Green House Blog

The Power of Language in Culture Change

The institutional “dragon”  is too big to swallow in one mouthful. If we really commit to understanding the depth associated with institutional creep (sliding back into medical model practices), it’s important to start small with dragons that are manageable. One such deeply rooted institutional practice includes language; what we say and how we say it makes a significant impact on those with whom we work, and those for whom we hope to create a life worth living. Since words have the power to make or break someone’s day, it’s imperative to explore their impact on transformational success.

The Green House Project is certainly not the first, nor will it be the last, to challenge the language of long-term care. In her article entitled, “Mayday: The Language of Culture Change,” Karen Schoeneman, Deputy Director at Center for Medicare and Medicaid’s Division of Nursing Homes, explored the barriers hidden in words commonly used in nursing homes. “Part of transforming long-term care practice is finding new words to describe staff, programs, parts of the building, and the ‘industry’ itself.” Person-centered language allows us to do just that, as its goal is to acknowledge and respect residents (elders) as individuals. Sometimes, as Karen states, it’s “as simple as reversing common phrases to put the person first and the characteristic second.” In one such example, “a feeder” becomes “someone who needs assistance with dining.”

So, what can you do today in your organization to combat traditional language? First, work as a team to discuss and understand the power of language. There’s magic in synergy, and teamwork produces an overall better result than if each person was working to the same goal individually. Next, continue sharing ideas and tools to help direct conversation. (One decision making tool we embrace is the learning circle, as it provides everyone with an equal voice.) Lastly, ask yourselves questions to really challenge the reasoning behind the words we use. Examples include, but are not limited to, “What do the elders say they want?” and “How does this drive the standard forward?”

Although policy and regulation are often the most referenced barriers to true culture change implementation, one of the real obstructions is closer than we think. I, you, our colleagues – the language each of us uses creates a barricade that separates us from them. Whether it is staff v. elders, leadership v. care givers, or yet another division of people with and without power, we need to sharpen our awareness of what we say and how we say it, or words will continue to separate worlds. And that’s no world where we would choose to be.

This article is based upon a presentation by Melissa Honig, Project Guide, at The Green House Project’s 2009 Annual Meeting and Celebration in Kansas City, Missouri.

Consumer Preference Asserts, Small is Better!

The Green House Project was higlighted in  Senior Housing News, to describe consumer preference for household models of Long Term Care. By exploring the viability of small household models like The Green House Project, there are opportunities to move to this more desirable setting for providing skilled nursing care.

In recent years, there’s been a shift away from the institutional model of care offered at most nursing homes, to a more “resident-centered” one, and some see these new models as great business opportunities

Read the full article here: Long Term Care Preferences Shape “Household” Model

Green House Educator Program Logistics: August 13th-17th

The Green House® Educator Program

Logistics Details

 Cohoes, NY

Monday, August 13– Friday, August 17, 2012



We will begin promptly at 12:00 noon on the 13th and end by 1:00 pm on the 17th.   It is critical that you plan your travel to allow you to participate in the full learning experience.  If you are flying, please plan to arrive at the airport NO LATER THAN 10 a.m. on the 13th and to depart NO EARLIER THAN 3:00 p.m. on the 17th.

Our schedule will vary daily.  An agenda that indicates starting and ending times for each program day is included in your packet of materials. 

Note: This will be an intensive experience, including visits to the Green House homes at different times of day, including early morning and evening, in order to offer you a glimpse of the daily rhythms of elders and staff.  It will be important to your learning experience for you to be fully present and available to participate in all sessions.  You will also have several opportunities to relax and explore the area with your fellow Green House Educators or on your own. We ask you to refrain from planning specific leisure-time activities for your stay that will conflict with the enclosed schedule.


Eddy Village Green

421 Columbia Street
Cohoes, NY 12047-2222
(518) 237-5630

 Hotel information:

There are many reasonably-priced hotel options in the Cohoes area. We have secured a group rate at the following location:

Holiday Inn Express

400 Old Loudon Rd

Latham, NY 12110

(GROUP RATE: $144/night; in order to receive the group rate, call individually and book your room by July 13, 2012)


Travel and planning tips:

  • The closest airport is Albany International. The hotel is approximately 2 miles from the airport and about 7 miles from Eddy Village Green. (We strongly recommend renting a car from the airport, but we are happy to help you explore other options if necessary.)


