By Lisa Milliken / Posted on March 27th, 2018
Reposted from The Pioneer Network Newsletter
Lisa Milliken serves as the Director of Education for Select Rehab, where she researches evidence based practices and develops continuing education courses on current hot topics for therapeutic intervention in the post-acute setting. Her goal is to assist this field in the prevention of unnecessary re-hospitalizations and to help therapists deliver the highest level of rehab practices for the most optimal clinical outcomes.
“If my therapist asks me to do something that makes sense to help me achieve I want to do, then I would be motivated to do it. It would make sense to me. But how is this bicycle thing going to help me work in my garden or wash my clothes? That doesn’t make sense, so why should I have to do them?”
These are often the thoughts of residents in a community’s rehab department who are there to regain a prior function. I’m reminded of a story shared by a colleague about one man (Tom) who was in short-term rehab following his stroke. His goal was to regain function of his left arm and leg to go home and resume work on his farm. Initially Tom did not like doing the same old exercises, which were assigned to him by the physical therapist to improve his leg strength. And he surely didn’t enjoy the tabletop pegboard and exercise putty his occupational therapist gave him to work on. His comment to all of this was, “This is ridiculous, why I am doing this?” So they stopped and asked “What would you like to be able to do again?” To this he responded, “Well, I want to go home and get on my tractor and get back to work!” So the therapist called Tom’s son and they arranged for the tractor to be brought to Tom’s senior rehab community and parked it in the parking lot. Every therapy task from that point included goals to get on and operate the tractor. This meaningful therapy had a purpose and Tom’s progress then increased dramatically.
Each elder’s rehab goal is different. We should not assume that everyone wants to walk 100 feet and improve standing balance to 15 minutes. There may be no meaning or purpose to such goals. But if we ask them, they will often tell us exactly what they want. It may be that they want to sweep their own floors, go get their mail or walk to the living room to visit with other elders by themselves. Or maybe it’s to independently work in the kitchen because they’re a chef and frequently volunteer at a local shelter to help with meals.
A successful meaningful therapy task includes the following components:
• Person-centered and individualized
o Based on preferences
o Meaningful versus rote
o Graded to abilities
• Volume and content are appropriate to skill level
• Therapy and nursing team members’ attitudes are supportive of the elder’s goals
According to a study by Port and others in 2011, we can effectively solicit an elder’s preferences through a series of steps, including the systematic narrative history of activities enjoyed prior to admission and a direct interview of the elder about activity preferences and available choices. We can then identify health-related or contextual obstacles and develop novel interventions to re-engage each elder in their preferred task. Historically, traditional therapy would focus on impairment-based treatment approaches. And components of such approaches may still be necessary and beneficial at specific points of treatment, such as to collect baseline data for range of motion, strength and activity tolerance.
But functional-based treatment approaches should also be included in the elder’s skilled plan of care. Each elder needs to be challenged and tested in functional skills that will be required of him/her in the following skilled rehab, whether that be within a community setting such as a nursing home or assisted living, , or in their own home. This approach prepares the client for the specific activities and skill sets which they will need to attain their optimal level of functioning in any setting, and where possible, to successfully transition and remain in their home without the potential risks.
The recently updated Rules of Participation for Long-Term Care now cites the resident’s preferences as a requirement in many of the codes of federal regulations. For instance, the Resident’s rights section includes this statement:
“A facility must provide a person-appropriate program of activities that should match the skills, abilities, needs and preferences of each resident with the demands of the activity and the characteristics of the physical, social and cultural environments.”
Furthermore, payer sources such as Medicare and various managed care and insurance companies stress the importance of quality outcomes in a timely manner. So it should be of no surprise that our detailed graphs and charts of outcome data per client shows better and faster improvements as a result of the functional based therapy where we focused on the residents’ personal goals.
Such regulatory and outcome requirements further support our priority to first seek the resident’s input regarding their preference and then help them to achieve their unique goals. Whether we’re working to get Tom back on his tractor, helping Louise to return to her kitchen, or supporting the best quality of life possible as defined by each resident in a community, we can cater each therapy session to their unique goals and the result is a win-win for us all.
By Claire Lucas / Posted on October 17th, 2017
Many traditional nursing homes are scrambling to meet the new person-centered regulatory standards; however, it is business as usual for Green House homes. What set’s Green House homes apart is the comprehensive transformation of the homes… physical design, organizational structure and philosophy of care are all changed to reflect elder-directed care. The three Core Values: Real Home, Empowered Staff & Meaningful life provide a guidepost for establishing operational practices.
