elder in The Woodlands who plays dominoes every day after lunch and loves to teach anyone else, and an individual who recovering in short term rehab and plays his harmonica. Knowing him is a priority, and his full personality shines! There is a new garden growing in another one of the homes—it is amazing how nature, growth and learning enhances well-being for everyone.
Ribbon Cutting Ceremonies for 12 Green House Homes at John Knox Village in Florida – A Special Celebration!
By Mary Hopfner-Thomas / Posted on June 17th, 2016
Grand opening festivities took place in late May and included Elders, staff, aging services professionals along with a host of local and state officials. This $34 million project was truly the result of elders voicing their desire to see Green House homes on their campus that serves 900 John Knox residents in Pompano Beach, Florida. “The Woodlands is the first Green House to be initiated by resident involvement,” said Nancy Lee Matthews, one of several John Knox Village residents sharing input when the project was being planned. “It was us, the residents, who initially researched The Green House and presented the information to administration and the board of directors.”
President and CEO of John Knox Village, Gerry Stryker, welcomed those attending the event and definitely agrees that residents were a critical link in the project. “This is an incredibly emotional and fulfilling time for John Knox Village as we celebrate the culmination of our vision – to change the face of care and rehabilitation services in South Florida. Our residents’ dedication and determination has fostered an incredible sense of community – a home where families and elders will come together and set a new progressive standard for healing as set forth in The Green House Project model.”
The Woodlands is a total of 7 floors…the main floor has a common area and the remaining six floors each have two Green House homes with 12 private bedrooms and bathrooms surrounding a hearth area, open kitchen and dining area. Four of the homes will be dedicated to short term rehabilitation.
Senior Director of The Green House Project, Susan Ryan, was asked to spend additional time on campus to meet with medical professionals and Elders to share her insight into the Green House model. She met with physicians involved with care at John Knox Village, specifically those with Elders who will be receiving rehabilitation services in the homes. She also met with Sages that will be working in the homes. Sages act as an advisor and facilitator for the Shahbazim, the self-managed work team. In addition to Susan, Green House Project Guide, Debbie Wiegand met with the group to answer questions and share their appreciation for the work they will do in the homes.
A Sage is a volunteer and someone that has demonstrated wisdom and good communication skills. We are grateful for the work they will perform and wish them much success in the days and months ahead!
The Woodlands at John Knox Village was designed by RDG Planning & Design (Architects John Birge, Scott Pfeifer and Kevin Ruff). The Weitz Company served as the construction manager, and William Gallo, of Gallo Herbert Architects, worked with John Knox Village as the Owner’s Authorization Representative.
By Mary Hopfner-Thomas / Posted on September 15th, 2015
If you thought you would not have enough time to offer your input on the long-term care regulation reform rule you have just been given another 30 days!
The Centers for Medicare & Medicaid Services have extended the comment period until October 14, 2015.
If you are a Green House adopter or an advocate for culture change it’s important we share our vision and core values to change long term care in our country. The last time regulations were written was 1991!
Culture change advocate, Carmen Bowman who was a Colorado state surveyor for nine years and policy analyst with CMS Central Office, strongly urges everyone to make sure their voice is heard on the proposed changes. Carmen, who now is a consultant, trainer, author and owner of Edu-Catering said “As representatives of the culture change movement, what a grand opportunity we all have to encourage CMS to make some changes–to especially look at language.” She went on to say there are many other culture change practices that advocates may want to urge CMS to include in these new regulations.
Let’s make sure our thoughts and concerns are part of the process!
Click here to read more about the announcement
By Rachel Scher McLean / Posted on August 6th, 2015
The Green House Project was highlighted as an innovator and thought leader during the 2015 Pioneer Network Conference. The Pioneer Network is a convener of organizations who are moving away from institutional models of long term care to more consumer-driven models that embrace flexibility, self-determination and a belief that elders are meant to thrive. During the stimulating days of educational sessions, representatives from the national Green House initiative, and Green House organizations from around the country spoke on various topics to help move the field forward.
