The First Green House Homes Turn 15 Years Old

By / Posted on May 14th, 2018

“For thousands of years, elders have been held in high esteem and involved in the community,” says Steve McAlilly, CEO of Mississippi Methodist Senior Services. As the world shifted and the role of elders changed, Steve sought a way to bring them back to a place of reverence and respect. 15 years ago, Steve courageously opened the first Green House home in Tupelo, MS, effectively building a home where elders could live full and meaningful lives, “Within hours of moving in, a peace came over the home,” Steve remarks.

Not only do these homes positively effect the elders who live in them, but also the direct care staff who take on expanded roles to become the managers of the home. The skills that they learn in The Green House homes affect every area of their lives, “I’ve watched team members grow and thrive in the Green House” says Michele Daniel, VP of Philanthropy & Strategic Implementation. Mississippi Methodist Senior Services currently has 19 Green House homes on four separate campuses.

Returning the elders to a place of esteem, honor and respect is an investment in the quality of life of the entire community.

This 15 year milestone began with the vision of Dr. Bill Thomas and was embraced by Steve McAlilly’s leadership.  Thanks to the support of The Robert Wood Johnson Foundation, this radically simple innovation has become a proven movement that continues to grow with integrity and sustainability. Now with Green House homes open and operating in 33 states, small house nursing homes are a trend addressing many of the challenges in healthcare. The Green House model is demonstrating that the status quo is not good enough and that there is a better way. Thank you to Mississippi Methodist Senior Services, and all of The Green House partners who have opened their doors in the past 15 years. Together we are fostering environments of empowerment, dignity and respect, and a world where every individual can anticipate a hopeful future


The GREEN HOUSE Project Showcased in #ElderCareChat Discussion on Innovations in Senior Care

By / Posted on April 30th, 2018

#ElderCareChat recap - OurParents.comThe GREEN HOUSE Project was pleased to join the April 25 #ElderCareChat, with Director of Operations Debbie Wiegand serving as an expert panelist. Wiegand engaged participants in an informative Twitter conversation about innovations in senior care while also describing how The GREEN HOUSE Project has come to be recognized as the leader in creating high-quality, cost-effective, and sustainable, human-scale alternatives to the traditional nursing home.

The hour-long #ElderCareChat put the need for innovative solutions in context, with Wiegand explaining how an aging population is driving the need for more senior care options. The topic was inspired by a recent blog post that discussed how the Green House model has become a catalyst for change in the field of long-term care. The model’s emphasis on creating a “real home” environment, with a look and feel that is residential rather than institutional, has gained considerable attention in the skilled nursing care space.

The Twitter session, which generated more than 3.4 million impressions and nearly 400 tweets, gave the 25 participants the opportunity to share their thoughts on a variety of topics, including what they perceived to be the major trends in senior care. One participant identified a movement toward more person-centered care. Another mentioned the need for a social/cultural change with regard to how we look at aging. In addition, several participants cited technology as having an increasing impact on senior care solutions.

In conjunction with an aging population, Wiegand sees an increasing demand for more innovative memory care solutions. “Correlated with the increasing number of elders is the prevalence of Alzheimer’s disease, and the need for high-quality models that focus on the whole person, rather than the traditional biomedical model that focuses primarily on decline and disease,” Wiegand tweeted, adding that a Green House program called “Best Life” was created to equipment caregivers with the knowledge and skills needed to help elders living with dementia thrive.

Wiegand also stressed the importance of frontline professionals building meaningful relationships with elders and their families. “Changing demographics exacerbate staffing challenges in nursing homes,” she observed. “Without the availability of quality jobs that offer expanded roles and opportunities for growth, the long-term care industry is at great risk for worker shortages.”

The chat also included a discussion of the advantages of smaller, more residential living spaces for elders. Wiegand explained that Green House homes are designed to create warmth and foster “intentional community.” “Smaller is better,” she tweeted, “meaning less square footage, which helps to support elder mobility, familiarity and access to all spaces of home, and reduce costs of construction.”

A chat participant observed that smaller, more intimate environments allow for better relationships with caregivers, tweeting, “The social, family atmosphere of residential living spaces eliminates the institutional stigma that is often associated with eldercare.”

Participants were highly receptive to innovative solutions being introduced to the long-term care space. As one senior care professional tweeted, “The day we stop innovating is the day we need to find a new job!”

“The GREEN HOUSE Project is all about relationships and deep knowing,” Wiegand concluded. “We embrace technology, but never at the expense of the human touch and connection.”

For those wanting to learn more, the GREEN HOUSE Project will host a webinar on workforce issues at 1 p.m. ET May 3. Register now.

