The Heart of The Home: Elders and Staff

By / Posted on August 28th, 2015

Last year, when Claremont, CA resident Bill Andrus began to need 24-hour care in their home, he and his wife, Georgeann, chose Mt. San Antonio Gardens’ Evergreen Villas for his new home. The Villas are trademarked  GREEN HOUSE homes, which provides a real home for people needing skilled nursing care. In each of the two villas, the residents are supported by a small, self-managed team of care partners, known as shahbazim, and nurses. Mt. San Antonio Gardens pioneered what are California’s first and only small homes licensed for skilled nursing.

“We wanted Bill to live in a stimulating environment while receiving the care he needs,” says Georgeann. Acknowledging the difficulty of making that decision, the couple feels fortunate that the Villas were an option for them. Georgeann, who served on the Gardens board of directors for six years when The Green House homes were being considered, says, “We are so grateful for Bill to be part of it. It has been particularly heartwarming to see this from the initial concept and then to participate in the reality of seeing it work very well.”

Bill and Georgeann Anrus

Bill and Georgeann Anrus

While Bill was settling in, Georgeann applied to live at the Gardens as an active, healthy independent resident. She moved into an apartment on campus where she takes a quick walk to the Evergreen Villas. Living on the same campus means easy and frequent visits each day. The couple goes together to lectures and performances held at the Gardens or at the nearby Claremont Colleges. “Our neurologist had said to me, ‘Now you can just be a spouse, not the caregiver’, and he was so right!”

“Bill has become physically stronger since his move here,” marvels Georgeann. The special design of the great room has inspired Bill to use his walker, unassisted. The couple also credits the home-like atmosphere and the personalized attention of the shahbazim and nurses to his continued well-being. Because this team works so closely with such a small group of elders, the care partners get to know their personalities and individual needs and preferences intimately. While the shahbazim are also responsible for cooking and maintaining the house, their first priority, Georgeann notes, is always the care of the elders.

“The people are the best thing,” says Bill, who especially enjoys sharing common interests with Registered Nurse (RN) Michael Sansosti. Both are avid readers and love fishing.

Michael and Bill Reading for screen only 100 dpi

Bill and Michael reading

“It’s great,” says Michael. “We trade books and when I have some extra time in my schedule, we’ll spend time talking about them.” The ability to give everyone a little extra attention is very gratifying. Michael, who previously worked in structured hospital environments, enjoys the opportunity he now has to cultivate more personal friendships with the residents he cares for. “Certain people, like Bill, do very well in this kind of setting. It is especially well suited to those who prefer to take the initiative for their daily activities” and who enjoy the interaction and activity that is such an important part of the daily experience in the Evergreen Villas, according to Michael.

Working with the caregivers is also a new experience for Michael. “We work side by side with the shahbazim. While the RNs are in charge of everything clinical, the care partners spend all of their time interacting with the residents, so they can give us feedback on their behavior and needs, enabling us to intervene early.”

 

Amanda, shahbaz, and Michael, nurse, work together

Amanda, shahbaz, and Michael, nurse, work together

“Communication is a big thing here,” acknowledges shahbaz Amanda Phos, who began her training for her role long before the Evergreen Villas opened. With just 10 elders in each of the two Evergreen Villas, the care partners get to know each person personally, from their life stories to their health needs and abilities, their food preferences, and their hobbies and interests. “If you know the elders well, taking care of them is very easy,” says Amanda. “I think that’s the beauty of this place. We base each day’s activities on what they individually want to do. And every day is different. When we all come together around the dinner table, we like to talk about the day’s activities. It feels like a family.

 

“It’s hard work, and it takes a team to make it work so well,” says Amanda. “We’re the heart of the home, and that makes it very gratifying to be here.”

 


Minnesota Welcomes its First Green House Skilled Nursing Homes!

By / Posted on June 9th, 2015

Atrium crowdEpiscopal Homes of Minnesota celebrated the official grand opening of their six new Green House homes on May 20th.  The special event was well attended by Elders, families, staff members and community leaders in the St. Paul area.  Episcopal Homes’ President and

CEO Marvin Plakut

CEO Marvin Plakut

CEO, Marvin Plakut, welcomed attendees and

St. Paul Mayor Chris Coleman

St. Paul Mayor Chris Coleman

St. Paul Mayor Chris Coleman was on hand to congratulate all who helped in the development of the project.

The six skilled nursing Green House homes are called “The Gardens” and will be home for 60 Elders.  Each Elder will have their own private bedroom and bath, meals will be cooked in the home and the hearth area will provide a sanctuary for rich conversation in the house.

