Researcher Spreads The Green House Message Through Her Work

By / Posted on December 12th, 2016

Lori Gonzalez, Florida State University

Lori Gonzalez, Florida State University

Lori Gonzalez is a PhD researcher at the Claude Pepper Center of Florida State University who studies alternatives to traditional nursing care and social inequality.  She spoke at The 9th Annual Green House meeting about how she discovered The Green House model, and her passion to spread its message.   

“Of those who were surveyed, most frail elders reported that they would choose death over a nursing home.” This was one of the first studies that I came across when I started working as a researcher at the Claude Pepper Center at Florida State University. As I delved deeper into the research literature regarding quality of care and quality of life in long-term care it became clear why the elders in the survey would say such a thing.  Study after study reported resident lack of autonomy, lack of privacy, and lack of dignity.  The physical environment in many nursing homes resembles the hospital instead of home.  Staff and resident schedules are rigid.  Unhappiness and dehumanization abound.  Although the problems are well documented in the literature, few solutions are offered.

Eventually, I came across the early research on The Green House Project.  Not only were Green House homes the comprehensive answer to a complex problem, but the research showed that they were effective in reducing many of the ills facing both elders and staff in the traditional nursing home.  Since then, I have been following The Green House movement and advocating for the model as an independent researcher.  For example, my op-ed that appeared in the Tampa Bay Times earlier this year argues that Florida, during its temporary lift of the moratorium on new nursing home bed construction, has the opportunity to build more livable, human-scale residences like Green House homes instead of the traditional, large-scale institutional model.

I have also been documenting a story of elder empowerment at the Woodlands of John Knox Village (JKV) Green House homes in Pompano Beach, John Knox_Final ExteriorFlorida.  When the community’s rehab facility needed replacing, several elders used their vote on the board to bring The Green House model to JKV.  It took several years, lots of back and forth, but in the end—it was the elders who insisted that The Green House model was what they wanted, that according to their research, it was right for their community. I had the honor of touring the beautiful, bathed in natural light, full of life homes, and the honor of speaking with elders, guides, direct care staff, and the CEO—it is a place where elders truly rule.

I will continue to try to help spread the model because The Green House Project provides the type of long-term care that elders want and deserve.


2015: A Year of Remarkable Growth

By / Posted on December 28th, 2015

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Banner signed at the 2015 Annual Meeting by Green House adopters

2015 was a year of remarkable growth for The Green House Project. We are coming to a community near you, and our name is recognized as the pinnacle of long term care innovation. The Peer Network is one of those crucial elements that sets us apart and as our network grows, we develop and evolve because of their wisdom. The 8th Annual Green House Meeting was a powerful convening of this network. Green House adopters from around the country come together to learn from leaders in the field and each other.  They gain energy and successful practices toward continued success. To support this sustainability and apply the results of the THRIVE research that will be published in 2016, The Green House Project Thrive-logoreleased a tool to gauge model integrity. This tool will ensure that The Green House core values of Real Home, Meaningful Life and Empowered Staff thrive in all organizations who are living this model every day.

The Green House Project receives a great deal of recognition and media coverage. Here’s just a small sampling of the dozens of stories and accolades over the last few months.

  • Green House Project Founder Hailed as top “Influencer in Aging.” In its first annual list of people that are changing aging and how we think about aging, Next Avenue recognized The Green House Project’s founder Bill Thomas. Read more.
  • The New York Times Highlights Green House Homes. In a recently published story on the trend toward smaller nursing home residences, the author highlights the Green House model. Read more. The_New_York_Times
  •  Recognition at Annual LeadingAge Conference. At this year’s conference in Boston, thousands of attendees got to hear Atul Gawande’s keynote, where he discussed The Green House model and specifically called out the Leonard Florence Center for Living in Chelsea, MA. Read more. Dr. Eleanor Barbera of McKnight’s visited the Leonard Florence Center while attending the conference and wrote about it. Read more.

