Deep Knowing for a Person Living with Dementia Changes ‘Behaviors’ into Messages

By / Posted on May 8th, 2018

Laurie Mante

Joe moved into to Eddy Village Green (EVG) in early December 2017. His wife had been caring for him at home with great devotion for several years but was completely exhausted. They had four children who were all very involved and supportive of their parents. Joe moved in with the diagnoses of Parkinson’s disease, dysphagia, delusions, adjustment disorder, anxiety, dementia and hallucinations.

Joe was came to EVG after a fall at home where he lost consciousness and spent several days in the hospital. Joe’s biggest stressor in life was his retirement. Joe had a long career in law enforcement. His life was his career, and he was forced to retire due to his Parkinson’s disease. His wife reported that he never made peace with his retirement. Two of Joe’s sons were also in law enforcement.

Upon move in, Joe was very outgoing and friendly, and had a great sense of humor. But the first day Joe was in the home, he had two falls!  We knew right away that this was going to be a difficult journey. Joe also became very anxious as soon as his family left and was wandering around the house asking repeatedly where he was. Staff reassured Joe that he was safe and tried to engage him in some reminiscing. Joe had huge swings in his cognition throughout the day, so staff really had to adjust their approaches to meet him where he was. Sometimes he was very alert and lucid and could speak very well, and other times he was very confused and could not string together cohesive words. This was extremely frustrating and anxiety-producing for him.

We learned a LOT about Joe in the first few days from both him and his family. We learned that his routine used to be to work all day, come home and have a cocktail and some cheese and crackers with his wife, and then go back out on patrol with his son at night. This explained a lot of Joe’s roaming around the house in the evening hours – he would get restless after dinner and often be found rummaging in drawers of other Elder’s rooms looking for “contraband”. Joe would eat very well at breakfast and lunch but by dinner he was “on the go”. Shabazim brainstormed with Joe’s wife and began leaving out a plate of cheese and crackers and fruit at dinner time so that Joe could walk around and be “busy” but still get some calories in him. He had good and bad times of the day due to the Parkinsons, but when his meds were on board, he wanted to be moving, not sitting – so “snacking” for dinner was much better for him than sitting at the table.

A couple of weeks after moving to EVG, Joe was very agitated and walked out of the front door of the house. He was wearing a wander tag, so the door alarmed, alerting the shahbaz. The shahbaz followed Joe out of the house, but he was jogging through the parking lot, dodging among cars, as though he was engaged in a “chase”! Luckily, a staff person driving on campus saw the situation and offered Joe a ride, so he hopped in her car and she drove him around for a bit before returning him to the house. The team was wondering if getting him out more often would help, but the family was very against this as he had tried to jump out of the car with their mother driving during a hallucination.

Again, our partnership with the family was valuable in learning key information. We think Jim was hallucinating when he left the house and was running through the parking lot.. We were concerned about his speed when he exited the house, the winter weather, and the wooded areas on the campus, so we were able to place a gps-tracking devise on Joe’s ankle in case he exited the house like that again. I want to emphasize he was not exiting the house to get some fresh air or take a stroll, he was having a delusion that he was chasing bad guys and we were quite afraid he would get lost in the woods. We also instructed staff to call 911 immediately as Joe would not be threatened by a police response – these were his friends. There were other times, when Joe was calm and curious about the weather, when he would exit the house and come right back in when he was satisfied that it was cold, snowing, etc.

We also set up the den of the house with a desk for Joe, bringing case files and official forms, so Joe could do some work. Shahbazim also created a clipboard and would have Joe accompany them on rounds to inspect things. This helped to engage him, give him purposeful work – and seemed to keep the delusions away during the late afternoon and evening, which were very challenging for him.

We tried yellow signs on other Elder’s doors who did not welcome Joe’s visits, but this didn’t work at all – Joe  had spent his whole career walking through crime scene tape! So we put up a big “DO NOT ENTER – KEEP OUT!” sign, and this, interestingly enough, worked most of the time!

The Shabazim and nurses were so creative in their approaches to engage Joe and honor his law enforcement background. We ran ideas by his family regularly, and they were wonderful. Shahbazim also figured out that every time the weather got bad Joe would get particularly anxious. They figured out that Joe was worried about his family – especially his son who was out patrolling the road in the snow. So whenever there was ice or snow, the Shahbazim would call Joe’s sons and let him talk to them. They would assure him they were home and safe and Joe could settle down for the night. They also asked his wife to call whenever she left after visiting to let Joe know she arrived home safely. Joe had always been the “protector” of his family and it was important for him to continue to play this role.

Joe also enriched the lives of staff and the other Elders in the house in countless ways. His smile and laugh were infectious. He greeted visitors, and many people coming to the house called him “Sheriff”. He watched over everyone in the house. There was another Elder who sometimes was very sad and Joe would sit next to her and quietly hold her hand. This was a poignant reminder of the gifts people have to offer even when they are struggling so much themselves.

These are just a few examples of how deep knowing, listening to Joe, paying attention to his behavior when he couldn’t use words to express his needs, and partnering with his family, helped us to help Joe live his Best Life.