The Green House Homes "The Gardens"

The Green House Homes “The Gardens”

The Green House homes were part of a $45 million dollar expansion called Midway Village.  The campus now offers a range of Elder living options and affordability and is conveniently located near the city of St. Paul’s new Green Line light rail station.  “The outpouring of support for our project is both gratifying and humbling,” said Plakut.  “It is inspiring us to keep reaching higher on behalf of the individuals and families we serve.  It is also inspiring to see so many wonderful people interested in living at Midway Village.”

The 225,000-square-foot expansion on their campus is also receiving some special recognition…it has been selected as one of the state’s top projects in 2014 by Finance & Commerce.

The grand opening aroused the curiosity of neighborhood patrol officers.  Cornelia House Elder, Irma Wyman, helped make them feel welcome.

The grand opening aroused the curiosity of St. Paul neighborhood patrol officers. Cornelia House Elder, Irma Wyman, helped make them feel welcome.

We welcome the Elders, families and staff from The Gardens to the Green House family.   Congratulations and our very best wishes as you move forward in your Green House journey!


Nurses Organization of Veteran Affairs (NOVA)

By / Posted on May 8th, 2015

Gerontological Nurse, Green House Guide and RN Supervisor, Ann Wagle, from the VA Illiana Green House homes in Danville, IL will present a poster on “The Role of Nurses in the Green House home” during the NOVA 2015 Annual Meeting this June in Washington D.C. The poster will outline the impact of the Green House model on Veterans, families and staff. It will also describe actions that support and propel cultural transformation within long-term care in the VA system.

In her poster proposal Ann described how Green House homes are currently serving Veterans across the United States and future plans for the Danville campus:

“VA Illiana was the first VA in the nation to adopt the Green House model, although at least five additional VA sites have either opened Green House homes or are under design/construction, including VA’s in Chicago, Milwaukee, Tomah, Tuscaloosa, and Lexington. At VA Illiana, two more Green House homes are currently under construction, and an additional two homes are in the design phase, resulting in a total of 60 beds within the total of 100 long-term care beds at VA Illiana. One of these new Green House homes will include Veterans with short-stay skilled care needs.”

This presentation will be an excellent compliment to the recent THRIVE research results on the role of the nurse in Green House homes that The Green House Project has been sharing with our Peer Network of adopters.

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CMS Five-Star Rating Program Update

By / Posted on December 9th, 2014

The President and CEO of The American Health Care Association (AHCA), Mark Parkinson, recently released a statement to AHCA members regarding President Obama’s Executive Action on October 6th to improve the Five-Star Rating Program.

As a result of the President’s Executive Action, the Five-Star Program, created by CMS six years ago, will change in two key ways. First, payroll data will be collected in order to improve accuracy of staffing information. Second, the administration has developed three new quality measures that will be added to the nine existing measures: rehospitalizations, discharge back to community and antipsychotic use.

According to Parkinson, “As CMS changes the staffing and quality measures, it will need to create new scoring and therefore, new cut points. This inevitably will impact the staffing scores and quality measure scores for a significant number of providers.”  In light of this, AHCA has issued a collective call to action in order to educate providers, legislators and CMS about the potential problems that may result from the Executive Action.

To learn more about the history of the program and AHCA’s call to action, read the full statement here.


Long Term Care Community Coalition Reception Honors Mary Jane Koren

By / Posted on October 13th, 2014

The Green House Project is proud to help support the Long Term Care Community Coalition’s Sixth Annual Reception celebrating the life and work of Mary Jane Koren, M.D., M.P.H. at the Alzheimer’s Association chapter in New York City.

The Coalition is honoring Dr. Koren at a reception on October 22nd for her dedication and passion for improving the lives of seniors in her work and research. Some of her accomplishments include her work as Vice President for LTC Quality Improvement at The Commonwealth Fund and her position as past chair of Advancing Excellence: Long-Term Care Collaborative.

We are excited to celebrate Dr. Koren’s accomplishments and support the Coalition’s mission to improve care, quality of life and dignity for elders and the disabled.


End of Life Experience in Long Term Care

By / Posted on August 26th, 2014

Providing pain and symptom management along with religious, spiritual and emotional support can create the conditions for a good death.  In order to do this, a deep knowing of the individual is paramount.  But too often in skilled nursing settings, this is not the case.

In fact, a recent survey by Centers for Medicare and Medicaid (CMS) has found that traditional nursing homes were lowest ranked for end of life care experience when compared with home care and hospital settings.  The survey is a pilot right now but it will be officially launched by CMS in 2015 in an effort to provide better information to elders and their family members about hospice programs in their area.

The Green House model creates environments that support a meaningful end of life experience.  The Green House “home for life” philosophy, combined with the small number of elders in a home, and consistent staffing, leads to deep relationships.  In this setting, as an elder nears the end of their life, their desires and preferences are clear and respected.  End of life care is a time of honor and reverence in The Green House model.  Read this granddaughter’s experience at Tabitha Health Care in Lincoln, NE.   The Green House Project has placed an emphasis on end of life care, and has worked with adopters of the model to develop resources and guidance for the end of life that respect the needs of the individual, other elders in the home, support staff and families.

