Green House Featured as Innovator at National LeadingAge Conference

By / Posted on October 20th, 2017

To care well for others, we need to reinforce our own passion for what we do—and actively work to improve how to support our country’s aging population today. That’s exactly what we do at the LeadingAge Annual Meeting & EXPO, our nation’s largest annual event for the not-for-profit aging services field. In education sessions, during general sessions and through eye-opening, one-of-a-kind experiences, you and your team will be immersed in our shared mission of helping older adults thrive.”

The Green House Project is looking forward to opportunities to connect with visionary organizations at this of this event.  Please visit us in the exhibit hall at booth #1913.  Also, don’t miss this informative, challenging and stimulating sessions that feature Green House expertise and innovation:

Monday, October 30, 2017

3:30 – 5:00 p.m.

22-C. Integrated vs. Segregated Environments for Persons With Dementia

  • Examine the pros and cons of integrating versus separating elders living with dementia in different settings.
  • Consider how the approach to dementia care and programming has evolved as the physical environment of memory care “units” continues to change from locked wings to neighborhoods.
  • Assess your organization’s philosophy and care practices as they relate to those living with dementia and their care partners.

Speakers:

  • Audrey Weiner, President & CEO, The New Jewish Home, New York, NY
  • Ann Wyatt, Manager, Palliative & Residential Care, CaringKind, New York, NY
  • Susan Ryan, Senior Director, Green House Project, Linthicum, MD
  • Tammy Marshall, Chief Experience Officer, The New Jewish Home, New York, NY
  • J. David Hoglund, Principal and Director, Perkins Eastman, Pittsburgh, PA

 Tuesday, October 31, 2017

3:30 – 5:00 p.m.

48-F. From Traditional Skilled Nursing to Green House® Model

  • Discover how resident leadership, administration and board members achieved consensus to transition toward a new model of care.
  • Understand how the new financial model created a platform for new funding opportunities and revenue streams.
  • Consider planning, forecasting, marketing and implementation pitfalls to avoid from both a financial and care perspective.

Speakers:

  • Gerald Stryker, President/CEO, John Knox Village of Florida, Inc., Pompano Beach, FL
  • Rob Seitz, Marketing & Communications Manager, John Knox Village of Florida, Inc., Pompano Beach, FL
  • Jean Eccleston, CFO, John Knox Village of Florida, Inc., Pompano Beach, FL
  • David Haun, Resident, John Knox Village of Florida, Inc., Pompano Beach, FL
  • Twylah Haun, Resident, John Knox Village of Florida, Inc., Pompano Beach, FL
  • Nanette Olson, Executive Director of the Foundation, John Knox Village of Florida, Inc., Pompano Beach, FL
  • Monica McAfee, Director of Sales and Marketing, John Knox Village of Florida, Inc., Pompano Beach, FL


‘Politico’ Hails The Nursing Home of the Future

By / Posted on January 13th, 2017

politico1In Rebooting The Nursing Home, Beth Baker shares the deep human stories that describe The Green House model and shaped her visit to Lebanon Valley Brethren Home.  These Green House homes are a part of a “growing movement to transform nursing homes from medicalized institutions to places that feel much more like home.”

Resident choice and autonomy, a homey environment, and well-trained and invested staff are hallmarks of the Green House and similar models that are slowly and fundamentally changing long-term care for Americans who otherwise could be forced into traditional nursing homes.

Lebanon Valley Brethren Home has experienced the model’s benefits from a business politico2perspective, as well.  CEO, Jeff Shireman shared that after the capital investment, operating costs have been comparable or even lower than their traditional nursing home.  This cost savings is directly correlated with the comprehensive paradigm shift of the model and fully leveraging the role of the versatile worker (known as a shahbaz), “What you must do as a leader is to support [the shahbazim] and empower them and hold them accountable,” says the Green House Project’s Senior Director, Susan Ryan. “That is where you’ll see the efficiency.”

politico3This article paints a warm picture of a day in the life of a Green House home, and the elements that make it a viable model that is changing the landscape of long term care.