The Green House Project is about to end an historic year – there are now 185 Green House homes open in 28 states. Here’s just a sampling of some of the news from Green House projects around the country over the last few months:

  • Washington County (Colorado) Nursing Home Groundbreaking. In a total replacement of its current nursing home, Washington County will be developing 4 Green House homes. This is the second project in Colorado. Read more.
  • Saint Elizabeth Groundbreaking – First in Rhode Island. Rhode Island breaks its moratorium on new nursing home development to approve the first Green House homes in the state. Read More.

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    Groundbreaking at Saint Elizabeth’s Community in Rhode Island

  • Morris Hall Meadows (NJ) Grand Opening. In October, Morris Hall Meadows opened 6 new Green House homes, making it the second Green House project in New Jersey. Read More.
  • Clark-Lindsey (IL) Groundbreaking. In September, Clark-Lindsey broke ground on two Green House homes that will be dedicated to dementia care. This is a major step forward for Illinois providers and regulatory offices looking to spur innovation in the state. Read More.

As we look with hope and gratitude toward the new year, please take a moment to hear Doris Delanus, an elder who lived at The Village of Redford in Michigan, tell us about what these homes mean to her.  Elders Rule! 

Portrait of a Green House Elder: Doris Delanus (2 mins 42 secs) from The Green House Project on Vimeo.


ANNOUNCEMENT: THRIVE Research Results, Coming Soon!

By / Posted on October 14th, 2015

Thrive2The buzz is about to begin !!  The THRIVE research team, which collected information in and about Green House homes and other nursing homes, completed its efforts.

Presentations of the results have been made at meetings of The Green House Project, the Pioneer Network, Advancing Excellence, LeadingAge, the Society for Post-Acute and Long-Term Care Medicine, the American Society on Aging, Academy Health, the Gerontological Society of America, and others.

In a few months, the THRIVE results will be published in Health Services Research, one of the top journals that impacts health practice and policy.  So, to repeat:  the “buzz” is about to begin!  2

Publication is expected to generate great interest and discussion among policy makers, providers, investors, and other stakeholders — promoting what works best about Green House homes and informing new practices. Green House webinars will be offered to provide updates along the way. Hold on for the ride!  MORE TO FOLLOW!


Pioneer Network Highlights The Green House Project as Thought Leader

By / Posted on August 6th, 2015

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Rhonda Wolpert, Rob Simonetti and Debbie Wiegand share Design Lessons Learned

The Green House Project was highlighted as an innovator and thought leader during the 2015 Pioneer Network Conference.  The Pioneer Network is a convener of organizations who are moving away from institutional models of long term care to more consumer-driven models that embrace flexibility, self-determination and a belief that elders are meant to thrive.  During the stimulating days of educational sessions, representatives from the national Green House initiative, and Green House organizations from around the country spoke on various topics to help move the field forward.

Debbie Wiegand, Rhonda Wolpert and Rob Simonetti shared design lessons learned in their session, “Build This, Not That, Lessons Learned from a Decade of Green House Experience.”   Since the first home opened in 2003, there have been variations in layout and design. Through a formal Design Survey, The Green House Project asked every Green House adopter what works and what doesn’t for building design and regulatory challenges, and what strategies worked to overcome perceived regulatory code barriers. Also, insights from newly completed THRIVE research help us understand how the design contributes to sustainability, from operating cost and quality of care perspectives. Listen to this webinar that Debbie and Rob did to help those interested in changing the paradigm of long term care, build environments that support a new way of life.

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Cheryl VanBemden, Marla DeVries, and Susan Frazier take us into the “black box” or Green House

Susan Frazier, Marla DeVries and Cheryl Van Bemden took audience members “Into The Black Box of Green House homes”.  Here they talked about the impact of decision making to reinforce or erode culture change. Utilizing new insights from The Research Initiative Valuing Eldercare (THRIVE), a collaborative of top researchers created to learn more about what contributes to higher quality in nursing homes, this session explored the factors impacting problem-solving in long-term care organizations that lead to reinforcement or erosion of an empowered workforce, and person-centered models. Participants explored the four factors that the research determined to most greatly impact sustainability, while discovering organizational strengths and growth opportunities to create a slip-resistant change.