Debbie Wiegand, Rhonda Wolpert and Rob Simonetti shared design lessons learned in their session, “Build This, Not That, Lessons Learned from a Decade of Green House Experience.” Since the first home opened in 2003, there have been variations in layout and design. Through a formal Design Survey, The Green House Project asked every Green House adopter what works and what doesn’t for building design and regulatory challenges, and what strategies worked to overcome perceived regulatory code barriers. Also, insights from newly completed THRIVE research help us understand how the design contributes to sustainability, from operating cost and quality of care perspectives. Listen to this webinar that Debbie and Rob did to help those interested in changing the paradigm of long term care, build environments that support a new way of life.
Susan Frazier, Marla DeVries and Cheryl Van Bemden took audience members “Into The Black Box of Green House homes”. Here they talked about the impact of decision making to reinforce or erode culture change. Utilizing new insights from The Research Initiative Valuing Eldercare (THRIVE), a collaborative of top researchers created to learn more about what contributes to higher quality in nursing homes, this session explored the factors impacting problem-solving in long-term care organizations that lead to reinforcement or erosion of an empowered workforce, and person-centered models. Participants explored the four factors that the research determined to most greatly impact sustainability, while discovering organizational strengths and growth opportunities to create a slip-resistant change.
Tammy Marshall, Lori Grossman and Miriam Levi shared their experience of implementing person-centered care principles across Jewish Home Lifecare, a large organization with multiple sites. Tammy Marshall facilitated a second session with Sonya Barsness. They spoke about the importance of research to support “culture change” and “person-centered care.” They shared research that is being done at Jewish Home Lifecare, and how others can access research, translate it to those who need it most, and identify opportunities for additional research.
Finally, the team from Lutheran Homes of Oshkosh shared a special session called, “Honoring the Spirit Within Through Namaste Care: An End-of-Life Program for Persons with Dementia”. Namaste Care takes its name from the Hindu word meaning “to honor the spirit within.” The program was developed for elders with advanced dementia and strives to maintain their highest quality of life. It includes simple and practical ways for care partners to create opportunities for connection, meaning, and joy.
This conference is always an energy boost, knowing that the movement to transform long term care, and what it means to age, is growing, evolving and gaining momentum. The Green House Project is honored to be a leader of culture change and will continue to pursue evidence based excellence, that is based in deep knowing relationships, meaningful life and empowerment for all.
By Rachel Klumpp / Posted on July 15th, 2015
Rebecca Priest, Chief Operating Officer, and Jim Clark, Chief Financial Officer, of St. John’s homes in Rochester, NY share their Green House journey through the lens of delivering financial success to their organization and value to their customer. In the webinar St. John’s Journey: Providing the Best Quality of Care at the Lowest Operating Cost, Rebecca and Jim encourage listeners to “rethink all that you think you know” in order to provide the most incredible, elder engaged service at the best value in Green House homes.
Jim Clark, VP and CFO identifies that financial stability “is the side effect of doing things right.” Specifically, elder growth and well-being through positive clinical outcomes in addition to successful employees through retention and labor costs results in financial stability in two forms; revenue and predictability.
Listen to the webinar here: http://impact.adobeconnect.
By Meaghan McMahon / Posted on May 7th, 2015
The University of Wisconsin-Madison School of Nursing created the Center for Aging Research and Education (CARE) in response to the rapidly expanding care needs of our aging population. The center works toward transformation by using “…nursing leadership, discovery, education, and practice…” to support happiness, health and security for all older adults.
In a recent online post by the CARE team entitled, “What Makes a Green House Home? How You Decide Matters,” the author considers the persistence and commitment necessary to take the philosophical tenets of culture change and put them into practice.
The post describes how UW-Madison School of Nursing Associate Dean Barb Bowers, PhD, RN, FAAN and research manager Kim Nolet, MS have conducted research that analyzes the “lived experience” that the Green House model now has after more than 10 years as the pinnacle of culture change.