Read The Full Article>>


The Green House Project Reaches Important Milestone

By / Posted on August 9th, 2016

 

Over 200 Green House Homes Now Open in 30 States 

BALTIMORE, MD (August 9, 2016)– THE GREEN HOUSE® PROJECT has spent over a decade creating a new vision for the future of elder care. In June, the organization reported an important milestone: more than 200 Green House homes are being operated by leading organizations in 30 states.

Upon reaching this new milestone, Green House Senior Director, Susan Ryan says, “It is beyond exciting to see this initiative gaining momentum.  It took us 10 years to reach the first 100 homes, and only five years to add the next 100.  As our numbers continue to grow, it means that more people are able to live full and meaningful lives.  Both the elders who live in Green House homes and those who work there, benefit from the elements of the model that returns value and autonomy to those who it matters to most.“

Exterior of new JKV with 12 homes May 26 2016John Knox Village, a lifecare community in Pompano Beach, Fl represents the 200th Green House home to open.  In May 2016, they opened 12 Green House homes.  Says CEO, Gerry Stryker, of the momentous occasion, “Being the 200th Green House home is incredibly emotional and fulfilling for John Knox Village.  We recognize that we are a part of a rapidly growing national movement to change the face of care and rehabilitation.  Our elders deserve this.”

kitchen_cedar sinaiCedar Sinai Park, in Portland, OR, opened the first of four Green House homes in July, representing the thirtieth state to include this lifestyle model.  Sandra Simon, CEO said, “This is the future of aging services, and we are proud to create the first Green House home in Oregon.”

Research  finds that comprehensive adoption of the model has the potential to impact re-hospitalization rates, end of life care, and the quality of decisions made in the homes.  A strong evidence base makes this model an appealing option to consumers, policymakers and long-term care providers and increases potential for scaling.

The Green House concept has already spread nationwide, with Green House projects operating or in development in 34 states.  The organization’s goal is to increase the pace of growth, and have at least 300 homes open by 2020.

About The Green House Project

Based in Baltimore, MD, The Green House Project promotes an alternative to the traditional institutional skilled nursing, replacing it with an innovative new model of care that balances quality of life with quality of care.  In the Green House model, large nursing facilities are replaced with small, self-contained homes that include private bedrooms and baths, home-cooked meals and access to the outdoors, while meeting all skilled nursing regulatory and reimbursement criteria.  Incorporating the core values of meaningful life, real home and empowered staff, the Green House model creates a higher quality of life, improved medical outcomes, and greater caregiver satisfaction.  There are currently more than 200 Green House homes in 30 states.  The Green House Project is an initiative within the newly formed Center for Innovation. Visit our website at www.thegreenhouseproject.org.


Portrait of a Green House Leader, Joyce Ebmeier

By / Posted on January 29th, 2016

What Does it Mean to Lead Meaningful and Sustainable Change

The “Portrait of a Green House Leader” webinar series continues by highlighting the talents of Joyce Ebmeier, Senior Vice President of Strategic Planning for Tabitha Health Care Services in Lincoln, NE. Tabitha offers a continuum of services to elders, including the first Green House homes in Nebraska and the second built nationally. Joyce attributes her desire to work in elder care to her deep relationship with her grandmother and the wisdom she shared with her growing up. After graduating from the University of Nebraska with a bachelor’s degree in Education, she pursued a career in teaching before beginning her career with Tabitha in 1981, where she served as the administrator of their nursing and rehabilitation center for fourteen years. Currently, as the Senior Vice President of Strategic Planning, she is responsible for directing the overall planning, monitoring, communication, and progress of Tabitha’s business and strategic plan.

