Green House Blog

Where Love Matters, 10 minute Green House Overview Video

What would you need if you had to move into a nursing home tomorrow? Some people would say, ‘my coffee in the morning!’, some would say, “access to the outdoors’, some would say, ‘I need people to know me’. The Green House Project is a radically new, national model for skilled nursing care that returns control and a sense of well being to elders, their families and direct care staff.

Continue reading “Where Love Matters, 10 minute Green House Overview Video”

Illiana System Dedicates First Green House Homes for Veterans Next Week

The Illiana System is the first VA in the country and the first agency in Illinois to adopt The Green House Project. The first two homes are almost done, and will be dedicated next week, “From the day they poured the foundation, it was exciting,” Green House Guide, Cyd Mason said. “It’s a very exciting time for all of us here at Illiana.” Continue reading “Illiana System Dedicates First Green House Homes for Veterans Next Week”

Research Update and Map of Green House Projects

Download this one page overview of the latest research findings of The Green House Project, as well as an up to date map of where there are projects open or in development. 

Improved quality of life: Green House elders reported improvement in
seven domains of quality of life (privacy, dignity, meaningful activity,
relationship, autonomy, food enjoyment and individuality) and
emotional well-being.
Improved quality of care: Green House elders maintained self-care
abilities longer with fewer experiencing decline in late-loss Activities
of Daily Living. Fewer Green House elders experienced depression,
being bedfast and having little or no activity.
Improved family satisfaction: Green House families were more
satisfied with general amenities, meals, housekeeping, physical
environment, privacy, autonomy and health care.
Improved staff satisfaction: Green House staff reported higher job
satisfaction and increased likelihood of remaining in their jobs.
Green House homes relative to nursing home comparison sites3
Higher direct care time: 23–31 minutes more per resident per day
in staff time spent on direct care activities in Green House homes
without increasing overall staff time.
Increased engagement with elders: More than a four-fold increase in
staff time spent engaging with elders (outside of direct care activities)
in Green House settings.
Less stress: Direct care staff in Green House homes reported less jobrelated
stress.
Improved care outcome: Fewer in-house acquired pressure ulcers in
Green House homes.
Green House homes versus traditional and other culture change
nursing home costs4
Cost neutral operations: Green House homes operate at the same
median cost as the national nursing home median cost.
Lower capital costs: Green House homes provide private bedrooms
and baths and enhanced common space while building the same or
fewer square feet than other current culture change nursing home
models. Lower square foot costs lead to lower capital costs.
Role of direct-care workers5
Comparable quality: Removal of formal nurse supervision of direct
care workers did not compromise care quality.
Timely intervention: High level of direct care worker familiarity
with elders led to very early identification of changes in condition,
facilitating timely intervention.
1 Kane R, Cutler L, et al. “Resident Outcomes in Small-House Nursing Homes: A Longitudinal Evaluation of the Initial Green House Program,” Journal of the American Geriatric Society

Evaluating The Green House Model

Notes from Meeting with Stephen Hammil, 10/11/2011

hi Team– We had a great inservice with Stephen yesterday and learned a lot of good information to utilize our online resources to their max! One of the most exciting things, is that we can create pages (the bucket) and posts (stuff to fill the bucket) through our website, that can be accessed by a URL, but is not visible to the public. This has great implications for The Peer Network, Project Workspaces, sharing resources and Team Collaboration!

Twitter: goal of 10 tweets/day– the main purpose of twitter is to link people to our website. So we will 1) tweet links to our blogs (say if it is a video or photo, because people like that) 2) retweet interesting headlines by following our key words (alternative nursing, culture change, etc) 3) conversational tweets, like if you are at a conference and want to amplify quotes from a session, or to direct people back to a facebook post. username: Greenhouse_Proj , password: greenhouseproject11

Facebook: we have great engagement, which means that people “like” and “comment” on things that are posted. It isn’t enough to have a lot of fans, we need people to be engaged in order for our posts to show up on their newsfeed. username: rscher@ncb.coop , password: engagement2010

Google Analytics: we will collect data from this site monthly to determine the impact of our online resources/communication, and the strength of our digital audience. username: greenhouse@awsystems.com , password: greenhouseproject09

Editorial Calendar : click here and add this link to your “favorites” we will use this template for adding in ideas for blog posts that come up during the month, they might be cool articles, highlights from a project, or an upcoming event. You don’t have to be the one who is going to write the post, but this is a central way to keep track of all of the newsworthy stuff that should be amplified to our target audience. This will also be where our google analytics reports are stored and tracked.

