The Small House Pilot in California, Changing the Face of Aging

By / Posted on May 8th, 2018

Update, 05/18: The Green House Senior Director, Susan Ryan was honored to join Leslie G. Moldow, FAIA, LEED of Perkins Eastman and Mary Muñoz of Ziegler at the LeadingAge California conference to speak about The Small House Pilot, and how providers can seize this moment to enhance the way elders in California age. Collaborating with strong leaders in our field makes our collective voice louder and our impact greater. 

Originally Published 01/18

It is a pivotal moment in California’s history.  The Small House Pilot Program is now live, and it has the potential to clearly demonstrate that there is a better way to deliver skilled nursing care. This profound opportunity requires that nursing home providers across the state, take a stand, and say, NOW IS THE TIME!

The wait has been long, making this moment all the more powerful.  In 2013, through a tenacious journey, Mt. San Antonio Gardens became the first Green House Project in California. The work that they did to make regulatory gains with stakeholders across the state blazed a trail and were codified in late 2012, as Governor Brown signed into law Senate Bill 1228 (introduced by Sen. Elaine Alquist). The bill created The Small House Skilled Nursing Facilities Pilot Program, which authorized the development and operation of 10 pilot projects to deliver skilled nursing care in smaller, residential settings, “It puts the ‘home’ back into nursing home”, said Senator Alquist (D-San Jose). However, it wasn’t until early 2018, that the regulations to support this bill were released, and the request for applications is now open to the public. As a perennial advocate for elder directed, relationship rich living, The Green House Project is eager to support every effort to ensure the success of this opportunity.

The Green House Project has come to be recognized as the leader of the small house movement to create a high-quality, cost-effective, human-scale alternative to the traditional nursing home. Studies of the Green House model have found that:
• Residents have a better quality of life and receive higher-quality care than residents in traditional nursing homes.
• Staff report higher job satisfaction and increased likelihood of remaining in their jobs.
• Family members are willing to drive farther and pay more to have access to a Green House home for a loved one.

Real Home, Meaningful Life, and Empowered Staff: these core values align well with the regulations of the Small House Pilot in California, and they drive change in Green House homes, creating quality outcomes, consumer demand and preferred partnerships in the healthcare system.

With 15 years of expertise in design, education and evaluation, The Green House Project is a strong partner to support the expedited timeline and in-depth requirements of this pilot. The first deadline for submission is June, 2018. Design tools, like The Green House Prototype, along with educational protocols and policy and procedure expertise, will ensure an organization is able to successfully navigate this application. Susan Ryan, Senior Director of The Green House Project says, “The Green House Project specializes in a comprehensive cultural transformation that shifts the beliefs, behaviors, and systems to ensure a lasting investment across an organizational system. It is more than simply a process from ‘this’ to ‘that’; a real transformation unleashes the best of what can be by accessing collective wisdom.” The national initiative stands ready to support nursing home innovators in California, to ensure better lives for elders and those who work closest to them.

With California’s number of individuals 85 and older expected to triple by 2030, the market for Green House homes and others like them is rapidly growing. Consumer demand for the kind and quality of care that The Green House model provides has long existed, but until recently, California’s regulatory and approval process had been unable to accommodate non-traditional models of care. In fact, it took almost seven years for Mt. San Antonio Gardens to gain the approval it needed from multiple local and state agencies. Inspired by their lessons learned, Senate Bill 1228, and the newly released regulations, will enable innovation without obstacle. The Green House Project calls every organization interested in creating a real home, meaningful life and empowered work opportunities for the citizens of California to contact us, and together we will forge a trail to a brighter future.


Improving the Long Term Care Workforce with Strategies that Work

By / Posted on April 25th, 2018

In the opening session of our “Workforce” series, Robyn Stone, Senior Vice President for Research at LeadingAge provides an overview of the demographics, trends, and challenges of the workforce in Elder care. Robyn begins by urging listeners that as providers, we must invest in our workforce to produce the high quality of care we are promising to Elders and families. Our sector will be the center of many jobs in the future and therefore, investing in our workforce is a key component to overall organizational success.