Joyce_web

Joyce (right) with her mother

Joyce was inspired to champion the development of Tabitha’s four Green House homes after listening to Dr. Thomas speak about The Green House vision in 2001. As an administrator of a traditional facility, she knew the opportunity to imagine a blank page, and create more of what she knew elder care could be through The Green House model was the next step in writing Tabitha’s future chapters. After sharing the vision, the board approved the development of one Green House home after half the initial funds were raised. Joyce identifies that engaging with a grant writer to help locate available funding sources and network with organizational leaders was a crucial strategy to raise the initial funds for the Martin house, their first Green House home to nine elders. After they demonstrated the success of the model through the Martin house, three more homes were built, with plans to purchase property and build four additional homes in the future.

From a cost perspective, Joyce states that their Green House homes are major contributors to the success of the

Construction of a Green House home on Tabitha's campus

Construction of the Good House

entire company. Specifically, adding Green House homes for long term care into Tabitha’s continuum of services provided an opportunity to expand their capacity for post acute short term rehabilitation in their legacy building. This balance of costs and revenues combined aids in the growth of Tabitha’s entire organization. Further, Joyce describes that the quality of care associated with their Green House homes has become a hallmark within the community that is a “magnet” for people seeking long term care. This high demand results in a reliable, sustainable census that is crucial for overall operational success.

However, Joyce notes that the true success or “magic” of The Green House model comes from the incredible people who live and work in the homes and the culture created to foster deep knowing relationships. “It’s the most important part of getting The Green House model correct. If you don’t have the right people and you don’t provide an environment which empowers them to do their work with the elders… if that doesn’t happen the most beautiful and perfectly designed houses are really a waste of time and money.” At Tabitha, recruiting extremely creative, great people has resulted in

Annual Green House carnival

Annual Green House carnival

unique teams in each home where people feel empowered to bring who they are into their work. This results in extraordinary events and celebrations, such as their annual Green House carnival, and quiet everyday moments of compassion, love, and joy in the homes that couldn’t occur in a traditional setting. For Joyce, when talking about her accomplishments in her career, she identifies working with The Green House Project as the one she’s most proud of, yet is continuously striving for success in providing the highest quality of care for elders. When thinking about her Green House legacy in the future, she hopes it reads “But as remarkable as the Green House model became, what came next from these pioneers in elder care was even better.”

Listen to this recorded webinar interview>>


Lebanon Valley Brethren Home Releases New Video Highlighting Their Green House homes

By / Posted on January 6th, 2016

At Lebanon Valley Brethren Home we believe in empowering our elders and providing innovative ways to care for their needs both in mind, body and spirit. This video is the story about our Green House homes, which are designed to serve those who need the highest level of nursing care.

LVBH

Lebanon Valley Green House home

We decided to tell our story by video for a few different reasons.  First and foremost, we wanted to create a clear and visual way to describe The Green House model to prospective elders and their families.  Because we limit outside visits to preserve the value of ‘real home’,video is another way to create that “seeing is believing” experience.

Additionally, this video is a great way to educate our team, community and stakeholders about The Green House model.   By ensuring that our network understands the value of this model and the life that we are creating at Lebanon Valley Brethren Home, we are looking forward to their support in building more Green House homes in the future.

Thank you for taking the time to watch our video, and if you would like to learn more about our community, please visit our website.

Jeff Shireman is the President and CEO of Lebanon Valley Brethren Home

 


New York Times Highlights The Green House model and Trend toward Small Nursing Homes

By / Posted on November 23rd, 2015

“This is my home,” said Kay Larmor, an elder who currently lives at Porter Hills Green House homes. “And I feel cared for.”

kay larimor

The New York Times recently explored the movement toward smaller nursing home residences, highlighting The Green House Project as the premiere example of this trend, “Green House homes were developed from a blank sheet of paper,” said Scott Brown, Director of Outreach at The Green House Project. The results, he said, have been encouraging. Studies show that residents have higher-quality lives and significantly fewer hospital readmissions.