“By interviewing 166 staff members at 11 Green House homes, Bowers and Nolet identified patterns of problem solving as important to the erosion or reinforcement of the Green House model over time.”
The researchers found that along with the architecture of the Green House home, it is collaboration across the organization and between nurses and Shahbazim that allows the significant benefits of this model to be realized.
Both Bowers and Nolet are a part of The Research Initiative Valuing Eldercare (THRIVE). Interested in learning more about the THRIVE initiative? Take a look at this recent blog post which discusses the importance of the soon to be published THRIVE research results.
By Rachel Scher McLean / Posted on April 13th, 2015
In an exclusive interview with Provider, Dr. Thomas casts the vision of living in a world where the ageist slur, “elderly” is no longer a part of polite conversation. He says, “Think back in memory to the last time an older person referred to themselves as ‘elderly.’ People don’t introduce themselves by saying, ‘Hi, I’m Bob’s elderly mother.’ That’s put onto them. That’s the definition of a slur.” Dr. Bill Thomas believes that to change long term care, we need to change the larger societal attitudes toward getting old.
In pursuit of this reality, Dr. Thomas is hitting the road for the Age of Disruption Tour, “I’m going on tour again, starting in April,” [Dr. Bill Thomas] tells Provider. “I feel a responsibility to have an impact on not just long term care, but how our country views aging and how our country thinks about older people. I think that many of the issues we deal with in long term care are driven by deep, cultural misunderstandings about aging.” Part of the tour will be an old-fashioned rap session, with Thomas sitting down with leaders, that “explores new ideas, practices, and models to transform the experience of care and caregiving,” the tour’s ad copy says.
While there have been great strides to create opportunities for elders to live a life worth living, we have a long way to go… and there is always the danger of a good idea being turned into a marketing gimic, rather than the real deal. Take “person-centered care” for an example, “The problem with person-centered care,” Thomas says, “is that it’s possible for people to become satisfied with the name and to actually lose interest in the hard work that’s required to turn the name into a lived experience. The words are everywhere, but the meaning of the words is changing… What we really mean by person-centered care is relationship-rich care.”
In The Green House model, relationships are the cornerstone of success. The deep knowing relationships between elders and the direct care staff facilitates a familiarity that leads to positive outcomes, including increased workflow, cost savings, and health outcomes.
Dr. Thomas has truly made an impact on the field of aging, as the reporter says, “he is a founding father of a revolution. (How many other Birkenstock-wearing gerontologists are getting shout-outs from the Senate floor?)” As he embarks on this latest adventure, there will be new ideas shared, fires stoked, and people moved to action… bringing us ever closer to the ideal of meaningful lives for all.
By Al Power / Posted on January 15th, 2015
My work often brings to mind my good friend and mentor, Nancy Fox. Nancy is Chief Life Enhancement Officer for Vivage in Colorado, was the first Executive Director of The Eden Alternative™, and has many years’ experience as an administrator and an educator. The lessons she has taught me pop into my head on many occasions.
In 2007, Nancy wrote a book called Journey of a Lifetime: Leadership Pathways to Culture Change in Long-Term Care (available at www.edenalt.org or online booksellers). The book lists ten important principles for enlightened leadership, illustrated by stories of good and not-so-good experiences she has had, and lessons learned. One of these is called “Expect the Best,” a principle that is ignored with alarming regularity in long-term care, on both the provider and the regulator sides.
Here is an example of each:
First, a recent McKnight’s article described a study in the upcoming issue of Geriatric Nursing that can only be described as what my friend Jane Verity would call “a blinding flash of the obvious.” This study of nursing homes in the US and Germany showed that CNAs had a much better work experience if they were notified of the deaths of their elders before discovering it for themselves (such as walking into a room to provide care and finding an empty bed). The study recommended “more mindful” approaches to such transitions for those who have formed close, caring relationships.