Given the broad and multidisciplinary nature of our field, our workforce meets at the intersection of the medical, social, and environmental sectors. While this creates a dynamic work environment, it also creates challenges when recruiting and retaining quality clinical, administrative, and management positions. Specifically, Robyn urges the importance of frontline professionals who deliver 60-80% of care and are the “eyes and ears” of our communities. Frontline professionals are critical to building meaningful relationships with Elders and families and are essential to the success of an organization when cultivating an Elder-centered culture.

Robyn highlights long-term trends and the importance of building a competent workforce to meet the changing demographic. A rise in care needs, particularly in the 85+ population coupled with the pending workforce shortage of frontline professionals has created an emerging gap in care services. Additional trends include more ethnically and racially diverse older adults and an increase in highly educated older adults with greater access to technology and health literature. Lastly, Robyn discusses economic disparities between cohort groups and the growing group of older adults that will not have the resources to access services they may need in the future.

What are the challenges to workforce development? Robyn discusses that across all jobs and occupations, our sector is continually undervalued when compared to peers in other healthcare settings. She suspects ageism is the catalyst for a lack of attention and investment in public policy, education, and reimbursement rates to support a quality workforce. “We need to have policies that actually incentivize our service systems to be investing and supporting a quality workplace.” At the organizational level, growth in quality supervisors, in-service trainings, career mobility, and competitive compensation and benefits are critical components to building and maintaining a strong workforce.

In closing, Robyn shares public policy, education, and workplace solutions to support the workforce of the future. Specifically, she advocates for tying Medicare & Medicaid reimbursement directly to workforce development, developing quality clinical placements to attract students to our field, and creating innovative career ladders that support organizational retention.

 

To listen to the webinar, please visit: https://attendee.gotowebinar.com/register/3609958745640052481


White House Conference on Aging Launches Regional Forums- We Need Your Voice!

By / Posted on January 29th, 2015

In a blog post earlier this month, Executive Director Nora Super began to outline the goals and events that will occur as a part of the 2015 White House Conference on Aging (WHCOA). The WHCOA happens only once every decade, so you don’t want to miss this opportunity to have your voice heard! The regional forums, announced this month, will provide a venue for the public to discuss issues in the aging field that are most important to them including: retirement security, healthy aging, long-term services and supports, Elder abuse and supporting caregivers.

More specific details of the forums are to follow but the locations and dates are the following:

Tampa, Florida (February 19th)

Phoenix, Arizona (March 31st)

Seattle, Washington (April 9th)

Cleveland, Ohio (April 27th)

Boston, Massachusetts (May 28th)

According to the WHCOA website, “The regional forums are co-sponsored by AARP and being planned in coordination with the Leadership Council of Aging Organizations, a coalition of more than 70 of the nation’s leading organizations serving older Americans.  While participation is by invitation, all of the events will be live webcast to engage as many people as possible.”

We encourage all Green House adopters and culture change advocates to engage in the regional forums by watching the webcast and using social media during that day and the weeks leading up to the event.  Stay tuned for details and ideas to assist you with that process!  In addition, consider having an event at your Green House homes or in your community during the same time that a regional forum is occurring and invite local legislators and press to attend. The more Green House buzz near each regional forum, the more national attention we will receive as others recognize that now is the time to push for radical changes in aging and long-term care!

 


Introduction of H.R. 4122 for Reauthorization of Older Americans Act

By / Posted on April 30th, 2014

Today, President Barack Obama proclaimed May 2014 as Older Americans Month and so it seems timely to take a look at where reauthorization of the Older Americans Act of 1965 stands.  Although there isn’t visible progress on proposed legislation on the hill these days, it is encouraging to see certain policymakers take up the cause for Reauthorization of the Older Americans Act. Last year, the Older Americans Act Reauthorization Act of 2013 (S.1562) was introduced in the Senate to address the fact that authorization ended in 2011 and critical funding for the Act’s programs are in jeopardy.

On February 28th of this year, H.R. 4122 was introduced in the House of Representatives as a bill “to reauthorize the Older Americans Act of 1965, and for other purposes.” The bill was introduced by Representative Suzanne Bonamici (D-OR) with Rep. Ruben Hinojosa (D-TX) and Rep. George Miller (D-CA). What makes this bill unique is that it goes further than simply reauthorizing the Older American Act by including other provisions to protect the health and well-being of older adults.