“This is the way that elders want to be cared for,” said Audrey Weiner, chief executive of Jewish Home Lifecare, who will open 22 Green House homes in Manhattan.  Currently there are 185 Green House homes operating in 28 states; an additional 150 are in development. That compares with about 15,700 nursing homes in the United States housing 1.4 million people.  There is still much work to do to make Green House homes an option for elders in every community.  Whether you are an advocate, provider or developer, visit www.thegreenhouseproject.org to learn how you can get involved.

Read the full article>>

 


Fresh, farmed produce debuts at Virginia Mennonite Retirement Community

By / Posted on October 14th, 2015

October 7, 2015

Contact: Maureen Pearson, director of Communications

540-438-4205, 540-908-8979

Eating locally is a common phrase in the agricultural heavy Shenandoah Valley of Virginia, but for Virginia IMG_4056Mennonite Retirement Community, eating locally took on an entirely new meaning this summer.

The continuing care retirement community cultivated 1 ½ acres of land from its nearby farm for food production. The Farm at Willow Run owned and operated by VMRC began the growing season with an anticipated production yield goal of $24,000.

“Knowing where your food comes from is important, and the nutritional value of fresh produce grown nearby is excellent,” said Eric Phipps, executive chef at VMRC.

Growers used untreated and organic seeds and plants in plantiIMG_3903ng as much as possible, and with the farm just minutes from the retirement community, shipping and delivery were kept to a minimum.

Produce was integrated by Dining Services into soups, salad bars, side dishes, and desserts with excess sold at produce table.

“The feedback from the Heirloom tomato bisque and butternut squash pie was amazing,” said Phipps, who designed the menus to accommodate the garden produce.

Farm fresh produce also was utilized in assisted living activities of bean snapping and zucchini bread baking.

“The farm made good sense for VMRC as we identified ways to help people live a healthier lifestyle,” said Judith Trumbo, president and CEO.IMG_4043

Nearly 750 residents live at VMRC which also is home to Virginia’s only Green House community – Woodland Park.


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.”

 


Short Term Rehab in The Green House Model – A Case Study

By / Posted on August 5th, 2015

Leonard Florence Center for Living

6x7X3CrHokb6SwAIWDKUKSWCpdd6M78Ay_XOPVuW9LcThe Green House model  was originally designed as a long term care solution where  elders could live for the remainder of their lives. Leonard Florence Center for Living (LFCL) has expanded their Green House homes to include three short term rehab homes within their ten home building in Chelsea, MA. In the webinar, Short Term Rehab in the Green House Model – A Case Study, Ina Hoffman, Director of Admissions, and Jill Tura, Director of Rehabilitation, describe how short term rehab can be delivered in a real home environment, and highlight their positive clinical and financial outcomes. Their decision to incorporate short term rehab into their Green House homes outlines how providing this service has made them   a preferred provider in the community and creates a highly attractive environment that increases consumer demand.

In order to provide high quality care to elders and those who living with diseases such as  Multiple Sclerosis or Amyotrophic Lateral Sclerosis, LFCL needed to create a financial situation that  would enable them to serve Medicaid recipients, while managing organizational needs.   Incorporating short term rehab into their Green House homes provides financial balance to their building and allows individuals to receive short term CF00eJRB_q1f5bqRESlaGAnrAXs_IbIOBlU-ZcNFcTYorthopedic, cardiopulmonary, neurological, or medical rehabilitation in a real home environment. Currently, LFCL has up to 30 individuals receiving short term rehab at any given time, averaging 45 admissions per month. Through strategic marketing, seeking connections with Boston area hospitals and Accountable Care Organizations, and referrals from elders and their families, they became a choice provider of short term rehab in their community – and a reputation that proves it.