CMS is placing a larger focus on use of non-pharmalogical interventions and staff having appropriate competencies and skills. Appropriate treatment and services for Elders living with dementia is also emphasized in the new regulations.
A key element of The Green House model is the use of specially trained versatile workers, whose responsibilities include food preparation and service, activities, light housekeeping, and laundry. The versatile workers are called Shahbaz, and are Certified Nursing Assistants who receive an additional 128 hours of education which encompasses all elements of their work including infection control procedures, culinary skills, dementia, communication skills and activities. Not only are staffed provided the training they need, but consistent staffing allows for Shahbazim to get to know their Elders, establish strong bonds of friendship. Being well-known supports allows for non-pharmalogical interventions to be effective.
Residents Rights has become the largest section in the new CMS regulations.
Shahbazim understand that one of their fundamental roles is to nurture, sustain and protect the Elders in their care. Elders are in control, driving decisions in the home from menu choices to daily activities. Staff learn about how to provide Meaningful Life to elders in their care, including honoring their natural rhythms. Elders can sleep in and go to bed when they wish.
New regulations set new standards for care planning.
Elders can decide who attends and now must participate in setting goals. A nurse aide and a member of food services staff are required to attend care plan meetings. Again, this has always been part of the Green House model. Shahbazim lead the care plan meetings. Because they are consistently assigned to work in one home, they know their Elders well. Staff are coached on how to respect Elder’s wishes, while informing them of risks and benefits of proposed care. Ultimately, the Elder decides.
Grievances must be acted on quickly by staff and recommendations from Elders must now be considered. In a Green House home staff are talking to Elders daily, hearing their concerns and following up on their issues in “real time.”
Shahbazim are empowered and therefore can often make immediate changes to address Elder’s concerns, eliminating the need to go through a long chain of command to have issues heard and changes made.
CMS has put more emphasis on creating a “homelike” environment.
Green House takes it to another level providing “real home.” Every elder has a private bathroom and their own bathroom/shower. Elders can personalize their bedrooms, bringing in many items from home.
Meaningful Engagement is now a greater focus of new regulations.
Elders must be provided with a choice of activities that encourage both independence and interaction with the community. Activities in a Green House home include a combination of planned and spontaneous events, with a majority of activity occurring naturally and recorded as appropriate. Although the full-time activities director will act in a facilitative role, providing assessment and evaluation of activity preferences and individual engagement, assistance with activity programming, coaching and teaching; versatile workers within each home will have primary responsibility for leading meaningful and engaging activities on a daily basis. While anticipated activities can be scheduled, the spontaneity fostered in a Green House home means not all activities can be planned. Some programs will occur naturally, such as folding laundry, a family visit, or assisting with the day’s meal.
The Green House team is proud of the work of our adopters and the strides we have made to lead the field, creating better lives and better jobs.
By Christie Tutschulte / Posted on February 25th, 2017
It’s another first for The Green House Project, as Missouri is welcomed into the list of innovative states to offer a Real Home to elders who need skilled care. The Cottages of Lake St. Louis, located in the western suburbs of St. Louis, opened the first of six cottages in January 2017. Now, residents of the “Show-Me” state will get to see firsthand what skilled nursing looks like when its designed — from the inside out — to be a home.
Al Beamer, CEO of the Cottages of Lake St. Louis, says people are struck by how different the community is from a traditional nursing home before they even step inside.
“When people think about nursing homes, they expect to see a large facility designed to house hundreds of residents,” says Beamer. Instead, the Cottages of Lake St. Louis is six cottages built alongside one another on a residential street. Each cottage is a stand-alone home that houses only 10 elders. “What surprises them most is that Green House homes are truly homes,” continues Beamer. “We are very deliberate in saying each cottage is a home — not ‘like a home.’”
This means no medicine carts rattling down long hallways, no big lights flashing above residents’ rooms, no large institutional kitchens and dining areas. In a word, the Cottages are “cozy.” Each elder has a private bed and bath. This supports their dignity and privacy — but privacy does not mean isolation.
Relationships are at the core of Green House communities. “There’s one big kitchen table in each cottage, so everyone eats together,” says Christie Tutschulte, vice president of care management for the Cottages of Lake St. Louis. This encourages the natural social interactions that happen around a family table. The elders in each cottage decide what they want to eat, and they see their meals prepared in an open kitchen so they can enjoy the smells and sounds of a busy kitchen.
The focus on relationships extends to those between the staff and the elders. A small, self-managed team of educated, universal caregivers is dedicated to caring for the elders in each cottage. Because this team works in only one cottage, they get to know their elders on a personal level. This helps them see health changes and reasons for concern much sooner than in a traditional nursing home, allowing for earlier interventions and better health outcomes.