Joe’s life was very hard – he fell a LOT – but what to do? Restrain him? Absolutely not. We managed the environment as much as we could to prevent injury. His family was adamant that Joe be allowed to be as mobile as his disease would allow him to be. Sometimes he was so jerky from the Parkinson’s that he couldn’t have purposeful movement OR rest. This was very hard on Joe, his family, and the staff. In early March Joe experienced a very rapid decline – he couldn’t ambulate independently at all and was very lethargic most of the time. We suggested to the family that it might be time for hospice – and that their expertise could support Joe, the family and the house. The family agreed and hospice was added as another layer of support. Joe came down with a respiratory infection in mid-March. He was running a temperature and was very weak. He was having a lot of shortness of breath. He had lost weight. Three weeks after his admission to hospice, Joe died, in the house, with his family and Shahbazim surrounding him with love. Family was there 24/7 for the last week of his life, and the whole house grieved when he died.

Joe was not with us long – just a little less than four months. But in that short time, he taught us a lot about living his Best Life, and caring for others, right up until the end.


Behavioral and Psychological Symptoms of Sonya

By / Posted on March 2nd, 2018

 

Reposted from, Being Heard: The Voice of A Revisionary Gerontologist

Sonya Barsness is a proud gerontologist with over 20 years of experience. Gerontology is the multidimensional, non-medical, study of aging. This is important because each one of us is multi-dimensional. Aging is multi-dimensional.  Her mission is to help person-centered values come to life in order to better support people in growing older and growing with dementia.

 

 

 

Hi. My name is Sonya and I have behavioral and psychological symptoms of Sonya (BPSS). Yes, it is true. You see, sometimes when I am doing something I don’t want to do, I get agitated. And then there are the times when I am tired or not interested and I have apathy. The other day I was combative when my husband tried to feed me a strawberry and I pushed his hand away (I really do not like being fed by others, although I really like strawberries.). I irritably yelled at my computer for several minutes this morning when I read the headlines. I am anxious any time I have to drive in this heavily congested area. Unfortunately, I also am paranoid. I KNOW that my husband took the car keys and hid them from me.

Maybe you are saying, “Sonya, what are you talking about? BPSS? Why can’t you just say you are angry or anxious? Why the labels? You are so weird.”

Maybe you are also wondering to yourself whether you have some form of BPSS. “I get angry too”, you might be saying to yourself. In fact, you are getting more angry and anxious as you read this. “Sonya, where are you going with this?” you are thinking nervously.

Have you noticed that we take actions of a person with dementia and ab-normalize and medicalize them? I have.

There is a term, called Behavioral and Psychological Symptoms of Dementia (BPSD) that is used to describe the following “symptoms” that occur in people with dementia: agitation, aberrant motor behavior, anxiety, elation, irritability, depression, apathy, disinhibition, delusions, hallucinations, and sleep or appetite changes.

A 2012 study¹ said that 90% of people with dementia have BPSD. Hmm. What percentage of the general population has BPSD? 100%?

I experience these symptoms and as far as I know, I do not have dementia. So, if I have them, and you have them, what are they symptoms of? Maybe of being human? So, because I do not have dementia, they must be Behavioral and Psychological Symptoms of Sonya. And if we are going to describe them that way for people with dementia, it is only fair that I describe them this way for myself.

Note: For the purposes of this article, I will refer to these “symptoms” instead as actions or expressions.

In everyday life we use these terms to describe our actions. They are, for the most part, considered “normal”. Yet, we seem to have a double standard when we are talking about people with dementia.

A person without dementia might be angry because he does not want to wake up. But a person with dementia is agitated when he does not want to wake up.

A person without dementia flirts with the waiter and it is just flirting. A person with dementia flirts with the waiter and she is disinhibited.

I am in no way minimizing the seriousness of these expressions/actions. These expressions are very distressful for both people with dementia and those who care for them. They are very real. But I want to suggest that they are not abnormal. They are human responses.

Being with many people living with dementia, and those who care for them, has taught me that living with dementia is very, very hard. People with dementia are doing the best they can. They are trying their best to make sense of everything and everyone around them. Because they are human, of course they are going to experience the same human emotions as any of us. If not more, because of the challenges of living with dementia. Their actions are expressions. Normal, human expressions to what are often experienced by them as abnormal situations. I have sat with many of these humans, and heard their experiences. They made me change the way I thought about their “behaviors”.

For these reasons, and more, we need to reconsider this term of BPSD. Perhaps more importantly, we need to think about the meaning behind it.

I understand why we use this term. We needed a way of describing some things we were seeing, so we created a term. But there is a danger in this term that is bigger than these words, I am afraid. Because a term is often, if not always, a reflection of a paradigm.