 

“There are not many places that can do what we do.” Ina says when describing short term rehab in a Green House home as an “Occupational Therapist’s dream.” Rather than stimulating home-like environments, functional, practical therapy is provided seven days a week in a real home to ensure maximum safety and success upon discharge. Those who come to LFCL for rehab  practice activities of daily living with their core rehabilitation team in the common areas of the home, while more personal tasks such as bathing, dressing, and toileting can be done in the privacy of their own bedroom and bathroom. The Green House environment fosters a sense of community and family within the home.  The members of the house encourage each other during therapy sessions, discuss therapy goals and frustrations over meals, and exchange telephone numbers when they return to the community to keep in touch beyond their stay. Because LFCL is within the larger Chelsea Jewish Foundation, when a person is ready to transition to in-home care, they can continue to receive therapy from the same core team, allowing for a continuous, efficient transition of care.

 

By incorporatingD_YEvbOIK7ASoF2DEyGTUyKUR795WiRz3exvUwkEzps short-term rehab into their Green House homes, LFCL created a financial strategy that “keeps the building going.” Short-term rehab created an opportunity to stay true to their mission while providing high-quality, integrated care with positive outcomes, including decreased length of stay, higher overall satisfaction, and decreased rehospitalizations.

 

Interested in learning more about short-term rehab in Green House homes? <<Listen to the webinar recording here>> 


Wedding Celebration Honors Generations

By / Posted on July 28th, 2015

Chelsea Jewish Foundation is an innovative organization that has infused meaningful life across all of their communities.  In addition to Chelsea Jewish Nursing Home, they also operate the groundbreaking Leonard Florence Center for Living that includes 10 Green House homes in a high rise structure, serving elders, short term rehabilitation and those living with MS and ALS.  

The Chelsea Jewish Nursing Home’s first wedding in its 96 year history took place on Friday, July 10, 2015. Rose Stetson, a 91 year old resident, truly wanted to see her son Kevin get married and her son couldn’t imagine his mom not being present. What better place for a wedding than Rose’s home at Chelsea Jewish Nursing Home? Kevin and Sharon were married by Sharon’s father, who became a Life Minister and officiated the ceremony. The bride’s daughter, Lexie, was the maid of honor and Rose’s grandson, Tim, was the best man. All in all, it was a wonderful family affair on a beautiful July day.

Stetson-wedding-CJNH

Chelsea Jewish Nursing Home first wedding with Kevin and Sharon Stetson.

 

 

 

 

 

 

 

Rose-Stetson-with-grandchildren

Chelsea Jewish Nursing Home resident Rose Stetson, 91, and her great-grandchildren.


Joint Provider Surveyor Training: Building Vital Relationships

By / Posted on April 2nd, 2015

Susan-Frazier_8924A mutual goal of providers and regulators is for elders to experience high-quality lives, enjoying choice, freedom and dignity. The Green House Project understands this, and supports dialogue and education to build strong relationships among all stakeholders. The Joint Provider Surveyor Training, recently held in Grand Rapids, Michigan, provided an opportunity to spread our message about the importance of partnership, and its necessity to achieve positive outcomes for the future of aging.

As Senior Director of The Green House Project, I joined Renee Cunningham, Director of Nursing for Kalkaska Memorial Health Center, to present the latest research on The Green House model. Renee shared her organization’s journey to adopt The Green House trademark, and the value that they believe it will bring to help them achieve their goal of opening two Green House homes in 2015.

The Green House Project partners with state regulators to understand the specific regulations of each state, and educates them about The Green House model. Since the Omnibus Budget Reconciliation Act (OBRA) of 1987 was enacted, mandating that nursing homes “…help each resident attain or maintain the highest practicable well-being…” (CMS 1987), person-centered thinking has been inscribed in long-term care policy. The Centers for Medicare and Medicaid Services (CMS) continue to advance this agenda through regulations and interpretive guidelines that mandate person-centered approaches. It is essential to bring regulators and providers together for vital collaboration. Building those relationships at the policy and advocacy level are essential to achieving meaningful life at the individual level.


"Expect the Best!"