In many ways, each cottage is its own little family — and this is exactly how this family owned and operated business wants it.
Al Beamer and his wife, Kathy, are the CEO and chief financial officer, respectively. Their daughter, Christie, is vice president of care management, and son, Matt, is vice president of operations.
Christie, who graduated with a master’s in Gerontology, says living in the community makes opening the Cottages of Lake St. Louis personal for her and her family, “Our kids go to school here, we go to church here, we have built our home and our lives here — and we really want to make a difference in our community.”
Family is so important to the business that five of the six cottages are named after the Beamer’s grandchildren: Ava, Ella, Grace, Harper and Kris.
“When it came to naming the cottages, my husband, Al, and I hit upon an idea that we feel really speaks to the ideals that we are trying to provide for our elders and our family,” Kathy explains. “We believe that it is important to build relationships across the generations, and to value the gifts within each of us. In this spirit, we chose to name each cottage after one of our five grandchildren and the sixth cottage to honor the late mother of our director of development.”
As with all Green House communities, you won’t find any of the institutional markers of a traditional nursing home in the Cottages of Lake St. Louis — yet they still meet all state regulations for skilled nursing facilities. In fact, the Cottages provide a much better nurse to elder ratio. While state regulations require skilled nursing facilities to provide 208 nurse hours per 60 elders per week, the Cottages of Lake St. Louis will provide more than 500 nurse hours per 60 elders per week.
The Cottages of Lake St. Louis are opening gradually. The first two of the six cottages have opened, and the remaining four will open by the end of March. This staggered opening is intentional, says Christie, “We are so excited to welcome our first elders, but we want to do it right and get to know each person.”
To learn more about the Cottages of Lake St. Louis, visit www.cottageslsl.com or call 636-614-3510.
By Lori Gonzalez / Posted on December 12th, 2016
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, Florida. 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.
By Rachel Scher McLean / Posted on October 27th, 2016
Saint Elizabeth Community in Greenwich, RI broke a 20 year moratorium on new nursing home beds with their development of 4 Green House homes that will provide both long term care and short term rehabilitation. Learn more about their project and progress in this news report.
By Kathy Beamer / Posted on August 19th, 2016
Our family strives to to do meaningful things together and our decision to open Missouri’s first Green House homes, Cottages of Lake St Louis, has been the ultimate endeavor in camaraderie. These six, skilled nursing homes of 10 elders each, will be built on a beautiful site in suburban St Louis. When it came to naming the cottages, my husband, Al, and I hit upon an idea that we feel, really speaks to the ideals that we are trying to provide for our elders and our family.
We believe that it is important to build relationships across the generations, and to value the gifts within each of us. In this spirit, we chose to name each cottage after one of our five grandchildren and the 6th cottage to honor the late mother of our Director of Development, and long time team member. I brought paint samples to them and had each choose their favorite color and had signage made up for the cottage porches proclaiming the names. At the groundbreaking ceremony in July, we surprised the grandchildren as we unveiled the cottage names. They were thrilled, and to further include them, we will paint the front door of “their” cottage using the color that they chose! We expect them to be involved regularly in the activity of their cottage and will be well known to their elders and families.
Cottages of Lake St Louis is a place for OUR family and for ELDERS. We are so proud to have been able to move forward on such a wonderful project with:
- Ava’s Cottage
- Ella’s Cottage
- Grace’s Cottage
- Harper’s Cottage
- Kris’s Cottage
- Betty’s Cottage
By David and Twylah Haun / Posted on July 26th, 2016
The Woodlands at John Knox Village in Pompano Beach, Florida is the first Green House project to be initiated by the residents themselves. My wife, Twylah and I, live at John Knox Village and were instrumental in bringing this model to our community. When the organization began discussing plans to build a new nursing home, the residents had a simple request; we wanted private rooms with private baths. However, as we researched more, we discovered The Green House model, and realized that privacy was only the beginning.
Twylah immediately got excited about the concept. I was not as convinced. I questioned if the program was financially wise, and if our village could afford it. I had doubts as to the quality and efficiency of preparing meals in each home, and how worthwhile it would be for us to pay outside Green House “experts” who might dictate plans and organizational structures not appropriate for John Knox Village.
In 2011, I suggested that Twylah and I visit some existing Green House homes. I felt it unfair for me to reject the concept in ignorance, so we arranged our summer vacation to include requests to visit Green House homes across the country.
