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.
Grand Opening Celebration Takes Place for Colorado’s First Green House Homes – A Story of Partnership and Vision
By Mary Hopfner-Thomas / Posted on October 25th, 2014
The beautiful Rocky Mountains provide a wonderful view for Elders that will live in The Green House Homes at Mirasol in Loveland, Colorado. That view will only be matched by the person-directed living they will experience in this innovative model of skilled nursing care. Built on the campus of the Mirasol Senior Living Community, there will be six homes with each including: ten private bedrooms and bath, open kitchen, a hearth area along with a variety of other open spaces that will embrace socializing and the ability to live life in a meaningful way.
Sam Betters, Executive Director of the Loveland Housing Authority, said,
From my own personal experience of trying to provide the best care for my parents, I discovered that aging in America presents many challenges. I knew that there had to be a better option than the traditional institutional models for elder care. There is. It’s called The Green House Project. As we began our vision-quest, we didn’t know how we were going to make this happen. We just knew it had to be done.
Senior Director for The Green House Project, David Farrell, was on hand for the festivities on October 21st along with a number of other state and local leaders in Colorado.
David said, “These homes will help the Loveland Housing Authority meet a gap in its continuum of care-skilled nursing and allow Mirasol residents to remain a part of their existing community, deriving the benefits of receiving a higher level of care while still living independent and social lives.”
The Green House Project is part of Capital Impact Partners, a certified community development financial institution, which led the financing for this $17 million dollar project.
As a mission driven lender, this project fits well into our larger strategy to build strong, vibrant communities of opportunity for underserved populations. We are not only proud to help bring the Green House model to Colorado, but also the fact that a large percentage of the residents are Medicaid eligible,
said Terry Simonette, CEO of Capital Impact Partners. “It took a number of partners, and use of innovative tools like New Market Tax Credits to make this happen.”
Funding for the project included: $2 million dollar grant from The Harry and Jeanette Weinberg Foundation, program related investments from the AARP Foundation and the Robert Wood Johnson Foundation, $2.5 million New Market Tax Credits, $3.4 million in tax credit equity from JPMorgan Chase plus a land donation by the Loveland Housing Authority.
We congratulate all who helped in the process of making these homes possible…and welcome everyone to the Green House family!
Click here to read more about this project and why leaders from The Harry and Jeanette Weinberg Foundation and the AARP Foundation were most pleased to make this development a reality!
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 Mary Hopfner-Thomas / Posted on June 7th, 2014
Citing his extensive work in transforming long-term care in California, the California Association of Long Term Care Medicine (CALTCM), honored our own Sr. Director, David Farrell with their 2014 Leadership Award.
CALTCM is the professional organization for California physicians, medical directors, nurses, pharmacists, administrators, and other professionals working in long-term care. CALTCM is the state chapter of the American Medical Directors Association (AMDA). It is an organization that advocates quality patient healthcare, provides long-term care education and seeks to influence policy within the industry.
The Leadership Award presentation took place at the CALTCM 40th Annual Meeting for group. Prior to joining The Green House Project, David served as a nursing home administrator and regional director of operations in California. As many of you know, David has long been a strong advocate for person-directed care and culture change within long-term care.
We congratulate David on receiving this award!
By Mary Hopfner-Thomas / Posted on April 7th, 2014
None of us would argue that staff turnover creates a host of problems for organizations. Staff retention is vital from a quality perspective, but what about the economic impact it plays for a health care provider?
The issue is explored by the Director of THE GREEN HOUSE® Project, David Farrell and PHI Strategic Advisor, Steven Dawson, in the Spring/Summer 2014 publication of the Indiana Health Care Association “Insight”.
High turnover of your direct care workers can mean reduced quality of care, increased stress for the staff, inefficiencies across many levels, the constant need to recruit and train—which lead to some very high dollar issues.
While some nursing home providers say it is “inevitable”, when they sit down and truly calculate those costs they are shocked so see their annual turnover costs! In the article Farrell and Dawson discuss investing in proven retention strategies.
Click here to read the full article and let us know how turnover has affected your organization!
Are you curious about staff turnover in a Green House home?
The Green House model gives Elders four times more contact and reduces staff turnover. A Green House home is created from the ground up to foster the same feeling and experience you get from living in a real home. Each home is designed for 10-12 Elders keeping it flexible and maintaining a warm feel. The comfort of private rooms and bathrooms are combined with the family-like atmosphere of open common spaces.
The innovative organizational structure in the Green House model is based upon “the conviction that we need a new framework around which to organize the experience of those who protect, sustain, and nurture our Elders.” The structure challenges the traditional nursing home hierarchy to create environments that empower elders and those who are closest to them.