  • Note that Southwest Airlines flies to Albany and is often the most cost-effective option, depending on your home city.  Southwest does not participate in travel booking sites such as Expedia or Travelocity, so be sure to check for available options and fares if interested.


  • Attire will be business casual.  Since it is often difficult to control meeting room temperature to everyone’s satisfaction, we suggest dressing in layers to allow for your own maximum comfort.


  • Meals: We will provide lunch daily, as well as two group dinners on Monday, August 13th and Thursday, February 16th.  The Holiday Inn Express offers a complimentary breakfast.  Other meals will be on your own.


Directions on Campus
Take a left onto The Eddy Cohoes campus. Follow signs to 300 Village Green Drive/EVG Training Center. Parking is on the left hand side next to 200 Village Green Drive.

Please note that EVG Training Center is located in the basement level, please do not go to the front door of the house, but
follow the signs to 300 Village Green Drive/EVG Training


July 17,2012, 2pm-3pm EST

Educator Program Advanced Webinar 

 Educator Program Logistics Details – August 13th-17th, 2012

Where Love Matters: 18 Minute Video

This video takes you into four open and operating Green House homes around the United States. All of these homes are licensed as skilled nursing facilities, and uphold The Green House principle of creating Real Home: elders are able to remain in The Green House home regardless of their physical, cognitive status, or their ability to pay.

While the best way to understand The Green House model is to visit a home, watching this video, is a great first step. This model transforms long term care by changing the environment, philosophy and organizational structure. To date, the results show, that this radical transformation positively impacts the lives of those who live and work there, and has the potential to change aging as we know it.

The Power of Choice

I was speaking in Ohio earlier this month and had an experience that reinforced an important lesson for me. I was giving a community talk on dementia and a TV reporter came to interview me before the talk. We put on the microphone and launched into a 10-minute conversation on camera. She asked a lot of good questions, and then as my message became clearer to her, she threw me a curveball. Continue reading “The Power of Choice”

Building an Evidence Base for Enjoyable Dining

“All great change in America begins at the dinner table.” -Ronald Reagan

Eating at a dinner table with friends and family is not only the quintessential portrait of Thanksgiving, but also an activity that can promote significant positive change.

In this month’s LeadingAge Magazine, the article, Enjoyable Dining: Can We Build an Evidence Base? , speaks volumes about how creating a dining environment that looks and feels more like home can have a tremendously positive impact on elders- boosting overall morale, without significant cost increases.

“We have had better intake. We’ve reduced the use of supplements. They are eating real food. Our meals are part of a concerted period when the residents are up and active, which then has a positive effect…We have less weight loss, and residents have fewer complaints about food service. They are better nourished, and there’s an increase in family involvement. And it doesn’t add to the cost, because residents are getting what they like. There is less waste.”

The article also highlighted recent research conducted by The Pioneer Network to develop great evidence-based food and dining standards for long-term care facilities. These best-practices contain sections that concentrate on the liberalization and honoring of choice when it comes to diet as related to diabetic and calorie controlled, low sodium, cardiac and altered-consistency diets. The new dining standards of practice can be found here.

Click here to read the full article.

Dr. Bill Thomas Speaks to an organization in England about Culture Change

Dr. Bill Thomas recently spoke to a group in England about the potential to change the way “aging” is viewed in society. Below is a reflection from Sarah McKee, the Chief Operating Officer of the organization who received Dr. Thomas’ wisdom

Sara McKee, Chief Operating Officer, Anchor

Nothing less than a radical transformation of the way we care for older people is needed if we are to meet the challenges of the 21st century. So I’m incredibly excited to be working with Dr Bill Thomas as we focus on creating happy living for older people in England.

With 100 care homes and around 900 retirement housing properties in either ownership or management, Anchor is England’s largest not-for-profit provider of housing and care to older people. We provide services to more than 40,000 customers and we’re thrilled to be working with Dr Thomas as we evolve to meet changing needs, expectations and demographics.

It’s not news that the population is ageing but the scale is truly remarkable. For example, figures released for International Older People’s Day (1 October) by the Office for National Statistics revealed that the number of centenarians in the UK has seen a five-fold increase in the last 30 years. The major contribution to the rising number of centenarians is increased survival between the age of 80 and 100 due to improved medical treatment, housing and living standards, and nutrition during their lifetime.

These changing demographics require a different approach. It was somehow appropriate that Dr Thomas visited the UK to speak at an Anchor conference on 11/01/11, as many colleagues went away feeling that his visit had marked a new start in the way we care for older people. At the event, Dr Thomas spoke to colleagues from Anchor locations across England about The Green House project, which is reinventing care homes in America.