When we define these actions and expressions as symptoms, we do several things:

 

  • When we describe these expressions as symptoms, we medicalize them. We also then frame them as “abnormal”.
  • We are suggesting that the only explanation for them is the underlying medical condition of dementia. Then we are less inclined to try to understand the reasons behind these actions. They are “just what people with dementia do”. When we don’t understand the reasons, or what people are communicating to us through their actions, we are not able to meet their needs.
  • When we medicalize expressions that might be normal for the person and his or her situation, although abnormal to us, we also contribute to a paradigm that sees people with dementia as different than us. Because WE certainly don’t ever have those expressions, but people with dementia do because of their dementia. A very concerning possible consequence of seeing people as different than us, “othering” them, is de-humanizing them.
  • When we frame expressions in medical terms, as a medical problem, the next step is to try to address them with medical solutions. This might mean using antipsychotics unnecessarily.
  • To take this a step further, when we frame these expressions in medical terms, even if we are looking for non-medical ways of addressing them, we still see them as medical problems to be addressed by these “non-pharmacological” solutions. The challenge with this is that we are still limiting ourselves to seeing these expressions through a medical lens, rather than trying to understand what they might mean for that person, and trying to address the underlying reasons behind the expressions, whether they be unmet needs, or emotional distress. Even a non-pharmacological solution can be a band-aid and not address the reason behind a person’s action and what it means.

We are already seeing ramifications of this paradigm in how we view and treat people with dementia. One of these areas is in the use of antipsychotic medications, which are used to address BPSD in people with dementia. A recent report by Human Rights Watch reiterated the overuse of antipsychotics for people with dementia. The article pointed out various possible reasons for overuse. Unfortunately, they are not untrue. Not having enough staff and training to meet the needs of people with dementia is unfortunately real in too many cases. In some cases, these medications are used for convenience. However, in my experience, I think it is more often due to people not knowing how else to respond.

Yet, I think it is something much bigger. It is a reflection of this paradigm of dementia – the story of dementia that we have told ourselves for too long. This is the story that tells us that the way people with dementia act are symptoms or “behaviors”. The story tells us that not only are behaviors bad, they are not normal. Because they are abnormal medical problems, we need to address them with medication.

However, what we are neglecting in this story is this – the way people act, i.e. behaviors, are not abnormal for them. In many cases they are perfectly normal responses to how a person is experiencing the world around him or her. They are an expression of what a person is experiencing, what she or he is telling us, and what needs we might not be meeting for a person.

Yes, it is true that there are changes in the brain that happen as a result of various types of dementia that influence the way a person acts. Parts of the brain that regulate emotions are affected, making it more difficult to control various emotions. There are indeed various part of the brain that cause a person with dementia to see and experience the world differently. So yes, dementia changes the way we might act.

I am also not dismissing the intent behind terminology such as BPSD – to attempt to understand and help people with dementia.

It is for all these reasons that we have to think differently. There is too much at stake, and we want and need to do better for people with dementia.

This term of BPSD can perpetuate a paradigm of dementia that does not honor the human experience of dementia. Who people are as individuals. What they need. What is important to them.

It is time for a new paradigm. One that sees people with dementia as no different than us. That strives to see things from the perspectives of people with dementia so we can find better ways to support them. A paradigm that truly sees people with dementia as whole, not broken. And one part of building a new paradigm is to critically and respectfully question how we are describing and thinking about the way people with dementia act.

Note: I am well aware that I am not alone in this desire to change the paradigm of dementia. I am being heard here, with my own voice, but know that there are many who are in this together. They are people living with dementia, their care partners, and people whose professional lives are dedicated to making life better for people with dementia. I learn from them every day. Rather than speak for all of you, I hope you will chime in, as much more needs to be said.

¹Cerejeira, J., Lagarto, L., & Mukaetova-Ladinska, E. B. (2012). Behavioral and Psychological Symptoms of Dementia. Frontiers in Neurology, 3, 73. http://doi.org/10.3389/fneur.2012.00073


My Mom Recovered in a Green House home and It Made All The Difference

By / Posted on January 22nd, 2018

Where does one begin to describe The Green House difference? There just are not enough superlatives.  So how about I start here? I do not believe that my mother would be alive today if she had received care anywhere else.

A Green House home is different, and you know it the minute you see the beautiful building, and step inside.  My mother was transported to The Green House homes of Green Hill by ambulance.  Both of the EMT personnel were taken aback when they arrived. They thought they were in the wrong place.  Surely this was someone’s private home, not skilled nursing!

My mother is 89, petite, and living with dementia.  She went to the hospital because she had a swollen tongue, trouble swallowing and they feared she may have had a stroke.   She was in the hospital only 4 days and she was so weakened by being confined to a hospital bed that she could no longer walk.  The hospital said that she would have to spend the rest of her life on a pureed food diet.

I did my research.  I looked at average hours of physical therapy and occupational therapy each day.  With every search, The Green House homes at Green Hill, were always at the high end.  But here is what numbers cannot capture.  My mother has dementia.  She drifts in and out of lucidness.  So if the physical therapist or the occupational therapist arrived when she was not fully present, they did not force her to participate.  (Did you notice that I said that they came to her not that she was brought to them in a sterile “workout” room?) They adjusted to her rhythms and came back when she could most fully participate and best benefit from the therapy.  Those statistics do not capture that every staff member of a Green House home is a champion of the elder and takes on whatever role the elder needs in order to help.  For example, with my mom, it would have been much easier for them to put her in a wheelchair and wheel her to the bathroom or to the dining table or to the open hearth.  But they walked with her.  And the statistics don’t count all those minutes that add up to hours… and add up to strength, mobility, dignity, resolve, hope and a  desire to get well.