According to Peter Notarstefano at Leading Age, some of these provisions include:

–          Creation of Federal Database to address Elder Abuse and Neglect

–          New standards for screening and assessment at OAA Nutrition Programs

–          Plans to modernize community senior centers

–          Increased service availability for person-centered transportation

–          Improved resource access for LGBT Older Adults

In addition to H.R. 4122, a bill to simply reauthorize the Older Americans Act (H.R. 3850), was introduced on January 10, 2014 by Rep. Chris Gibson (R-NY) and cosponsors, Rep. Tom Reed (R-NY), and Rep. Betty McCollum (D-MN).

 


Senate Bill 1562: Older Americans Act Reauthorization Act of 2014

By / Posted on February 6th, 2014

Keeping track of what is happening in Congress is no easy task- but here is some news that will interest all of us because it affects elders across the country. Last September, Senator Bernard (“Bernie”) Sanders (I-VT) introduced a bill to reauthorize the Older Americans Act (OAA) of 1965 and funding for its programs for FY2014-FY2018.

The Older Americans Act established the United States Administration on Aging (AoA) as well as state aging agencies that provide a comprehensive network of community based services for older adults that allow them to live meaningful lives in their homes and communities.  The Act is comprised of seven titles that are primarily funded by the AoA except for Title V, a senior employment opportunity program, funded by the Department of Labor. Included in the OAA is the long-term care ombudsman program, nutrition services, grants for Native Americans, support services for caregivers, employment opportunities for older adults, elder abuse prevention programs and transportation assistance.

If you’d like to learn more about the Older Americans Act and the bill to reauthorize it please visit:

The National Council on Aging

AARP Policy Institute

National Association of States United for Aging and Disabilities


Supporting a White House Conference on Aging for 2015

By / Posted on May 24th, 2013

This month, in celebration of the 50th Anniversary of Older Americans Month, THE GREEN HOUSE® Project participated in the Healthy Aging Forum put on by the U.S. Senate Special Committee on Aging.  We were joined by congressional representatives, leaders in the aging field and elder advocates, all of whom demonstrated their passion and dedication to serving older adults by discussing policy frameworks and strategies that result in robust aging services for all.

We must not lose the momentum gained from this event! A national discussion on relevant aging issues, policy strategies and effective care delivery is necessary. Recently, in an article from the National Academy of Social Insurance, Anne Montgomery provides a call to action in order to gain support for a proposed White House Conference on Aging (WHCOA) for 2015. Included in her article is a Letter to the President, signed by 40+ organizations, which explains that now is a critical time for such a conference since, “…By 2015, twelve million baby boomers will have already turned 65 with sixty-six million more to follow.” If the proposal were to be supported, this would be “…the sixth White House Conference in history and the second of the 21st century.”

In order to ensure that core values such as meaningful life, real home, and empowered staff are a non-negotiable part of long-term services and supports, we need to participate in events like the Healthy Aging Forum and the proposed White House Conference on Aging.  

Join us in Unleashing the Power of Age for Older Americans Month by reading the article in support of the 2015 WHCOA and by telling friends and colleagues why we need this national forum.

 


Capitol Hill Policy Briefing Highlights, The Green House Project

By / Posted on February 19th, 2013

On February 8, the Robert Wood Johnson Foundation held a policy briefing on Capitol Hill entitled, “Redesigning the Nursing Home: How The Green House® Project is improving the Way We Care for Older Americans”

Held in one of the beautiful rooms of the Capitol Visitors Center Room, more than 100 representatives from Congressional offices, Congressional Committee staff, Federal , State and Municipal Government Agencies, as well as National and State Aging Organizations attended the briefing.

The intent of the policy briefing was to raise awareness of The Green House Project as a solution for transforming Nursing Home Care and meeting the needs of the impending “age wave” facing our nation.

Moderated by Dr. Jane Isaacs Lowe, senior advisor for program development, Robert Wood Johnson Foundation, the briefing began with and brief introduction and presentation of a video to create a virtual experience of The Green House model.