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Tammy Marshall, Mirian Levi and Lori Grossman from Jewish Home Lifecare

Tammy Marshall, Lori Grossman and Miriam Levi shared their experience of implementing person-centered care principles across Jewish Home Lifecare, a large organization with multiple sites.  Tammy Marshall facilitated a second session with Sonya Barsness.  They spoke about the importance of research to support “culture change” and “person-centered care.” They shared research that is being done at Jewish Home Lifecare, and how others can access research, translate it to those who need it most, and identify opportunities for additional research.

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Marla DeVries speaking about Research and Sustainability

Finally, the team from Lutheran Homes of Oshkosh shared a special session called, “Honoring the Spirit Within Through Namaste Care: An End-of-Life Program for Persons with Dementia”.  Namaste Care takes its name from the Hindu word meaning “to honor the spirit within.” The program was developed for elders with advanced dementia and strives to maintain their highest quality of life. It includes simple and practical ways for care partners to create opportunities for connection, meaning, and joy.

This conference is always an energy boost, knowing that the movement to transform long term care, and what it means to age, is growing, evolving and gaining momentum.  The Green House Project is honored to be a leader of culture change and will continue to pursue evidence based excellence, that is based in deep knowing relationships, meaningful life and empowerment for all.

 

 

 

 


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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CARE: Dedicated to Improving How We Age

By / Posted on May 7th, 2015

The University of Wisconsin-Madison School of Nursing created the Center for Aging Research and Education (CARE) in response to the rapidly expanding care needs of our aging population. The center works toward transformation by using “…nursing leadership, discovery, education, and practice…” to support happiness, health and security for all older adults.

In a recent online post by the CARE team entitled, “What Makes a Green House Home? How You Decide Matters,” the author considers the persistence and commitment necessary to take the philosophical tenets of culture change and put them into practice.

The post describes how UW-Madison School of Nursing Associate Dean Barb Bowers, PhD, RN, FAAN and research manager Kim Nolet, MS have conducted research that analyzes the “lived experience” that the Green House model now has after more than 10 years as the pinnacle of culture change.

“By interviewing 166 staff members at 11 Green House homes, Bowers and Nolet identified patterns of problem solving as important to the erosion or reinforcement of the Green House model over time.”

The researchers found that along with the architecture of the Green House home, it is collaboration across the organization and between nurses and Shahbazim that allows the significant benefits of this model to be realized.

Both Bowers and Nolet are a part of The Research Initiative Valuing Eldercare (THRIVE). Interested in learning more about the THRIVE initiative? Take a look at this recent blog post which discusses the importance of the soon to be published THRIVE research results.

 

 

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Highlights of 2014 for The Green House Project

By / Posted on December 29th, 2014

2014 has been a whirlwind year for The Green House Project. There have been so many relationships, conversations and experiences with people around the country who are making deep change for elders and those working closest to them.  The year culminated at our 7th Annual Meeting and Celebration, where record numbers of Green House adopters came together to capitalize on the momentum, energy and knowledge that is collectively growing.   Working with innovative and high quality organizations, how can we not be inspired, and spurred forward to spread this model even further? It is hard to sum up the year in a way that honors all of these individual moments, but here is a sampling of some of the highlights to demonstrate that this model is not only the right thing to do, but also the smart thing.