By David Farrell / Posted on March 28th, 2013
Visionary leader Randy Stoll, CEO of Mt. San Antonio Gardens, and his dedicated team have been toiling away for years to navigate California’s complex regulations in order to introduce the very first Green Houses to the state. As we toured the construction site, you could see the home taking shape – the fireplace, the kitchen, plenty of windows and the 10 bright, private bedrooms with private baths and showers. At the end of the tour I thought – the day the elders move in, these two homes will immediately become the top two places to receive skilled care in the state.
I felt a great sense of relief to see Green House homes under construction on the campus of Mt. San Antonio Gardens. After all, I have been a licensed Administrator in the state of California since 1989. We have over 1,150 licensed Skilled Nursing Facilities here – more than any other state. In California, many well-intentioned providers are struggling to deliver high quality care and service to over 100,000 people each day. The typical setting is an old institution with 2, 3 or 4 beds per room with an adjoining single bathroom (one sink and one toilet for 4 – 8 people to share). Speaking from experience – we paint the walls, we buy new beds, we add flat screen TVs, but…at the end of the day, it’s still not the place we would want for our loved ones or ourselves.
I am grateful for the leadership team at Mt. San Antonio for making this happen. California needs to see this. When The Green House homes open this spring, California’s providers, regulators and policy makers will see the future of skilled nursing care. It represents a radical change from what we are all used to, because, these Green House homes are the places that we would want for our loved ones or ourselves.
By David Farrell / Posted on March 11th, 2013
One of the subjects that have befuddled Long Term Care leaders over the years is worker motivation. One of the foremost researchers in this field is Frederick Herzberg, an industrial psychologist. It is Herzberg’s work on motivation and job enrichment that strikes at the heart of the success of self-direction concepts that are so foundational to The Green House model.
In the 1960’s, Herzberg proposed that a person’s needs break down into two categories: hygiene factors and motivational factors.
Hygiene factors relate to what makes us work and our biological needs, such as providing food, clothing, and shelter. Herzberg says we have a build-in drive to avoid pain relative to these needs, so we do what is necessary, such as work, to provide what we need.
Motivator factors, however, are very different. These factors include those specific items related to what makes us work well such as achievement, and through achievement, the ability to experience psychological growth.
Herzberg used the term job enrichment to describe how the motivator factors can be used to achieve higher levels of satisfaction with a job. The following list was taken from his Harvard Business Review article of 1968 (reprinted in 1987) entitled, One More Time…How Do You Motivate Employees? Take particular note of how closely these factors align with concepts embodied in radical workforce redesign with The Green House model.
Herzberg said that meaningful job enrichment involves the following:
1. Removing controls while retaining accountability.
2. Increasing the accountability of individuals for their work.
3. Giving a person a complete natural unit of work.
4. Granting additional authority to employees in their activity such as job freedom.
5. Making data and reports directly available to the workers themselves rather than just to supervisors.
6. Introducing education programs designed to enrich critical thinking skills.
7. Assigning individuals specific assignments or specialized tasks, enabling them to become experts.
It is surprising to think that Herzberg first discussed these concepts in the 1960’s, but that we are now just beginning to incorporate them through innovative models. In the elder care field, we have a mountain of research that supports the link between frontline caregivers involvement and improved clinical outcomes of care and quality of life. Organizational changes that support self-direction will continue to grow because it makes sense to leaders desperately searching for ways to increase responsibilities of frontline staff as well as the elders’ perception of feeling valued and respected. The Green House model’s systematic approach to workforce redesign and the creation of the Shahbazim, combined with radical environmental redesign, help ensure that the institutional, hierarchical model can’t slip back in.
The empowered Shahbazim that you find within the Green House homes nationwide helps to explain why 83% of Green House projects are ranked as either 4 or 5 Star homes on the CMS Nursing Home Compare website. The Green House model supports the relational coordination among the Shahbaz and the nurses and other staff. The theory of relational coordination states that the effectiveness of care and service is determined by the quality of communication among staff. The quality of staff’s communication depends on their relationships with each other. This theory is highly applicable in healthcare settings where tasks employees perform are closely interrelated. Their interdependence forces the staff to work with one another. But if their relationships and communication are weak, and institutional hierarchies minimize the voice of the elders and their caregivers, then elders’ needs tend to fall through the cracks.
The Green House model develops people’s communication and critical thinking skills so they know what to share and why it’s important. And the redesigned work environment supports good communication creating both a culture of safety and a meaningful life for the elders. Systems and redesigned roles that support relational coordination among staff are the key to the successful outcomes achieved by Green House projects.
Forty-five years ago, Herzberg was spot on. And he still is.