While there may be other “small house” homes, Green House homes are based on an evidence-based set of principles that make a big difference.  Therapy in their real home is just one example.  Another is that all meals are prepared in the home and the dining room table big enough for all of the elders, staff, and a few guests to have a place.  Elders eat when and where they are ready.  This really amazed me.  Someone was always cooking in the kitchen.  Breakfast at 6 am, no problem.  Breakfast at Noon, no problem.  Breakfast in your room, no problem – but never on a metal tray.  Dinner while watching TV in the living room – no problem.  Want your eggs soft, over easy, scrambled – no problem.  Don’t like what we are having for lunch, how about a sandwich of your choosing.  I found that most elders and their caregivers loved eating meals at the big table.  We had fun.  We supported on another – elders and caregivers and Green House staff.  Elders helped elders.  Caregivers helped caregivers.  If Dorothy’s daughter wasn’t there, I sat next to Dorothy and encouraged her to eat and I know Dorothy’s daughter did they same for me.

As soon as my mother arrived from the hospital with her pureed food order, the speech pathologist at the Green House home questioned that and asked permission to “challenge” my mother with non-pureed food under her supervision.  Of course, I agreed.  My mom had lost a good deal of weight and we discovered that if food had whipped cream on it, she would eat it.  In addition to her meals, the staff surprised her with special treats, healthy snacks topped with whipped cream, and my mother began to enjoy the pleasure of eating once again.

The Green House home at Green Hill have front porches with rocking chairs and  back patios with bar-b-qs.  There is nothing like fresh air and sunshine to heal the soul…except the joy of a four-legged furry friend.  Pets are encouraged to visit or stay.

The Green House staff, the physical, occupational, and speech therapists ,and the nurses and doctors all take great pride in where they work and the care they deliver.  They become family quickly, maybe even better than family.  They talk about how much they like where they work.  A number mentioned that they almost left their profession, being discouraged at traditional facilities.  But here they flourished.

My mom was getting better, which brought new risks.  She was strong enough to get out of bed on her own, but still unstable on her feet.  So when my mom could not sleep and had potential to get up and fall, the nurse invited my mom to sit with her while she did her work.  My mother loves helping, and this engaged time enabled her to naturally feel drowsy and go back to bed for a sound sleep. – no medication necessary.  Love and caring is the very best medicine of all.

Today, my mother’s wheelchair and walker are gathering dust in the basement and she can eat absolutely everything.  Where you receive care really does matter.  Green House homes are the very best care that you can get.  Anywhere else,  I believe that my mother’s spirit would have been crushed, her appetite less than zero, and her strength and ability to walk permanently drained.  The current paradigm, sets low expectations for an elder’s potential, and it becomes a self- fulfilling prophecy.  Green House homes believe that elder’s are whole people with ability to grow and thrive, and this attitude translates to supporting the best life they can live.

Green House homes have been around for over a decade and we all owe a big thank you to the Robert Wood Johnson Foundation and their commitment to proving that there is a better way to provide long term care, that is clinically sound and cost effective.  The Green House home is just better, it is as simple as that…for the elder, for the family, and for the people who work there.  If there is a Green House home where you live and you have someone or you know someone who needs care, go there.  If there is a Green House home in your neighborhood and you don’t need their care, stop by.  I guarantee you will volunteer there, especially at mealtime. And if there is no Green House home in your neighborhood, make some noise to your elected officials to correct the situation.  This is the way health care for elders needs to be, and it is the way we would want it for ourselves!  In my state, of New Jersey, there are only two Green House organizations.  I count my blessings daily that this was an option for my family, and I hope that one day, everyone will be able to have this same experience.


Register Today for The Distinguished Speaker Webinar Series and OnSite Workshops

By / Posted on December 22nd, 2017

Register Today for The Distinguished Speaker Webinar Series and OnSite Workshops
  • Cultural Transformation Through Green House, January 9 (3:00p ET). Join Green House Senior Director, Susan Ryan to hear an Overview of The Green House model as you’ve never heard it before! THE GREEN HOUSE believes that all elders deserve to grow and thrive no matter where they reside, and that to impact lives in a meaningful way, it takes more than environmental change. To make meaningful change a reality, it is imperative to infuse the entire organization with optimal systems and structural changes that create a cohesive approach to elder-directed care.  Register>>
  • Innovations and Trends in Elder Care, February 1 (3:00p ET). Lisa McCracken, Director of Senior Living Finance Research and Development with Ziegler will provide an overview of the key trends and innovations in Elder Care. This is the opening session of our Business Case series which will shed light on how The Green House model is a viable solution amidst the backdrop of a dynamic economy and healthcare climate.Register>>
  • Improving Long Term Care Workforce With Strategies that Work, February 22 (3:00p ET). Robyn Stone, Senior Vice President of Research, LeadingAge, will provide an overview of the demographics, trends and challenges of the workforce in Elder Care. This is the opening session of our Workforce series. which will identify practices within The Green House model that create the potential for successful workforce development. Register>>
  • Living with Dementia: New Perspectives, March 22 (3:00p ET). Dr. Al Power, author of Dementia Beyond Drugs and Dementia Beyond Disease, will look at the experience of dementia through the frame of well-being, and explore how this perspective is challenged, both by brain changes, our attitudes, and care systems. Register>>


Authenticity, Why it Matters

By / Posted on August 1st, 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.