Wow. What’s sad about this study—even the need to conduct such a study!—is that it reveals how often we give lip service to honoring our hands-on care partners, but choose actions that say the opposite. Then we are quick to blame those same people for lack of a “work ethic.”
Look at your employee handbook and ask yourself, does this document expect the best of our employees? Does it treat them as responsible adults or as children (or worse yet, as potential criminals)? Then look at the actions and interactions of leaders and managers throughout the day. Are our care partners included in decision-making discussions? Do we ever ask for their opinions or advice?
Expecting the best creates two complementary results—it improves people’s abilities and their accountability. Nancy frequently says that “empowerment is not something you try; it is something you do.” When we approach those who support our elders with an expectation that they are capable of great wisdom and growth, we create an environment where growth can occur and wisdom will blossom. And by treating people as equals, we create an environment where people care about each other and about the consequences of their actions, and accountability thrives.
Such discussions raise the inevitable objection that there are people who will take advantage of your good intentions and try to game the system. Welcome to the planet Earth. The problem not that such people exist; the problem is that we write our policies and choose our actions based on the worst person we can imagine and punish everyone else with our low expectations, rather than addressing (or removing) the individual in question. Nancy would likely say, “Expect the best, (and individually address the worst).”
The second example was raised by Karen Schoeneman, formerly of CMS, in a recent culture change discussion that highlights this issue on the regulatory side. She was upset to hear that surveyors in her home state were not permitting elders to have refrigerators in their rooms because of the concern that a resident with diabetes could potentially enter the room and take something that would not be good for his/her diet.
There is so much wrong with that citation that I could devote an entire post to it. But let’s stick with “Expect the Best,” as it applies to surveyors. The fundamental flaw in our regulatory system, I believe, is that surveyors inhabit a primary identity as enforcers, rather than educators. Therefore, they come into the nursing home expecting the worst and constantly imagining “What could possibly go wrong?”
(Of course, Nancy added her two cents to the discussion thread as only she can do, suggesting that perhaps “surveyors shouldn’t be allowed to drive, because they might hit a diabetic.” If it’s possible to laugh and cry at the same time, that’s what I did when I read her comment.)
Incidentally—to be fair to surveyors—many of them work in states where they are required to be enforcers only, because the rules say that they cannot advise providers, only tell them if what they are doing is “in compliance” or not. Apparently the concern is that surveyors might lose their objectivity if they try to mentor the homes. And apparently the rule makers have never heard of school teachers, who mentor their students every day and still give them quarterly grades. If the regulatory bosses don’t expect the best of their surveyors, then a trickle-down effect at survey time is entirely predictable.
These are two examples of why I sometimes despair that our current system of elder care will never truly create well-being for anyone. There is far too much talk about “culture change” and too little evidence of it. Nancy Fox is one person who has always walked the talk. We would all do well to read, or re-read, Nancy’s book.
By Mary Hopfner-Thomas / Posted on December 2nd, 2014
While those of us who work with Elders in Green House homes know what a wonderful place it is…it’s always nice when the model is included in an article for a national financial organization.
Kiplinger’s Retirement Planning 2014 booklet includes information on finding the right nursing home, and this month an article includes information on culture change advocates including The Green House model. Here is an excerpt from the article:
Rather than making incremental changes, some culture-change advocates are starting from scratch. The Green House Project, for example, builds skilled-nursing facilities that house about 10 residents around an open kitchen. Each resident has a private room with a private bath. There are no nursing stations, room numbers, call bells or medication carts, says David Farrell, senior director of the Green House Project. Each Green House is “built from the ground up to look and feel like a real home,” Farrell says.
Click here to read the entire article including information about culture change and nursing homes.