There have been a number of firsts:
Green House Homes Opened in Colorado. The grand opening for The Green House Homes at Mirasol, located in Loveland, Colorado, was significant for many reasons. This project marked the first Green House homes in Colorado, the 27th state to open this model, and also utilized public/private partnerships to make this model accessible to low income elders. Read more about this project on Capital Impact Partners‘, website.
Green House Homes Approved in Rhode Island by the Department of Health. While a moratorium on building new nursing home beds has been in place for years in Rhode Island, the state acknowledged the need for an innovative model of long term care. St. Elizabeth Home has received approval to build 4 new Green House homes. Read more.
State Regulators Unanimously Approve Plans for the First Green House Homes in Missouri. Gaining a Certificate of need for new nursing home beds is no small feat. The Healthcare Facilities

Review Committee of the Missouri Department of Health and Senior Services granted approval for an 80 bed Certificate of Need to build Green House homes in Ozark. Read more.

Some great press coverage:
Atul Gawande’s Being Mortal. Chapter 5 of this best-selling book focuses on culture change and the Green House model. In the media coverage of the book, as well as interviews, there’s a lot of discussion about the Green House model. On Diane Rehm’s show on NPR he called the Green House model “revolutionary.” and The President bought the book to read over the holidays!

Kiplinger. In the retirement planning issue, which covers a variety of topics, including advice on finding the right nursing home. They recommend consideration of organizations that have implemented culture change or that offer Green House homes. Read more.

Research and resources to ensure growth with integrity:
The Research Initiative Valuing Eldercare (THRIVE) honored for studies: The longitudinal studies by researchers from top universities, and funded by The Robert Wood Johnson Foundation, has been completed. Their work has already received high honors, such as the Ollie Randall Symposium at the 2015 Gerontological Society of America conference. This research provides insights into the quality, cost and sustainability of The Green House and other culture change models.
Design Manual and Model Integrity Process: The Green House team has developed guidelines for architects and operators to build homes that are warm, smart and green (‘green’, meaning a place where people grow). This manual will be used as a tool for groups under contract with The Green House Project. Once opened, Green House homes now participate in a model integrity process to protect their investment in the model and to ensure that the elements of the model will grow and thrive.

And some other great news:
Dr. Bill Thomas’ Second Wind Tour. Susan Frazier and David Farrell joined Dr. Thomas on a 25 city tour to offer audience members powerful insights into slower, deeper, more connected ways of living & working. Watch Susan’s talk
Occupancy Growth Exceeds Expectations. At the Water’s Edge, with newly opened Green House homes, the rush of elders interested in moving in has exceeded expectations. Read more.
Tomah VA Medical Center Opens Two New Green House Homes. The Tomah VAMC became the fourth VAMC campus to offer Green House homes to veterans. Read more.

This is just a sampling of some of the wonderful things happening with The Green House Project. Along with amazing people and organizations, we are transforming the way that we age. To become a part of this movement in 2015, contact us or visit our website: thegreenhouseproject.org


Dancing Reduces Pain

By / Posted on July 7th, 2014

If you have knee pain, try dancing the aches away. As reported in Mcknight’s, Saint Louis University’s School of Nursing released a study of elders who complained about knee pain or stiffness in their joints. The results showed that those who danced reported less pain.

“The researchers separated the senior residents into two groups — one group that danced for 45 minutes up to two times a week and another group that did not receive any kind of dance therapy. On average, those in the dance group attended 21 out of 24 sessions.

Results showed that participants in the dance group were able to walk faster and reported less pain. In addition, residents in the dance group took 39% less pain medication while participants in the non-dance group took 21% more medication.”

Although this was a small study consisting of 34 participants, with an average age of 80, “the dance therapy sessions became a regular program after the study was finished.” They plan to continue researching the benefits of dance on the body’s joints.

Click here to read the published study, and don’t stop dancing!


THRIVE: Understanding the Language of Research

By / Posted on June 30th, 2014

The Green House Project has partnered with the Robert Wood Johnson Foundation’s THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care. Supported by the Robert Wood Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes. Each quarter, a member of the THRIVE team will contribute a blog post to the Green House Project website.