In Green House homes, authenticity matters – for example, we strive to build real homes, not fake homes, not pretend homes, not places that look like a home but really feel more like an institution.  We want to create that sense of belonging, of warmth and deep knowing that we all crave.  We want the elders to feel connected to the people and the space.

Best Life supports elders living with dementia (ELWD), and here too, we strive for authenticity.  For many ELWD, their experience has been one of loss and lack of choice.  Family, friends, and professionals may respond to their diagnosis rather than to the individual person, focusing on inabilities rather than retained talents and abilities.  The opportunities for real, authentic life experiences may be taken away, justified by saying, “It doesn’t really matter, they won’t know the difference.”

Best Life understands that being authentic does make a difference to elders and those working closest to them.  We know that real friendships, real relationships are meaningful.  One of the Best Life core principles is “Elder-directed, relationship-rich living.”  Offering opportunities for ELWD to sustain old relationships as well as the opportunity to form new ones is part of a normal life, and should be part of living with dementia.

Relationships with pets can also be important for ELWD.  How many of us enjoy the companionship of our pet cat or dog?  The joy that a dog brings when he puts his head in your lap, or a kitten who runs through the house chasing a ball of paper brings a lot of smiles.  An ELWD who can assist with feeding or walking the dog, or enjoys rubbing the neck of their favorite cat knows the significance of rapport with live animal.

As I visit many care locations, I am sometimes shown a community’s “pretend” pet animal program.  There are many varieties available of these fake pets, all of them claiming to bring joy to the elder.

Best Life focuses on real relationships built on retained abilities. If an ELWD is offered a robotic pet, they may respond and stroke it, but there’s no relationship, no purpose, no bond of love that is formed.

What would be the reason for not having a real pet – a loving dog or a real cat who can be the “diva” of the home?  Do we offer a robotic pet because again, we think, “It doesn’t really matter, they won’t know the difference?”  The magic that happens between an ELWD and a real pet cannot be substituted by offering a mechanical toy.

I’m reminded of one woman I knew who had recently moved into a home and was quickly labeled as a “challenge” by the care team.  Joan yelled out frequently, disrupting other elders.  She criticized both staff and elders and refused to participate when invited to meals or engagements.

As an annual event, the home sponsored a pet adoption day by the local animal shelter.  In preparation, the ELWD helped clear the patio where the public would be coming to view the adoptable pets. On the day of event, many volunteers with a variety of dogs and cats showed up at the home and as the volunteers and pets arrived, the elders greeted each one and welcomed them to their home for the pet adoption.

Joan initially resisted becoming involved, but as the dogs arrived, she focused on one small dog who was blind in one eye and was anxiously barking a lot.  As she pet the dog, it seemed to relax and finally laid down and closed its eyes.  Joan said, “It just needed some love,” and continued to sit by its side for the entire afternoon.

At the end of the day, the dog had not been adopted and the care team asked Joan if she would like to adopt it?  The look on Joan’s face said it all.  The significance of the friendship between Joan and her dog Freddy (Joan’s chosen name for it) was evident as the months passed.  It seemed Joan found purpose and peace when she and Freddy would sit together or as she fed it some of her favorite chicken dish that she had saved from her own dinner plate.

Best Life encourages an authentic, real home where an ELWD has opportunities for a life that is purposeful and relationship-rich. learn more>>

 

 

 

 


Green House Highlighted at 2017 Pioneer Network Conference

By / 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.

Learn more about The Pioneer Network>>


Green House homes in Florida are Supporting Elders to Live their Best Life

By / 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
  • Advocacy

 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.

 

 

 


Electric Energy Takes Green House Adopters Beyond Better!

By / Posted on November 30th, 2016

The energy is always electric when Green House adopters are together. “As a national initiative, amazing things happen when so many changemakers are in the same room,”  shares Senior Director, Susan Ryan, “The opportunity for rich discussion, relationship building and thoughtful questions is irreplaceable. ”   That was certainly the case as over 250 Green House adopters gathered at The 2016 Green House Annual Meeting—Beyond Better.tshirt-shot_web

visit to Green HillHosted in New Jersey, attendees were able to visit two open Green House homes, Morris Hall Meadows and Green Hill.  Representing 30 states and over 200 open homes, the growing Peer Network is one of the greatest values of participating in this initiative.  Green House stakeholder, John Grace, said, “It was nice to attend an intimate gathering where “practical application” is the theme of the day.”