The Green House Project creates small communities for groups of older people and staff to focus on living full and vibrant lives. The model is a radical departure from traditional care homes. It is based around households of seven to 10 older people, supported by a ‘Shahbaz’, a versatile worker who provides a wide range of assistance including personal care, activities, meals and laundry.

Dr Thomas stressed at the event that, while building design played a part in the concept, the important difference from traditional homes was in the way individuals work with the older people. He stressed the importance of building relationships, really understanding older people’s needs and helping them to be meaningfully occupied – playing a full part in the way the home runs.

“Ageing is not primarily about decline,” he told the attendees, stressing that enabling older people to play an important part in the way a home is run helps them remain independent and happy.

At Anchor, we’re doing a great deal of work to ensure we really understand the individual life stories of our customers, so we can provide really person-centred care. But I know that we’re just getting started with the transformation that’s needed. Even Dr Bill, who has decades of experience, still calls himself a “beginner”.

Dr Thomas stressed that regulators in the US had been persuaded of the merits of his approach when they saw the positive outcomes for older people. I’m confident that regulators in the UK will take the same view. And while it had been challenging at first, perseverance had paid off. “All you have to do is keep putting one foot in front of the other and keep learning and growing,” he told attendees.

Attendees then broke into smaller groups to discuss how the approach could apply both in existing Anchor care homes and in new homes that we plan to build.

At Anchor, we are embarking on exciting development plans for new properties across the south of England, as part of our drive to grow the organisation. The properties will be developed by 2015 and we have been seeking sites on which to develop retirement villages, care homes and smaller extra-care properties.

Starting with a blank sheet of paper gives us an exciting opportunity to develop something completely new and we’re doing just that with West Hall, our exciting new development being constructed in Surrey. We are also keen to develop our thinking in our existing care homes and there are small, incremental things that can be implemented today in every care home in the world which would make a real difference to older people.

Dr Thomas has been an inspiration. I’m excited to be working with him, as I know are my colleagues across Anchor. What really resonated for me after his visit is the passion it inspired in our people to change ageing – and deliver new ways of making older people happy.

Leading a Strengths Revolution

Pop quiz: Write down all of your personal strengths and weaknesses. Have a lopsided list? So did participants at this October’s Leading Age Annual Meeting & IAHSA Global Aging Conference in Washington, DC.
Attendees were asked to complete a similar reflection on personal strengths and weaknesses.

A show of hands illustrated that while most of us have little sense of our talents, we have become experts in our flaws and how to repair them. According to Marcus Buckingham, co-author of First, Break All the Rules, our strengths often lie dormant and neglected while our managers, teachers, and parents guide us to become experts in our weaknesses. Select general sessions at Leading Age’s 50th Celebration reminded leaders of this unique perspective: motivating staff to build on their strengths rather than correcting their weaknesses is a successful management strategy to develop and retain people.

The Green House Project was created to do just that – grow people – elders and staff alike. One core philosophical belief is the acknowledgment of good in every person, every organization, and heck, even every policy and procedure. Appreciative Inquiry (AI) is the search for the best of. Unlike a cookbook approach, it’s a view and a process for facilitating positive change. And, like cupcake bakeries, it’s becoming widespread.

Appreciative Inquiry to Foster Change featured Schlegel Villages, a senior living organization with 11 communities in southern Ontario, and their evolution from institutional to social models of living. In partnership with the Research Institute for Aging at the University of Waterloo, their collaborative process examined the best of what exists, a stark contrast to discussions about what doesn’t work. Using the Appreciative Inquiry 4D cycle (discovery, dream, design, and destiny) over the course of two years, residents, families, and Schlegel team members are living their vision of the future.

Has the cynic in you kicked in? Until you do it, there’s no way to discover AI’s practicality. Don’t worry if you don’t have a major change program established. The process begins with a simple question at the end of a meeting: what did we do well?

The Green House model, like Schlegel Villages, mobilizes change through reflection and action. Wherever you are on your journey, involving all stakeholders is one of the most effective culture change initiatives. Appreciative Inquiry reminds us that our focus becomes our reality; we have the power to bring forth the best in people and in our own organizations.