In addition, The GREEN HOUSE Project is presenting opportunities to visit Green House homes and take a deep dive into the model at the following locations:

Feel free to peruse the transcript of the 4/25/18 #ElderCareChat session.

#ElderCareChat is presented by A Place for Mom‘s OurParents.com in conjunction with sister sites SeniorAdvisor.com and VeteranAid.org as a forum to share resources, experiences, and expertise in eldercare. Stay tuned to @OurParents Twitter handle for information regarding the next #ElderCareChat.


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


Engage a Diverse Workforce to Increase Success

By / Posted on February 21st, 2018

James Wright, nationally recognized diversity and inclusion strategist, and 2017 keynote speaker at The Green House Annual Meeting, shares some wise words for effectively engaging a diverse workforce.


Person-Directed Lives Exemplified Through Interviews

By / Posted on January 16th, 2018

Lori Gonzalez, is a researcher with Claude Pepper Center at Florida State University. She wrote an Op-ed for a Tampa Bay newspaper about the need for Green House homes in the state, and the national initiative reached out to discuss further collaboration. Recently, The Claude Pepper Center had the opportunity to capture interviews at The Woodlands in John Knox Village, and highlight the words of the people living this model everyday.  Check them out here:


Register Today for The Distinguished Speaker Webinar Series and OnSite Workshops

By / Posted on December 22nd, 2017

Register Today for The Distinguished Speaker Webinar Series and OnSite Workshops
  • Cultural Transformation Through Green House, January 9 (3:00p ET). Join Green House Senior Director, Susan Ryan to hear an Overview of The Green House model as you’ve never heard it before! THE GREEN HOUSE believes that all elders deserve to grow and thrive no matter where they reside, and that to impact lives in a meaningful way, it takes more than environmental change. To make meaningful change a reality, it is imperative to infuse the entire organization with optimal systems and structural changes that create a cohesive approach to elder-directed care.  Register>>
  • Innovations and Trends in Elder Care, February 1 (3:00p ET). Lisa McCracken, Director of Senior Living Finance Research and Development with Ziegler will provide an overview of the key trends and innovations in Elder Care. This is the opening session of our Business Case series which will shed light on how The Green House model is a viable solution amidst the backdrop of a dynamic economy and healthcare climate.Register>>
  • Improving Long Term Care Workforce With Strategies that Work, February 22 (3:00p ET). Robyn Stone, Senior Vice President of Research, LeadingAge, will provide an overview of the demographics, trends and challenges of the workforce in Elder Care. This is the opening session of our Workforce series. which will identify practices within The Green House model that create the potential for successful workforce development. Register>>
  • Living with Dementia: New Perspectives, March 22 (3:00p ET). Dr. Al Power, author of Dementia Beyond Drugs and Dementia Beyond Disease, will look at the experience of dementia through the frame of well-being, and explore how this perspective is challenged, both by brain changes, our attitudes, and care systems. Register>>


"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.


Power Belongs with The Elder and Those Working Close to Them

By / Posted on August 4th, 2014

New research from The Journal of Applied Gerontology showed that involving Nursing Assistants in decision making has a positive effect on quality of service. From my experience with person-centered care, I can tell you that the research rings true. The Nursing Assistant is the person who works closest with the Elder, day in and day out, and gets to know them best. These staff members know Elders as individuals, rather than just a diagnosis, and when they are empowered to make decisions based on this intimate knowledge, both Elders and staff benefit.

We do a role play exercise during Green House education where we act out a Care Plan meeting. In the first round, the Care Plan meeting is handled as it would be in a traditional setting, with only the clinical staff involved in the conversation. In the second round, we include the Nursing Assistant, Elder, Family Member and Housekeeper. The reaction to this exercise is always astonishment, as participants realize how much important information is missing when all stakeholders are not represented. As the research states, “When nursing staff had the autonomy to make decisions, there was a higher relationship to service quality. The empowerment of nursing assistants had an even greater effect than empowerment of nurses…”

In The Green House model, the power shifts to the Elder and those working closest to them. Power means having the resources and authority to make and execute a decision. This creates a deep-knowing environment where the Elder’s natural rhythm and preferences are honored. Quality is also impacted because of this familiarity. Staff members notice the small things about the Elder’s well-being, that can lead to early detection of illness and acuity changes. When staff members are empowered to meet the needs of the elder, they feel ownership and valued in their job and Elders feel safe and content, because they are known. Ask yourself, “What is best for the Elder?”, when this question is central, it is clear that those who know them well must be involved with decision making.