Pre-Conference workshops provided role specific opportunities to explore areas that research proves are vital to the sustainability and success of the model, such as coaching and empowerment.  Senior executives joined President of Center for Innovation, Inc., the sponsor of The Green House Project,  Scott Townsley, to discuss the strategic trends impacting healthcare, and how The Green House model must continue to evolve in order to lead the way to a better tomorrow.

Marc Middleton, CEO of Growing Bolder, opened the meeting with an inspiring message that what the mind believes, the body embraces, and a call to belimarc-middleton_webeve in the potential of elders!  This multimedia presentation thoroughly dismantled the myths of aging, and set a tone of possibility for the rest of the meeting.

With breakout sessions focused on key operational topics like convivium, spirituality, team building and hiring, adopters left the conference with a full ‘toolbox’ of new skills and ideas to eni-am-green-house_webhance their homes and organizations.  An original spoken word piece, called, “I Am Green House”, brought the crowd to their feet, as a shahbaz, a nurse, a family member and an elder shared what it really means to live this movement everyday.

This year, intensive sessions were offered as opportunities to take a  deep dive in areas of dementia, coaching leadership and bringing Green House values into the legacy home.   Hot topics, real discussion, and an impetus to keep wali_question_webgrowing, resonated throughout the conference. The “Inner Circle” was a unique networking space for attendees to meet their peers and help to co-create the future.  Reciprocity of active learning and shared experience is making a difference and changing the world.

Sustainability is crucial in the work that we do, and a quality benchmarking resource was presented to attendees with a tangible charge to never stop improving.  Exciting results are being discovered as the evidence-base for The Green House model grows.

The conference closed with Ashton Applewhite, anti-ageism advocate and author of This Chair Rocks, an Manifesto Against Ageism, sending a passionate appeal to fight ageism in all its forms.  With humor and personal stories, Ashton served as the perfect way to end the conference feeling challenged and  inspired.

susan-speaking_web“THE POWER OF THE MOVEMENT IS YOU!” says, Susan Ryan, to an empowered audience of Green House adopters.  The national initiative is able to push the envelope of what is possible because of the innovative and excellent work of Green House adopters and those stakeholders who are changing what it means to age.

Next year marks the 10th Annual Green House Meeting.  Held in Florida, with host site, John Knox Village, this meeting continues to grow in meaning and scope, as Green House adopters truly go, Beyond Better!

 


Living the Good Life: Sharla Lee

By / Posted on July 13th, 2016

Living

 

“Living the good life” is a blog series celebrating the lives of people living with dementia in Green House homes.  In Green House homes across the country, elders are creative, resourceful and whole people who have a valuable story to share.

 

Sharla Lee lived a colorful life as a performer, gracing many stages and breaking many hearts. Legend has it that she was even asked out on a date by baseball superstar, Joe DiMaggio. When cognitive impairment made it unsafe for her tshahbaz and elder standing and embracingo live on her own, this talented pianist may have faded away, but thanks to Baptist Retirement Community Green House homes in San Angelo, Texas, her star continued to shine bright.

Always the professional, Sharla would wake up at 5:00a every morning in her Green House home in order to practice the piano. She loved to play for the elders during the evening meal, choosing to eat later, after her performance. In Green House homes, the day is centered around the individual elders’ natural rhythms and preferences. The small size enableelder woman and child at pianos the home to run smoothly based on deep knowing relationships rather than task oriented schedules. As a musician, Sharla’s preferred schedule was different than that of others living in The Green House home, and by honoring that, her personhood remained intact despite dementia.
exercises_setting table

Sharla brought joy to others in The Green House home, through her music, and also by being an engaged member of the household. She was made an “honorary shahbaz”, the name given to direct care staff in Green House homes, because she was always willing to help by rolling napkins, setting the table and befriending the other elders in the home. Reciprocity, the ability to receive and also give care, is a key element of Green House homes. As humans, we need to feel a sense of purpose. It may seem like a simple thing, but the value of sharing your gifts with others is something that can’t be overstated.elder man and woman eating on terrace 2

elder woman reading curled in chairMae West once said, “You only live once, but if you do it right, once is enough.” Sharla Lee dazzled audiences in San Francisco supper clubs, on cruise ships and thankfully, in her Green House home as well. By knowing Sharla’s story, and creating opportunities for her to shine, her Green House family made sure that Sharla lived “the good life”.

 


Living the Good Life: Dr. Lemuel Rogers

By / Posted on July 5th, 2016

Living

 

“Living the good life” is a blog series celebrating the lives of people living with dementia in Green House homes.  In Green House homes across the country, elders are creative, resourceful and whole people who have a valuable story to share.

Dr. Lemuel Rogers

“Without connections to the world that nurtures our human spirit, we hasten decline” -Susan Ryan, Senior Director, The Green House Project
dr r portraitOur lives are a rich tapestry of interests and experiences, woven together across time.  Sharing and celebrating our unique stories ensures that our personhood is preserved, even as our needs change.  Dr. Lemuel Rogers, was the epitome of dignity; a dapper, intelligent man with a great smile and beautiful singing voice.  He was well known in the community as a respected doctor, and leader of his church.  Meaningful life is a core value of The Green House model.  The means that a person must be deeply known, and have the power to maintain their identity through connections and engagement.