Distinguished speakers included Robert Jenkens, MSRED, Managing Director, Aging and Independence, NCB Capital Impact; Dr. David Grabowski, professor of health care policy, Harvard Medical School (via video conferencing); Dr. Alice Bonner, RN, FAANP, director, Division of Nursing Homes in the Center for Medicaid, CHIP and Survey & Certification, Department of Health and Human Services and Pamela Sanberg, RN, NEA-BC, MS, NHA, Green House home guide, Captain James A. Lovell Federal Health Care Center , North Chicago, IL.

Speakers highlighted the various aspects of the program, such as the research to support the clinical and financial viability of this model. Pamela Sanberg spoke on behalf of the Veteran’s Association saying, “The small house model, exemplified by The Green House model is well suited to serve our wounded warriors.” The mission of The Green House Project is to make this model an option for elders in every community. Currently in 32 states, The Green House Project feels confident that there are no regulatory barriers to inhibit the this model from developing across the country.

We are hopeful that all attendees especially congressional staff and federal, state and municipal staff came away with valuable information and will continue to look to The Green House® Project as an innovative model for the future of long term care.


Casey, Schumer, Enzi and Wicker Introduce Bipartisan Bill Help Older Americans Access Care Close to Family and Friends

By / Posted on December 23rd, 2011

REPRINTED from Senator Robert P. Casey’s Website
Friday, December 16, 2011

WASHINGTON, DC – U.S. Senators Bob Casey (D-PA), Chuck Schumer (D-NY), Mike Enzi (R-WY) and Roger Wicker (R-MS) today introduced legislation to help small house nursing homes more easily locate in small towns and rural communities, helping older Americans receive advanced care while remaining close to their friends, families and hometowns.

“At a time when older American’s need the love and support of family members the most, they should not be forced to relocate away from their support network in order to access the compassionate care provided by a small house nursing home,” said Senator Casey. “My legislation will remove barriers preventing small house nursing homes from being located in small towns and rural areas where access to care is currently scarce.”

“This bipartisan bill is just what families and older Americans need – the ability to receive high-quality care in a nurturing setting,” said Senator Schumer. “These smaller nursing homes will provide focused personal care in a comfortable setting for our country’s elderly citizens, all while allowing them to live a stone’s throw away from family and friends.”

“It is important to help seniors stay in their communities as they age to ensure they receive the highest quality of care, especially in rural communities,” said Senator Enzi. “This bill will help address some of the challenges that affect seniors and those who need long-term care by offering a better coordinated, community-oriented option for nursing care. This streamlined system of support and services will allow seniors to continue to receive advanced care while staying close to their family and friends.”

“Mississippi has been a leader in developing small nursing home models,” said Senator Wicker. “The small nursing home model has proven to be a success by allowing older persons to remain in their communities while receiving proper care. This legislation would help expand access to this worthwhile program.”

Residents of rural communities frequently have to relocate away from family and friends to access care in large nursing homes because federal rules do not currently allow small house nursing homes to be licensed together when they are not on a single campus. This prevents small house nursing homes from being located near smaller population centers and rural areas, where demand does not necessitate a nursing home large enough to be financially viable.

The Community Integrated Nursing Care Homes (CINCH) Demonstration Program Act of 2011 would test the financial and operational aspects required to break down large nursing homes into small house nursing homes by allowing small house nursing homes to be licensed together. While each home will meet or exceed federal and state standards for staffing, care and emergency services, certain services that can be safely delivered by staff traveling between homes to increase efficiency will be reconfigured to make the separate entities financially viable.

The CINCH Act would authorize 6 organizations to implement a small nursing home model. These organizations will submit a report to Congress to evaluate the programs and determine if expansion is appropriate.


Summer Call Series for Green House Adopters

By / Posted on May 11th, 2011

This series of calls/webinars will highlight the major goals of our second Robert Wood Johnson Foundation grant, through a dialogue about major initiatives and how you can be involved

We are looking forward to the stimulating discussions, questions, stories and successful practices that will emerge from these conversations. Your feedback is welcomed, appreciated and necessary to make these connection outlets reach their highest potential.

Topics Include:
* Marketing: Utilizing the Blogstream to tell your story and market to your community
*Policy: Activating Green House Projects to advocate for Culture Change
*Finance: Dollars and Sense of The Green House Model, updated findings
*Project Management: Living the Brand and the Mission
*Tool Development: Equipping Green House Projects for Success
*Peer Network: Sustaining our Promise to the Model

For more information, contact your Project Guide!