Empowered Staff Video: Celebrating 10 years of The Green House Project

By / Posted on June 24th, 2013

In The Green House model, the core value that contributes most significantly to a deep and sustainable transformation is “Empowered Staff”. The hierarchy of the organization is flattened to bring power into the home, with the elders and those working closest to them. This group of direct care staff, who have a base education as  Certified Nursing Assistants and then receive 128 hours of additional training, become Shahbazim, an honored and valued group who work in self managed work teams to protect, sustain and nurture the elders. The self managed work team reports to a Guide, and partners with a Clinical Support Team to provide individualized and holistic care with the elders. The Green House Project provides over 200 hours of education across the organization to develop coaching leaders in an environment where Elder’s Rule!

Check out this video to highlight how the Core Value of Empowered Staff!


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

By / Posted on March 11th, 2013

One of the subjects that have befuddled Long Term Care leaders over the years is worker motivation. One of the foremost researchers in this field is Frederick Herzberg, an industrial psychologist. It is Herzberg’s work on motivation and job enrichment that strikes at the heart of the success of self-direction concepts that are so foundational to The Green House model.

In the 1960’s, Herzberg proposed that a person’s needs break down into two categories: hygiene factors and motivational factors.
Hygiene factors relate to what makes us work and our biological needs, such as providing food, clothing, and shelter. Herzberg says we have a build-in drive to avoid pain relative to these needs, so we do what is necessary, such as work, to provide what we need.

Motivator factors, however, are very different. These factors include those specific items related to what makes us work well such as achievement, and through achievement, the ability to experience psychological growth.
Herzberg used the term job enrichment to describe how the motivator factors can be used to achieve higher levels of satisfaction with a job. The following list was taken from his Harvard Business Review article of 1968 (reprinted in 1987) entitled, One More Time…How Do You Motivate Employees? Take particular note of how closely these factors align with concepts embodied in radical workforce redesign with The Green House model.

Herzberg said that meaningful job enrichment involves the following:
1. Removing controls while retaining accountability.
2. Increasing the accountability of individuals for their work.
3. Giving a person a complete natural unit of work.
4. Granting additional authority to employees in their activity such as job freedom.
5. Making data and reports directly available to the workers themselves rather than just to supervisors.
6. Introducing education programs designed to enrich critical thinking skills.
7. Assigning individuals specific assignments or specialized tasks, enabling them to become experts.

It is surprising to think that Herzberg first discussed these concepts in the 1960’s, but that we are now just beginning to incorporate them through innovative models. In the elder care field, we have a mountain of research that supports the link between frontline caregivers involvement and improved clinical outcomes of care and quality of life. Organizational changes that support self-direction will continue to grow because it makes sense to leaders desperately searching for ways to increase responsibilities of frontline staff as well as the elders’ perception of feeling valued and respected. The Green House model’s systematic approach to workforce redesign and the creation of the Shahbazim, combined with radical environmental redesign, help ensure that the institutional, hierarchical model can’t slip back in.

The empowered Shahbazim that you find within the Green House homes nationwide helps to explain why 83% of Green House projects are ranked as either 4 or 5 Star homes on the CMS Nursing Home Compare website. The Green House model supports the relational coordination among the Shahbaz and the nurses and other staff. The theory of relational coordination states that the effectiveness of care and service is determined by the quality of communication among staff. The quality of staff’s communication depends on their relationships with each other. This theory is highly applicable in healthcare settings where tasks employees perform are closely interrelated. Their interdependence forces the staff to work with one another. But if their relationships and communication are weak, and institutional hierarchies minimize the voice of the elders and their caregivers, then elders’ needs tend to fall through the cracks.

The Green House model develops people’s communication and critical thinking skills so they know what to share and why it’s important. And the redesigned work environment supports good communication creating both a culture of safety and a meaningful life for the elders. Systems and redesigned roles that support relational coordination among staff are the key to the successful outcomes achieved by Green House projects.

Forty-five years ago, Herzberg was spot on. And he still is.


The Green House Workforce Model

By / Posted on October 26th, 2011

Betsy Mullen is the Guide at Leonard Florence Center for Living

Members of the newly opened Leonard Florence Center for Living in Chelsea, Mass. — the nation’s first urban Green House Project — joined the Green House team for a panel discussion at the 2011 LeadingAge conference in Washington, D.C., Oct. 17.

The topic of the discussion was the innovative workforce model pioneered by the Green House. In Green House homes, the focus of staffing is shifted away from administrative roles towards direct care of elders. Each Green House Project has a clinical support team, which includes nurses, therapists, social services, activities, and dietary professionals, working in partnership with the Shahbazim (universal workers who replace traditional CNA’s) to develop and implement individualized care plans for the elders. (more…)