For Dr. Rogers, that meant being respected and acknowledged for the expertise and reputation that took a lifetime to build.  In the home, he preferred to be called “Doctor”, and frequently perused medical journals with former St. John’s medical director, Al Power.  Staying connected to the community that he loved, shahbazim (care staff) supported Dr. Rogers to attend the annual African-American Health Symposium, a church event dr r fraternitydedicated to him and his wife, Gloria.  Being honored for one’s gifts is essential to living the good life.

Work hard, play hard.  Dr. Rogers was also an active member in his fraternity, Omega Psi Phi. His fraternity brothers were frequent visitors at The Green House homes, bringing joy and beautiful music. Dr Roger’s loved to sing and was able to share his talents with others in his home.  See the below video of Dr. Rogers singing “Swing Low, Sweet Chariot”.

 

Often, those living with dementia become known solely by their diagnosis.  The beautiful tapestry gets lost amidst the behaviors and medications. In a Green House home, however, the value is placed on WHO that person is, and WHAT will support them in living the good life.  Dr. Rogers was serious, but had a great sense of humor.  dr. r group shotYou really felt like you’d done something special when you made him laugh. When children would come to visit, he would shake their hands very formally when he met them and they loved it. His dementia was pretty advanced by the time he moved to The Green House home, but when a doctor talked with him, or his church or fraternity visited, he always sat up a little straighter, shone a little brighter, and rose to the occasion in conversation. The man just…exuded dignity.

 


GROUNDBREAKING OF CLARK-LINDSEY’S GREEN HOUSE HOMES FOR DEMENTIA CARE

By / Posted on October 2nd, 2015

Green House Homes Will Be First of Their Kind in Champaign County

(Reprinted from Perkins Eastman) Last Thursday, September 24, in Urbana, IL, team members from the Chicago office of international design and architecture firm Perkins Eastman joined leadership from Clark-Lindsey for the groundbreaking of the CCRC’s new small homes for specialized dementia care—one devoted to assisted living and the other for skilled nursing care—that will follow The GREEN HOUSE® model. Each home will feature 12 private bedrooms, individualized care from specially trained caregivers, and home furnishings. The Perkins Eastman design team is led by Principal Jerry Walleck AIA and Associate Principal Ramu Ramachandran AIA, LEED AP, two key members of the firm’s renowned senior living practice area.

clark lindseyClark-Lindsey has partnered with The Green House Project and Perkins Eastman to help usher in a new and superior standard of care for those suffering from Alzheimer’s and dementia-related illnesses. The introduction of these homes not only marks the first Green House project in Champaign County but also a major step forward for how Illinois providers and regulatory officials are looking to institute efficient and innovative care models for seniors. Green House homes are designed to provide a personalized model of care within a real home setting, replete with an open kitchen, dining room and other common areas, setting them apart from the traditional institutional model that can resemble a hospital or nursing home.

clark lindsey2The new homes, situated on a 10,000 sf footprint, will feature an architectural design where every inch of space has been carefully considered in order to transform the physical environment to feel more like home. From the outdoor courtyard, library and den areas to the open kitchen providing home cooked meals, these amenities encourage social contact among elders and caregivers. The homes’ design is tailored to maintain existing on-site trees as well as acknowledge the natural surroundings with respect to building proportion, scale and form, while also taking full advantage of the expansive views of adjacent Meadowbrook Park.

“Clark-Lindsey is already known within the industry as a leader and innovator when it comes to care,” says Jerry Walleck, the project’s design lead, “and the new Green House homes are a continuation of that. They will provide invaluable care and services to dementia residents and their families, and it’s an enormous privilege to have played our part in making that happen.” Both homes are scheduled to open in late 2016.

Clark-Lindsey Village was founded in 1978 and is the area’s first and only CCRC. It is one of only eight certified Centers for Successful Aging in the U.S. In addition to its forthcoming dementia care small homes, Clark-Lindsey Village offers extensive independent living accommodations, as well as inpatient and outpatient therapy services, assisted living and skilled nursing care at its Meadowbrook Health Center.

The Green House Project is a radically new national model for skilled nursing care that returns control, dignity and a sense of well-being to elders, their families and direct care staff. In the Green House model, residents receive care in small, self- contained homes organized to deliver individualized care and meaningful relationships between residents and care staff.