The Peer Network – An Intentional Community of Green House Adopters

Adopters of The Green House model are intrinsically bound by their common commitment to elders, empowering caregivers and creating intentional communities that facilitate growth for all who live and work there. Like any group of professionals, GHP adopters share a need to network, collaborate and celebrate the wonderful work they do with others in their field.

Geographic isolation is one obstacle to personal interaction among Green House adopters. Adopters live and work in communities separated by hundreds and even thousands of miles. Another barrier to relationship building that GHP adopters face is cultural isolation. GHP adopters often experience isolation from their peers in the greater long-term care community because dramatic differences between The Green House model and traditional, institutional models of long-term care are often not widely appreciated.

Despite obstacles such as geographic and cultural isolation, The Green House Project Peer Network is evolving into an increasingly invaluable resource for GHP adopters. Built on the concept that working, sharing and celebrating together turns like-minded individuals into a vibrant community, the Peer Network is successfully circumventing the challenges inherent to geographic and cultural isolation. GHP adopters have embraced a long-term strategic plan that relies on careful management of their time and resources to facilitate opportunities for meaningful collaboration, celebration and relationship building.
The Peer Network will feature committees focused on areas of mutual need and interest such as education and peer support, model integrity, regulation, public policy and development of the next generations of Green House adopters. The Peer Network will work in a close partnership with the Green House Project Initiative staff on a wide array of issues that are crucial to the continued success and growth of The Green House model.

The Peer Network will utilize a blend of social media technology and in-person gatherings to facilitate regular interaction among adopters and members of The Green House Project team. Peer Network members will be active participants in their network as they plan and implement strategies aimed at supporting one another’s continued success and the promotion of model growth.

This is an incredibly exciting time in the evolution of the community of Green House Project adopters known as the Peer Network. The path they have chosen will lead them to fully realize the potential of their community. As a result they will emerge as stronger advocates for elderhood and the empowerment of caregivers. Their wealth of knowledge, passion and experience will be leveraged to carry The Green House movement far into the future.

A New Research Article by Bowers and Nolet: Empowering Direct Care Workers

A basic tenant of THE GREEN HOUSE model is that an empowered, self-managed team of direct care workers will improve the quality of life and care of elders in long-term care settings, as well as the quality of life and job satisfaction of the people providing that care. While this has been a long-held belief of not only THE GREEN HOUSE model, but also other small-house models and the culture change movement in general, it has been difficult to substantiate in a quantitative fashion. A recent study by Barbara Bowers, PhD, RN and Kim Nolet, MS of the University of Wisconsin-Madison, published in the of Seniors Housing & Care Journal has attempted to do just that.

This study focused exclusively on THE GREEN HOUSE model, examining 14 Green House homes with site visits to 11 of them and in-depth interviews with 68 direct care workers (Shahbazim), 29 licensed nursing staff and 8 directors/assistant directors of nursing.
Here are some of their findings.
Selecting Workers / Implications for Empowerment
• Shahbazim have clear beliefs about the criteria that should be used when selecting new workers and this differs from the criteria most managers used in their selection process.
• Considerable variation exists in how direct care workers were selected to become Shahbazim. Few homes included direct care workers in the selection process. For those that did, the nature of their involvement varied across organizations.
• Management has a generally insufficient appreciation of the impact nurses have on direct care staff empowerment and the difficulty of implementing the model without the support and understanding of the nurses.
Meaning of Empowerment
Shahbazim were clear in how they defined being empowered.
• Not having someone looking over their shoulder, checking up on whether they’ve done what they were already planning to do and what is part of their everyday routine.
• Control over the prioritization of the work day – i.e. not getting pulled from a task underway to attend to some other matter.
• Ability to talk directly to family members about elder care. Being able to initiate such discussions during family visits or by phone is considered to be an important aspect of empowerment by the Shahbazim.

Benefits of an Empowered Worker Model
The benefits of being empowered played out in several ways:
• Learning to work as a team, responsible for all of the house and elders, not just “my elders”.
• Development of new work skills such as budgeting, mentoring and management that they would not have an opportunity to develop and use as CNAs in a traditional nursing home.
• Bringing natural talents and abilities to their work, such as baking, craft-making, music, photography, etc.
Sources of Variation in Empowerment Implementation
• Organizations have approached empowerment in different ways with varying degrees of obstacles and success.
• Variation was greatest in the homes that were among the first to be involved in the Green House culture change. Those that joined after the change in orientation that integrated nurses and included Shahbazim in the selection of new Shahbazim experienced more consistency in implementation strategies and a greater sense of empowerment of the direct care workers.
• As the model matured and the bringing of nurses and Shahbazim together from the beginning to discuss what empowerment means and how it relates to the roles each play resulted in greater comfort and satisfaction of both Shahbazim and nurses.