Doug Pace, "It is like any small town street in America"

Doug Pace, Executive Director of the National Commission for Quality Long-Term Care, visited the Green House Project home in Green Hill, New Jersey, and commented on what makes homes like it so special. He is struck by the fact that it feels like any small town street in America– this place where people can live their lives the way that they want to live. By investing in research, The Green House Project is able to show that this model is financially viable and fits within regulatory guidelines.

Doug Pace, “It is like any small town street in America”

Doug Pace, Executive Director of the National Commission for Quality Long-Term Care, visited the Green House Project home in Green Hill, New Jersey, and commented on what makes homes like it so special. He is struck by the fact that it feels like any small town street in America– this place where people can live their lives the way that they want to live. By investing in research, The Green House Project is able to show that this model is financially viable and fits within regulatory guidelines.

Doug Struyk, Green House Homes Shape the Future of Aging Services

Doug Struyk, President and CEO of the Christian Health Care Center and LeadingAge representative, reflects on his visit to The Green House homes during the 100th Home Celebration. He notes that The Green House home represents normal, everyday living where people just enjoy each other’s company. He sees this model as an effective way to provide high quality care with limited resources, which could impact policy initiatives, and aging services of the future.

The Research Initiative Valuing Eldercare, Launched


The Green House Project has partnered with THRIVE (The Research Initiative Valuing Eldercare) to learn more about the Green House model as well as other models of care. The THRIVE team is launching a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes. This effort is funded by the Robert Wood Johnson Foundation.
The THRIVE researchers represent leading research institutions and long-term care organizations around the country, including Harvard University, the University of Wisconsin-Madison, Health Management Strategies, Institute for Clinical Outcomes Research, Pioneer Network, and the University of North Carolina at Chapel Hill. Many of the THRIVE team members have previously researched the Green House model, and in part, these previous studies – and the questions left unanswered – provided impetus for the current project.
For example, in a comprehensive review of the research literature, THRIVE team members Sheryl Zimmerman and Lauren Cohen found strong support for certain components of the Green House home model, such as that private rooms and bathrooms and communal dining are related to positive outcomes. However, these researchers also found that very little research has been done around the concept of normalized engagement, and therefore there is no evidence to show that this type of engagement relates to better care or outcomes.
Other THRIVE team members, including Siobhan Sharkey, Sandy Hudak, and Susan Horn, found in their earlier studies of work flow that Green House elders receive more direct care time per day than do similar residents in traditional nursing homes. They also found that Shahbaz spend about 20 minutes more per day with elders than do CNAs in traditional homes. In their work on elder outcomes, they also found that elders living in Green House homes maintained their ability to perform activities of daily living such as dressing and eating, to a greater extent than residents living in traditional nursing homes. These findings suggest further exploration into what structures and processes are associated with better outcomes, such as less decline in activities of daily living or fewer falls.
Earlier work by Barbara Bowers and Kimberly Nolet provided important insights into the role of the nurse and how it differs across Green House homes; they found, for example, that there are differences across homes in how the Green House model is implemented. In particular, there are important differences in how Shahbazim and nurses relate to one another and the degree to which they collaborate or work separately. Although this study demonstrated that the choice of model had meaningful consequences for both staff and elders, it did not determine what had led some homes to use one model over another.
It is these unanswered questions – plus many more related to staffing, care provision, clinical outcomes, and costs – that the THRIVE collaborative intends to address. The THRIVE project will be taking place through 2013, and during that time, members of the team will be contacting Green House homes to complete interviews, request records, and schedule visits. In addition to providing homes the opportunity to inform these matters and influence the direction of nursing home care, participating homes will also receive confidential feedback about their organization.
We are excited to be able to learn more about the Green House model, and look forward to working together.

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

Two New Green House Stories From St. John's Living

ChangingAging Blogstream

By Dr. Al Power

Everyone who is building Green Houses® is delighted by the stories their predecessors tell about people rediscovering old capabilities in the new living environment. But we all hope to see it for ourselves with our own elders.

At St. John’s new Green Houses, we haven’t even opened yet, but we have already seen our first such example of the power of this model.