Our trip’s first visit was to Buckner Westminster Place, in Longview, Texas. I remember when we entered the home, thinking, “Wow, this doesn’t look like a nursing facility at all!” Visiting with their leadership and hearing of their success began to alter some of my concerns.
Continuing our trip, we drove to Magnolia, Arkansas, where we were welcomed at The Green House Cottages of Wentworth Place. Twylah’s enthusiasm grew, and after conversations with leadership and administration, I began to consider “why would we want to re-invent the wheel, this seems to be a proven model.”
Both of us were impressed by the testimonials of Shahbazim (versatile workers who serve as care staff) and Guides, who raved about the quality of care they were able to provide in this new model, “I never would want to work in a traditional style again” seemed to be a recurring theme.
By our fourth visit to The Green House Homes at Traceway in Tupelo, Mississippi, I found my concerns regarding the cost, the food, and the organization had been resolved. The value of working with The Green House Project was clear and we were certain that we could trust them to guide through this transformation.
All of our research paid off. We could adopt the proven elements and core values of The Green House model and still create homes that would reflect the culture of Florida and John Knox Village. John Knox leadership agreed and decided to become a trademarked Green House organization. In every way, we has benefited from working with The Green House Project on this quest. Their training and guidance is unsurpassed. After much hard work, the organization opened 12 Green House homes of 12 elders each, in a seven story building on May 26th, 2016.
As the first Green House nursing home in Florida, we hope that we are establishing a trend in the state toward person-centered care. How grateful we are to live at John Knox Village, an organization that really listens to its residents, and ensures that, as our needs change, we will receive top notch care in a wonderful home.
To learn more about The Woodlands at John Knox Village, we invite you to visit the web at http://www.woodlandsjkv.com
By Admin / Posted on July 22nd, 2016
Oregon became the 30th state to open Green House homes as Cedar Sinai Park celebrated the grand opening of their first long term care homes. “The Green House project creates an environment that doesn’t just feel like home – it IS
their home,” says Cedar Sinai Park, CEO, Sandra Simon. “It is built on the premise that each resident should be able to make the decisions that shape how they live each precious day. The Green House model is a natural progression of our philosophy at Cedar Sinai Park to treat everybody with love, honor and respect. This is the future of aging services, and we are proud to create the first Green House home in Oregon.”
The Green House Project has spent over a decade creating its new vision for the future of elder care and research shows, they have potential to deliver better outcomes than
traditional nursing homes.
Simon continues, “Green House homes combine the best of a real home setting with skilled care, giving elders the freedom to live life on their terms rather than conform to the rhythms of the institution.” The model is built on core values that include:
- Meaningful life focused on personal choices,
- Consistent, compassionate, highly trained and empowered staff
- Advanced, research driven medical services in a real
Senior Director, Susan Ryan commended the organization, “It says something when a community can be a part of a radical transformation like The Green House model. It says, that we are progressive, and we are creating an age friendly society.”
To learn more about Cedar Sinai Park, visit their website: http://cedarsinaipark.org/dignity-by-design/
By Admin / 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.
By Admin / Posted on July 16th, 2015
Ceder Sinai Park (CSP) is happy to announce it will be breaking ground on a $33 million construction project focused on renovation of the Robison Jewish Health Center and its transformation into a 44-bed post-acute rehabilitation center. The project will also include the construction of two additional buildings with four homes in THE GREEN HOUSE® model – providing 12 beds each (48 total) for an improved model of long-term care.
“We commend Cedar Sinai Park for their vision to further their mission by implementing The Green House model, and their commitment to transform long term care in Oregon” said Susan Frazier, Senior Director, The Green House Project.
CSP is committed to helping people stay at home as long as possible or maintain lower levels of care and is moving forward with this project in response to community needs for post-hospital sub-acute care rehabilitation services to facilitate returning home after a medical event such as a hip replacement or surgery.
Four new homes will be part of the Harold Schnitzer Health & Rehabilitation Care Center, focused on providing state-of-the-art long-term care in the model of Green House homes across the country. These homes will emphasize quality-of-life; person-directed care which results in improved healthcare outcomes for residents who can no longer remain at home due to conditions such as Parkinson’s, Alzheimer’s and Multiple Sclerosis.
On Wednesday, July 15th, we will officially break ground on the new center. The groundbreaking will take place at 4:00 p.m. on the corner of SW 62nd Avenue and Boundary Street, and will include remarks from CSP and community leaders.