About Perkins Eastman
Perkins Eastman is among the top design and architecture firms in the world. With almost 950 employees in 14 locations around the globe, Perkins Eastman practices at every scale of the built environment. From niche buildings to complex projects that enrich whole communities, the firm’s portfolio reflects a dedication to progressive and inventive design that enhances the quality of the human experience. With work in 46 states and more than 40 countries, the firm’s portfolio includes transportation and public infrastructure, high-end residential, commercial, hotels, retail, office buildings, corporate interiors, schools, hospitals, museums, senior living, and public sector facilities. Perkins Eastman provides award-winning design through its offices in North America (New York, NY; Boston, MA; Charlotte, NC; Chicago, IL; Los Angeles, CA; Pittsburgh, PA; San Francisco, CA; Stamford, CT; Toronto, Canada; and Washington, DC); South America (Guayaquil, Ecuador); North Africa and Middle East (Dubai, UAE); and Asia (Mumbai, India, and Shanghai, China).

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The Hitchhiker’s Guide to Dementia

By / Posted on September 10th, 2015

Dr. Al Power will be conducting an all day preconference session along with a plenary and education session at The Eighth Annual Green House Meeting & Celebration in Broomfield, CO from November 16-18th. The annual meeting is for Green House members only and this year’s theme is Better Together.  The title of Dr. Power’s preconference session is “Reframing Dementia.”  His plenary session is entitled “Living Better Together with Dementia: Taking it Further” and his education session is “Real Life Without Antipsychotic Drugs.”  Log-in to the Peer Network website today to register for the meeting so you can hear from Dr. Power first hand!

 

Like most people, I am subject to a regular barrage of media reports, coming from radio, television, internet news outlets, social media and daily RSS feeds. And here is what this information stream has taught me:

If I eat blueberries, I’ll lower my risk of Alzheimer’s. Or was that tomatoes? It now appears that yogurt lowers the risk as well—does that mean blueberry yogurt, or will any old flavor do? Maybe I should have coconut flavored yogurt, because apparently, if all that coconut oil doesn’t kill me with a heart attack, it may make my brain healthier.

And now it appears I may have to replace my plumbing, because a new study suggests that too much copper causes Alzheimer’s; though other medical studies have shown that a high copper intake actually lowers the risk. So which is it? And is lead involved? (I need to know because I tend to chew on my pencils when I do my daily Sudoku puzzles.)

And then there’s the glucose connection, the blood pressure connection, the inflammatory connection, the brain reserve connection, the mood disorder connection, the social connections connection.

And what kind of a teenager was I? Apparently, certain adolescent behaviors raise your risk. One of them is getting drunk; well, thank God, none of us ever did that! Also, it’s a risk if you have a history of adolescent antipsychotic use. (Tell that to the psychiatrists who are finding all kinds of new reasons to prescribe these drugs to young people, from depression to “oppositional disorders”.)

Another risk factor (cue Randy Newman) is being too short. Time to get out the gravity boots? And if that weren’t bad enough, now the folks in Manhattan say dementia can come from exposure to bacterial and viral infections. (Someone sneezed on me just the other day, and I swear my ADAS-Cog score dropped two points!)

Okay everyone, are you listening to me?? STOP! Just…stop. If there were a “Hitchhiker’s Guide to Dementia”, the first words would still be: “Don’t panic.”
Time…to…take…a…deep…breath.

What we have here is a collection of illnesses closely tied to the aging process, and a sequence of changes that may begin decades before we show any outward signs. And we are dissecting all the minutiae of the millions of things we do, eat, drink or experience in our lives—trying to find connections, however tenuous, that we can shoot to the media outlets to fuel the frenzy.

There are a lot of people making money off of our hysteria and paranoia. But it’s much worse than that.

You see, the more we fuel this kind of panic, the more we demonize the condition; and consequently, the more we demonize and dehumanize people who live with cognitive disability. Folks like Dr. Bill Thomas have long warned us that those people who do less or produce less are devalued in our society. It is also now clear that a similar fate befalls those who remember less in our hyper-cognitive, technology-obsessed world.

Here are a couple of known facts to keep in mind: We all die. Many of us who live to a ripe old age will experience changes in various organ functions and capabilities. Many of us will become forgetful as we reach our later years. Those who do are not bad people.

There is so much emphasis on “successful aging” these days—what does that mean? Are you successful if you run marathons until you are 96 and then die in your sleep, or at the completion of some incredible sexual escapade? That’s romantic, but highly subjective and unlikely. More important, this fixation on how we end our lives not only threatens to devalue who we are in our last years, but also how we have lived all of the earlier days of our lives.

And if you don’t make it to the grave with all of your organ functions intact (an oxymoron in itself), what is that called? “Failed aging”? What about people born with developmental disabilities or congenital illness? They would be “failed agers” from the very start. No need to even give them blueberries and yogurt, I guess.

You and I will always be more than the sum of what we can do and what we can remember. So here’s the advice I would put in my “Hitchhiker’s Guide”:

No matter who you are or how you live your life, you have a chance of becoming forgetful as you age. Your risk is never zero, but no one knows your exact “number”. You can almost certainly lower that risk somewhat if you eat well, exercise and do things that are good for your body, mind, and spirit; your risk will probably go up if you abuse any of those. But being obsessive about every little thing you do will likely not improve your odds to a greater extent than healthy moderation.

Find that “sweet spot” that gives you a life worth living. When we stop indulging the fear mongers, we can see the value in people of all abilities. This will help us to visualize a true path to well-being for all.