Last week, as the staff were undergoing in-house culinary training, they invited one or two elders and their families each day to come by and have lunch. On Wednesday, I was meeting with some design expert friends, and our Guide, Rebecca Priest, invited us to come out and join Don and his family for lunch.

Don, formerly of MIT, now lives with moderately advanced dementia. At the nursing home, he needs the fairly heavy assistance of two staff members to move from one chair to another. As such, he came out to the Green House in a wheelchair van and after a tour, he was transferred with a fair amount of effort into a chair at the dining room table.

All of us joined Don and his family for the better part of an hour, enjoying soup, sandwiches and good company.

When the time came to leave, Don’s wheelchair was brought over and he quickly stood, and with minimal help from one staff member, transferred back to his wheelchair. Rebecca said, “Hey Don, what’s the deal? It takes two people to help you transfer at the home!”

Don slowly replied, “Well…I guess I’m supposed to be sick over there.”

A humorous postlude to the story is that later that day, the mattresses arrived. We have broken another barrier by buying a full-sized bed for every elder in the Green Houses. We couldn’t find a single vendor in the country that would make us one, so Rebecca just went to the local mattress store and purchased 10 Tempurpedic-style residential beds for each house.

The doorbell rang, and there was a truck with two puzzled looking men at the door. One said, “We’re supposed to deliver a bunch of mattresses to some nursing home around here.”

He was assured that he was in the right place. As he walked into the living room, his jaw dropped, and he said, “This doesn’t look like any nursing home I’ve ever seen before!”

G. Allen Power, MD is Eden Mentor at St. John’s Home in Rochester, NY, and Clinical Associate Professor of Medicine at the University of Rochester. He is a board certified internist and geriatrician, and is a Fellow of the American College of Physicians / American Society for Internal Medicine.

Two New Green House Stories From St. John’s Living

ChangingAging Blogstream

By Dr. Al Power

Everyone who is building Green Houses® is delighted by the stories their predecessors tell about people rediscovering old capabilities in the new living environment. But we all hope to see it for ourselves with our own elders.

At St. John’s new Green Houses, we haven’t even opened yet, but we have already seen our first such example of the power of this model.

Last week, as the staff were undergoing in-house culinary training, they invited one or two elders and their families each day to come by and have lunch. On Wednesday, I was meeting with some design expert friends, and our Guide, Rebecca Priest, invited us to come out and join Don and his family for lunch.

Don, formerly of MIT, now lives with moderately advanced dementia. At the nursing home, he needs the fairly heavy assistance of two staff members to move from one chair to another. As such, he came out to the Green House in a wheelchair van and after a tour, he was transferred with a fair amount of effort into a chair at the dining room table.

All of us joined Don and his family for the better part of an hour, enjoying soup, sandwiches and good company.

When the time came to leave, Don’s wheelchair was brought over and he quickly stood, and with minimal help from one staff member, transferred back to his wheelchair. Rebecca said, “Hey Don, what’s the deal? It takes two people to help you transfer at the home!”

Don slowly replied, “Well…I guess I’m supposed to be sick over there.”

A humorous postlude to the story is that later that day, the mattresses arrived. We have broken another barrier by buying a full-sized bed for every elder in the Green Houses. We couldn’t find a single vendor in the country that would make us one, so Rebecca just went to the local mattress store and purchased 10 Tempurpedic-style residential beds for each house.

The doorbell rang, and there was a truck with two puzzled looking men at the door. One said, “We’re supposed to deliver a bunch of mattresses to some nursing home around here.”

He was assured that he was in the right place. As he walked into the living room, his jaw dropped, and he said, “This doesn’t look like any nursing home I’ve ever seen before!”

G. Allen Power, MD is Eden Mentor at St. John’s Home in Rochester, NY, and Clinical Associate Professor of Medicine at the University of Rochester. He is a board certified internist and geriatrician, and is a Fellow of the American College of Physicians / American Society for Internal Medicine.

Karen Schoeneman, Technical Director of CMS Division of Nursing Homes, shares impressions of The Green House Model

Karen Schoeneman with the CMS Division of Nursing Homes talks about what separates Green House Project homes from traditional nursing care facilities and what makes the Green House model a viable policy option for the future.

“This is way beyond homelike and goes all the way to home…[traditional]nursing homes are more like bus stations, you can sit by people and not really know them…this makes is easier for the staff to realize what they value is the persons day, not an institutional schedule, once you change that attitude, then anything is possible.”