 

 


Sr. Director of THE GREEN HOUSE® Project, David Farrell, Honored by California Medical Organization

By / 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.

Click here to read the full announcement.

We congratulate David on receiving this award!


Anna Ortigara, MSN, Honored by Long-Term Living Magazine

By / Posted on May 14th, 2014

We’re not surprised…but we are very pleased to hear that our colleague and friend Anna Ortigara is one of the four people selected this year to receive Long-Term Living Magazine’s 2014 Long-Term Living Leaders of Tomorrow award.

The award honors individuals who are “…making a difference in their towns and states while serving as exemplar model for others across the country” as leaders in the long-term and post-acute care field.

For the past six years Anna was the Resource Director for The Green House Project.  She was a passionate and driven team member who played an integral role in developing our educational program including countless tools and resources.

Earlier this month, Long-Term Living Magazine published a profile of Anna and the incredible work that she has done over the years, including her work before Green House and the role she holds now as an organizational change consultant with the Paraprofessional Healthcare Institute (PHI).  In the article, Anna talks about the importance of educating others about communication and team-based problem-solving skills and says, “I’ve come to really believe that using a coaching approach to leading change as the model or framework creates the capacity, the possibility of all the rest of the transformation for the organization.”


Green House Model Integrity Initiative and Questionnaire

By / Posted on May 7th, 2014

Since the beginning of this year, the Peer Network Model Integrity Committee has worked hard to establish goals for creating a benchmarking system based on the Green House Project core values and clearly defined essential practices. These goals are:

–          To develop a credible, efficient, and effective system to monitor, assist and promote excellence among Green House Model adopters

–          To create this system using a set of Standards of Excellence that in content and application become the gold standard in benchmarking superior performance in  Long-Term Care

This initiative, led by the Peer Network Model Integrity Committee in partnership with Peer Network Project Guide Marla DeVries and consultant Sandy Ransom, will include both quantitative and qualitative elements.  According to Sandy, “We want to be able to clearly show, in quantifiable terms, the Green House difference. This will enable both adopters and the Green House Project Team to definitively show that general long-term care expectations are exceeded in Green House homes, and people experience a greater sense of home and autonomy.”

In order to establish a system that will work for all communities, we will be sending a questionnaire to each adopter organization this summer that asks for information regarding Meaningful Life, Empowered Staff and Real Home and the essential practices that comprise each value. There will also be questions regarding each adopter’s current data collection processes.

This process will allow us to successfully implement and sustain the integrity of the Green House model now and in the years to come.

 


Green House Model Gains Traction as Providers See Payoff

By / Posted on April 30th, 2014

This may very well be the right time for your organization to consider Green House homes.

In a recent post by Senior Housing News they highlighted THE GREEN HOUSE® Project as a way to revamp traditional nursing care, explored the return on investment for Green House homes, and discussed how some providers have adopted the model to address specific concerns in their state.

The physical environment of each Green House home is designed to transform the institutional nursing facility into a small, residential environment that is home to 10 to 12 elders.  Green house homes fit within the current regulatory and reimbursement structures, and are thus able to nurture people of all abilities, disabilities and financial circumstances.

The story explained that “As regulations mandated by the Affordable Care Act emphasize initiatives related to providing better patient experiences, better outcomes and at lower costs—especially considering the looming threat of hospital readmissions for SNFs beginning in 2019—a Green House model may be able to produce cost savings and operational efficiencies for SNFs.”

Read the entire story here and find out how The Green House model has been developed in different parts of the country.

 


McKnight's Features Green House Pioneer, Steve McAlilly

By / Posted on August 9th, 2013

A recent profile in McKnight’s Long Term Care News, features Steve McAlilly, CEO of Mississippi Methodist Senior Services, the first Green House homes. “Thanks to McAlilly’s nurturing, the Green House model has grown from concept to phenomenon.”

The article profiles Steve’s upbringing, and the winding path that brought him to the helm of Methodist Senior Services in Tupelo, MS.  It has been 10 years since the first Green House homes opened, and it is astounding to look back at all the factors that aligned to make this dream a reality.  McAlilly says the “great adventure” of the Green House taught him how to “move forward without knowing all the answers.”

Chief Operating Officer,  Susan Frazier, decribes the leadership gifts that have contributed to the success of Steve’s organization and The Green House model, “He demonstrated you can work through the regulatory challenges, the capital challenges,” Frazier says. She calls him a “profound leader” who is warm and gracious, and known by all the direct care staff.

To read the full profile in McKnight’s >>

 

 


Empowerment is Foundational to Success: Herzberg and The Green House Model

By / 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.