“We are pleased to see this dynamic construction project begin. It is important to Cedar Sinai Park and the entire community that we develop a 21st century service capacity that is both beautiful and able to meet changing healthcare demands,” said Jim Winkler, Capital Campaign Chair.
“Cedar Sinai Park is proud to be working with LRS Architects and R&H Construction on this project” according to David Fuks, CSP Chief Executive Officer. “These two firms represent the highest quality teams and we are glad to be teaming with them on this very important work.”
The Green House Project is a radically new, national model for skilled-nursing care that returns control, dignity and a sense of well-being to elders, their families and direct care staff. In the Green House model, residents receive care in small, self-contained homes organized to deliver individualized care, meaningful relationships and better direct care jobs through a self-managed team of direct care staff working in cross-trained roles. Green House homes meet all state and federal regulatory and reimbursement criteria for skilled-nursing facilities.
About Cedar Sinai Park: Cedar Sinai Park provides residential and community-based care to elders and adults with special needs, allowing them to live with comfort, independence, and dignity in a manner and in an environment based on Jewish values. A nonprofit organization, we are committed to delivering a broad-based continuum of care that can be tailored to individuals’ unique needs. Our services include independent and assisted living (Rose Schnitzer Manor), nursing home care (Robison Jewish Health Center), daily respite care (Adult Day Services), affordable housing for seniors and people with disabilities (Rose Schnitzer Tower, Lexington Apartments, Park Tower Apartments, The 1200 Building), in-home care (Sinai In-Home Care), a collaboration with Jewish Family & Child Service), and affordable housing for developmentally disabled adults (Kehillah).
By Laura Vonch / Posted on March 10th, 2015
The Gardens – The First Green House skilled nursing homes in Minnesota
Sophie Canelake resides at Episcopal Homes of Minnesota on the third floor of The Gardens, which is a Green House home. A Green House home is an intentional community for 10 elders, that provides skilled nursing care. She adores her room, because the quaint corner location provides a wonderful view of the outdoors, and easy access to the rest of her home. At 91 years old, Sophie truly appreciates her new home, and the life she lives here!
Sophie is originally from Wisconsin, and spent most of her life in northern Minnesota. Sophie’s daughter resides in Minneapolis and this move enables her to visit frequently during each week. “The convenience of living in close proximity to my family is extremely important,” explained Sophie. Sophie and her family felt it was in her best interest to be in a community with the greatest level of care. A family friend of Sophie, who is an expert in senior care housing, highly recommended The Gardens – Nursing Home for the undeniably welcoming staff and respectable reputation Episcopal Homes has been providing for over 100 years.
She has her own independent bathroom and bedroom to decorate. “I love rearranging furniture and adding decorative touches as I see fit,” said Sophie. She has two large windows in her suite that bring in a plethora of sunshine every day. Her room is cozy, but there is also enough space to host family and friends. The important thing is that at The Garden’s, Sophie has a sense of belonging, and ownership of the space. This is her home.
“The transition into The Gardens was very smooth and staff has been supportive” said Sophie. Sophie expressed her transition was stress free because of the welcoming staff. She didn’t know what to expect when moving into her new home, but her favorite part of moving in was the comfort and homey feel The Gardens provides.
At Episcopal Homes of Minnesota, The Gardens community is a part of the national Green House Project. The Green House model is created to foster a feeling of home and comfort for elders. The trailblazing model supports meaningful lives for elders, empowered staff and a real home. With a goal to eliminate loneliness, helplessness and boredom from the lives of elders, The Gardens will create lives worth living through relationship based care.
Episcopal Homes of Minnesota: Despite Harsh Winter, Major Construction Progress has Occurred for Six Green House Homes
By Mary Hopfner-Thomas / Posted on March 25th, 2014
While we are all anxiously waiting for spring to truly arrive this year, none could be wishing for that more than the construction workers on the project for the Episcopal Homes of Minnesota! Warmer weather and fewer snow storms will be welcomed with open arms! Despite the tough winter season, major progress has been made on the $45 million dollar project.
Midway Village will provide a variety of living options for Elders including skilled nursing services in The Green House homes. Ten Elders will live in each of the six homes which is being called “Episcopal Church Home – The Gardens”. Not only will Elders enjoy their own bedroom, bath, home cooking, a hearth and balcony or terrace…they will also be able to enjoy the laughter of children each day. A day care center will be part of Midway Village. It’s something the organization has wanted to do for years, but they never had the space to provide the services. The center will be available to staff and neighborhood infants and toddlers. A truly wonderful inter-generational experience for all!
Another important aspect to the project includes light rail service that will pass right in front of the project…making transportation more convenient for Elders, staff and families.