These findings are important to consider as Shahbazim, nurses and the entire teams in Green House homes and other household models continue to develop and evolve.  Click here to read theNIC_2011_Journal_Bowers

Ms. Geneva Troxell Adds New Recipes To My Thanksgiving Dinner

Gathering at Thanksgiving always reminds me of the importance of convivium.  It is an opportunity to share memories and a meal with family and friends, individuals you may see regularly or others whose arrival comes with great anticipation.  Moreover, it is the time when those coveted recipes appear once a year, like my grandma’s sweet potato casserole and my aunt’s famous pumpkin pie. 

This year, instead of going home for Thanksgiving, I will be preparing a feast on my own for a couple close friends.  Although my family has been sending me recipes over the past few weeks, I was still missing one crucial element: corn casserole.  Thankfully, Ms. Geneva Troxell, an elder from St. Martin’s in the Pines, has come to my rescue.  I believe her corn casserole will be a hit this Thanksgiving, and her turkey casserole will be an even greater success when a creative solution is needed for all that left-over turkey.  Thank you again, Ms. Troxell, for your amazing recipes!

Corn Casserole

1 egg                                                                                                   ½ tsp. salt
½ C. melted butter                                                                          1 can whole corn
1 C. sour cream                                                                                 1 can cream style corn
1 T. sugar                                                                                           1 pkg. Jiffy corn bread mix

Mix all ingredients together and put in 2-quart greased casserole at 350o for 45 minutes or until done. 

 Easy Turkey Casserole

2 C. uncooked macaroni                                                                4 hard-boiled eggs, cut up
2 C. mushroom soup                                                                      1 chopped medium onion
2 C. milk                                                                                           Salt to taste
2 C. chopped turkey                                                                       ½ lb. Velveeta cheese, cubed

Mix and place in greased 9×13” baking dish.  Refrigerate overnight, covered.  Remove and bring to room temperature 1 hour before baking.  Bake, uncovered, 1 hour or more at 350o.

 Please share with us what you will be making this Thanksgiving, especially if it is one of Ms. Troxell’s recipes!

Robert Jenkens Testifies before Senate Special Committee on Aging

On November 2, 2011, Robert Jenkens testified before the Senate Special Committee on Aging, regarding Quality and Oversight in Assisted Living.  See Below for an exerpt from this testimony, as well as a link to view the full event. 

Thank you Senator Nelson, Chairman Kohl, Ranking Member Corker, and other members of the Committee for the opportunity to share my thoughts on sustaining high quality affordable assisted living.  I am Robert Jenkens.  I currently direct The Green House Project, a partnership between NCB Capital Impact, The Robert Wood Johnson Foundation, Dr. Bill Thomas, and the pioneering states and providers that have joined with us. 

 The Green House Project assists nursing home and assisted living providers to implement a radically different approach to long-term care, one that truly operationalizes the founding values of the assisted living movement – autonomy, dignity, and privacy.  Prior to The Green House Project, I directed the Coming Home Program.  The Coming Home Program was also a partnership between NCB Capital Impact and The Robert Wood Johnson Foundation.  Coming Home assisted nine states – Alaska, Arkansas, Florida, Iowa, Maine, Massachusetts, Vermont, Washington, and Wisconsin – to implement policies and programs to support the creation of high quality affordable assisted living for Medicaid-eligible individuals who cannot remain at home. 

 Coming Home worked with its state partners to implement or refine Medicaid waiver, regulatory, and housing finance programs essential to the creation and sustainability of high quality and affordable assisted living projects.  The successful approaches and tools created by these states delivered 42 affordable apartment-style assisted living demonstrations.  The policy, program, and financing tools created under Coming Home continue to assist in the development of new projects today.

 Through the Coming Home Program and The Green House Project we have learned just how good assisted living can be.  It can deliver on the promise of high quality resident-directed care combined with meaningful control, privacy, dignity, and better direct care jobs – all in a model affordable to Medicaid-eligible individuals. 

For more information about The Green House Project see  For more information on the Coming Home Program see

 To view Robert’s Senate testimony Click Here.  Highlights can be found at timestamp (63:10-72:20), (121:42-123:13), 124:156-124:10), (131:04-131:54), 133:35-133:59)