Thought Leaders in Aging Gather at the 2014 Pioneer Network Conference: THE GREEN HOUSE® Project Leadership Among Those Presenting
By Mary Hopfner-Thomas / Posted on September 4th, 2014
“Journey to the Heartland” was the theme for the 2014 Pioneer Network Conference held last month, and many indeed made the journey! Over 1,200 people made the trip to Kansas City for a chance to network and learn with others who are deeply committed to the cultural transformation of long term care. The Green House Project is a true trailblazer in this movement and we are strong supporters of the conference. Green House team members, David Farrell and Susan Frazier were presenters at two different sessions during this national event.
Nurses have a critical role to play in supporting deep transformation within aging services.
“Nurses Building Relationships for Organizational Transformation” was a session co-led by Susan and former Green House team member, Anna Ortigara who is now with PHI. Both Susan and Anna are nurses and can speak first-hand about nurses engaged in culture change. The session discussed the need to build effective communication strategies that will engage both the Elders and direct care staff members. The discussion also explored how nurses as leaders, partners, gerontological specialists and teachers are faced with many more opportunities to enhance quality of life and quality of care. The Green House model is designed to support Clinical Support Team Members, which includes nurses, in developing partnerships with individuals and self-managed work teams.
“THE GREEN HOUSE Model –Delivering Quality of Life and Bottom Line Results” was the special research session delivered by David to attendees. He confronted the myth that The Green House model is not viable—with over 150 Green House homes operating in 25 states, the innovators who adopted the model are happy with their consumer satisfaction and their bottom lines. David shared data from operating Green House homes that demonstrates an excellent return on their investment, and their decision to build even more Green House homes. He told the group that Green House homes are delivering the results that Accountable Care Organizations (ACOs) in health care reform are looking for today.
By Lauren Cohen / Posted on June 30th, 2014
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.
As the THRIVE research projects head toward completion later this year, our research team has developed plans to share our research findings. In addition to publishing articles in a special issue of the journal, Health Services Research, we also will share findings through conference and webinar presentations and blog posts.
Because some commonly used research terms may sound like jibberish to non-researchers (after all, who really knows what a p-value is?), we will devote our next few blog posts to explaining a few terms that will help non-researchers better understand the THRIVE articles, presentations, and posts. We’ll start by reviewing Quantitative and Qualitative research designs.
When people think of research, they’re usually thinking of a Quantitative research design, which essentially measures and compares things. Quantitative research asks questions like “How many residents in one nursing home have falls compared to residents in another?” or “Does providing one type of care work better than providing a different type of care?” A quantitative research design allows a researcher to establish “how much”, whether one thing is related to another (such as whether falls are less frequent when certain care is provided), and also – depending on the details of the design – to establish cause and effect. The data collected are usually in numerical form, and findings are expressed in terms including percents, means, and p-values (to answer the earlier question, a p-value denotes whether or not a number is or isn’t significantly ‘different’ from another…..we’ll come back to this in a future blog post).
Qualitative research designs essentially answer “how” and “why”. Qualitative research asks questions such as “Why are so many falls occurring?” or “What conditions are necessary for a nursing home to provide a certain type of care?” A qualitative research design permits a researcher to better understand events and the circumstances under which they occur and vary. The information gathered in these types of studies are usually textual, and include the researchers notes and observations, as well as in-depth interviews and quotes from people who have knowledge of the event being studied. This information is analyzed by looking for common themes across all of the information collected and reporting these findings – often contextualized using exemplative quotes.
The THRIVE team is using both quantitative and qualitative methods in their research, which is considered mixed-methods. This is the best of both worlds, and is allowing us to answer questions such as:
Quantitative: What was the annual turnover rate for shahbazim over the past two years?
Was this turnover rate statistically different (higher or lower) than that found
among CNAs in other nursing homes?
Qualitative: What was the role of the Director of Nursing in the Green House homes?
How might variations in this role relate to shahbazim turnover?
Stay tuned for the next THRIVE blog post. In the meantime, if you have questions about this post, or suggestions for future ones, please let us know.
Questions about THRIVE can be directed to Lauren Cohen (firstname.lastname@example.org or 919-843-8874).