As the THRIVE research projects head toward completion later this year, our research team has developed plans to share our research findings.  In addition to publishing articles in a special issue of the journal, Health Services Research, we also will share findings through conference and webinar presentations and blog posts.

Because some commonly used research terms may sound like jibberish to non-researchers (after all, who really knows what a p-value is?), we will devote our next few blog posts to explaining a few terms that will help non-researchers better understand the THRIVE articles, presentations, and posts.  We’ll start by reviewing Quantitative and Qualitative research designs.

When people think of research, they’re usually thinking of a Quantitative research design, which essentially measures and compares things.  Quantitative research asks questions like “How many residents in one nursing home have falls compared to residents in another?” or “Does providing one type of care work better than providing a different type of care?”  A quantitative research design allows a researcher to establish “how much”, whether one thing is related to another (such as whether falls are less frequent when certain care is provided), and also – depending on the details of the design – to establish cause and effect.  The data collected are usually in numerical form, and findings are expressed in terms including percents, means, and p-values (to answer the earlier question, a p-value denotes whether or not a number is or isn’t significantly ‘different’ from another…..we’ll come back to this in a future blog post).

Qualitative research designs essentially answer “how” and “why”.  Qualitative research asks questions such as “Why are so many falls occurring?” or “What conditions are necessary for a nursing home to provide a certain type of care?”  A qualitative research design permits a researcher to better understand events and the circumstances under which they occur and vary.  The information gathered in these types of studies are usually textual, and include the researchers notes and observations, as well as in-depth interviews and quotes from people who have knowledge of the event being studied.  This information is analyzed by looking for common themes across all of the information collected and reporting these findings – often contextualized using exemplative quotes.

The THRIVE team is using both quantitative and qualitative methods in their research, which is considered mixed-methods.  This is the best of both worlds, and is allowing us to answer questions such as:

Quantitative:    What was the annual turnover rate for shahbazim over the past two years?
Was this turnover rate statistically different (higher or lower) than that found
among CNAs in other nursing homes?

Qualitative:      What was the role of the Director of Nursing in the Green House homes?
How might variations in this role relate to shahbazim turnover?

Stay tuned for the next THRIVE blog post.  In the meantime, if you have questions about this post, or suggestions for future ones, please let us know.

Questions about THRIVE can be directed to Lauren Cohen (lauren_cohen@unc.edu or 919-843-8874).


THRIVE (The Research Initiative Valuing Eldercare) Update on Green House Homes

By / Posted on January 27th, 2014

The Green House Project has partnered with the Robert Wood Johnson Foundation’s THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care. Supported by the Robert Wood Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes. Each quarter, a member of the THRIVE team will contribute a blog post to the Green House Project website.
The THRIVE research team is committed to the timely dissemination of findings relevant to The Green House Project homes and stakeholders.  Members of the THRIVE team recently presented preliminary research findings at the 2013 Green House meeting and in a January 2014 webinar.  Highlights from these presentations include:

David Grabowski (Harvard Medical School) debunked several common myths about The Green House model.  Using administrative data, David’s presentation showed that although higher resource nursing homes are more likely to adopt the Green House model than are lower resource nursing homes, these lower resource homes can be successful adopters with adequate vision and internal and external support.  His data also looked at culture change more generally, and found that culture change homes perform better on survey inspections — in fact, they lowered their health-related survey deficiencies by almost 15%!  David’s findings appear in the February issue of The Gerontologist journal:

Culture Change and Nursing Home Quality of Care

Who Are the Innovators?  Nursing Homes Implementing Culture Change

Lauren Cohen (University of North Carolina at Chapel Hill) presented data comparing the characteristics of Green House, higher culture change, and lower culture change nursing homes.  Interviews with guides and administrators found that a greater proportion of Green House homes offer resident choice in bedtime and get-up time, but not in bath time.  Lauren noted that previous research has shown that the desire for choice is not universal, and that predictability may be most important.  Her data also showed that Green House homes were less likely than culture change nursing homes to offer prescheduled daily activities, but were more likely to empower caregivers to lead activities.  So, it remains essential that empowered caregivers offer activities and encourage participation.