By / Posted on January 15th, 2015

My work often brings to mind my good friend and mentor, Nancy Fox. Nancy is Chief Life Enhancement Officer for Vivage in Colorado, was the first Executive Director of The Eden Alternative™, and has many years’ experience as an administrator and an educator. The lessons she has taught me pop into my head on many occasions.

In 2007, Nancy wrote a book called Journey of a Lifetime: Leadership Pathways to Culture Change in Long-Term Care (available at www.edenalt.org or online booksellers). The book lists ten important principles for enlightened leadership, illustrated by stories of good and not-so-good experiences she has had, and lessons learned. One of these is called “Expect the Best,” a principle that is ignored with alarming regularity in long-term care, on both the provider and the regulator sides.

Here is an example of each:

First, a recent McKnight’s article described a study in the upcoming issue of Geriatric Nursing that can only be described as what my friend Jane Verity would call “a blinding flash of the obvious.” This study of nursing homes in the US and Germany showed that CNAs had a much better work experience if they were notified of the deaths of their elders before discovering it for themselves (such as walking into a room to provide care and finding an empty bed). The study recommended “more mindful” approaches to such transitions for those who have formed close, caring relationships.

Wow. What’s sad about this study—even the need to conduct such a study!—is that it reveals how often we give lip service to honoring our hands-on care partners, but choose actions that say the opposite. Then we are quick to blame those same people for lack of a “work ethic.”

Look at your employee handbook and ask yourself, does this document expect the best of our employees? Does it treat them as responsible adults or as children (or worse yet, as potential criminals)? Then look at the actions and interactions of leaders and managers throughout the day. Are our care partners included in decision-making discussions? Do we ever ask for their opinions or advice?

Expecting the best creates two complementary results—it improves people’s abilities and their accountability. Nancy frequently says that “empowerment is not something you try; it is something you do.” When we approach those who support our elders with an expectation that they are capable of great wisdom and growth, we create an environment where growth can occur and wisdom will blossom. And by treating people as equals, we create an environment where people care about each other and about the consequences of their actions, and accountability thrives.

Such discussions raise the inevitable objection that there are people who will take advantage of your good intentions and try to game the system. Welcome to the planet Earth. The problem not that such people exist; the problem is that we write our policies and choose our actions based on the worst person we can imagine and punish everyone else with our low expectations, rather than addressing (or removing) the individual in question. Nancy would likely say, “Expect the best, (and individually address the worst).”

The second example was raised by Karen Schoeneman, formerly of CMS, in a recent culture change discussion that highlights this issue on the regulatory side. She was upset to hear that surveyors in her home state were not permitting elders to have refrigerators in their rooms because of the concern that a resident with diabetes could potentially enter the room and take something that would not be good for his/her diet.

There is so much wrong with that citation that I could devote an entire post to it. But let’s stick with “Expect the Best,” as it applies to surveyors. The fundamental flaw in our regulatory system, I believe, is that surveyors inhabit a primary identity as enforcers, rather than educators. Therefore, they come into the nursing home expecting the worst and constantly imagining “What could possibly go wrong?”

(Of course, Nancy added her two cents to the discussion thread as only she can do, suggesting that perhaps “surveyors shouldn’t be allowed to drive, because they might hit a diabetic.” If it’s possible to laugh and cry at the same time, that’s what I did when I read her comment.)

Incidentally—to be fair to surveyors—many of them work in states where they are required to be enforcers only, because the rules say that they cannot advise providers, only tell them if what they are doing is “in compliance” or not. Apparently the concern is that surveyors might lose their objectivity if they try to mentor the homes. And apparently the rule makers have never heard of school teachers, who mentor their students every day and still give them quarterly grades. If the regulatory bosses don’t expect the best of their surveyors, then a trickle-down effect at survey time is entirely predictable.

These are two examples of why I sometimes despair that our current system of elder care will never truly create well-being for anyone. There is far too much talk about “culture change” and too little evidence of it. Nancy Fox is one person who has always walked the talk. We would all do well to read, or re-read, Nancy’s book.