Kim Nolet (University of Wisconsin – Madison) reviewed the variations in how the Green House model is being implemented across homes, and discussed the implications of this variation.  Kim described variations in several Green House elements, including the role of the Shahbazim and the use of the den.  Her presentation suggested that model variations occur due to the challenges presented by critical events, organizational changes, daily routines, and subtle evolution in how things are done in Green Houses.  These challenges lead to problem-solving that sometimes results in reinforcement of the model and its core values, and other times in practices that are inconsistent with the core values of the model.

The THRIVE team will be expanding upon these and other findings in 2014.  We have planned conference presentations, webinars, blog posts, and journal articles to communicate our findings to you and others, and invite your feedback about the best ways to keep you informed of the latest findings.

Questions about THRIVE can be directed to Lauren Cohen (lauren_cohen@unc.edu or 919-843-8874).


THRIVE: The Research Initiative Valuing Eldercare

By / Posted on June 17th, 2013

 

 

 

The Green House Project has partnered with the Robert Wood Johnson Foundation’s THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care. Supported by the Robert Wood Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes. Each month, a member of the THRIVE team will contribute a blog post to the Green House Project website.

Why is the Minimum Data Set so Important for Research?
The Minimum Data Set (MDS) – nothing very “minimum” about it! – was developed to monitor and improve the quality of care in nursing homes. Nursing home staff use it to develop resident care plans, and the information is used more widely to develop quality measures and resource utilization group case-mix reports. Indeed, the MDS is the source of the quality information on the Federal Nursing Home Compare website (www.medicare.gov/nhcompare).

What many nursing home staff don’t realize is that MDS information is tremendously useful for research. After all, it’s not often that a mandate exists to report on the status of over 400 data elements for roughly 1.5 million people across 16,000 settings on a regular basis, is it? Beyond purposes of oversight, this information provides a tremendously rich data set to understand the needs of older adults who receive nursing home care, as well as how their needs change over time, and differences in the care they receive across different homes and regions of the country.

Of course, some information in the MDS is more useful for research than other information. A number of items create “standardized” scales, such as those that compose the Brief Interview for Mental Status (BIMS), or the depression scale from the Patient Health Questionnaire (PHQ-9). Before being included in the MDS, these scales were tested to assure they are of research quality in terms of how reliably and validly they actually document mental status and depression. Other scales have since been created from the MDS items, such as one summarizing resident function, and tested for research-quality.

Hundreds of research studies have been conducted with MDS information; in fact, a literature search found almost 800 such studies! The focus of recent research relates to differences in incontinence by race, the relationship of fracture risk to antipsychotic medication use, and the relationship between resident pain and behaviors; clearly, research such as this and others is helpful to inform practice and policy.

The THRIVE team will be using MDS information in multiple ways. It will be used to inform the quality of care for residents, how it varies across participating sites, and how it changes over time. This information also will allow us to “control” for resident differences so we can better understand similarities and differences in care provision that are not related to differences in the resident population. In this way, the MDS is a powerful tool to help us all understand and predict the care needs of the people served in nursing homes.
Questions about THRIVE can be directed to Lauren Cohen (lauren_cohen@unc.edu or 919-843-8874).


Relational Coordination-A Practice with Big Benefits

By / Posted on February 6th, 2013

Via Provider Magazine

As we all know advances in medical equipment and technology play an important role in the care we provide Elders, but leaders must remember that staff and their relationships have the greatest influence on performance.   In the latest edition of Provider Magazine, relational coordination is explored as a critical element for high-performing nursing homes.  David Farrell, the new Director of THE GREEN HOUSE® Project, is one of three authors for the article.

Deep, knowing relationships are the foundation for Green House homes and support the core value of Meaningful Life.

Read more about the evidence that supports relational coordination and tell us what you think!