Green House Blog

Alternatives to Long Term Care Focus on the Elder

AARP‘s Caregiving Resource Center posted an article to address the, “90 percent of Americans prefer to stay home as they age”. There are alternatives  to traditional long term care that focus on the growth of the elder in their later years, and their well being rather than their decline:

Much like the Eden Alternative, The Green House Project caters to the life of the older adult rather than to their health needs only. The idea behind this project is to provide our loved ones with an excellent quality of life enriched by relationships with qualified staff who choose to work in an environment focused on enriching the life of the older adult. Taking the sterility out of long-term care, the Green House Project provides a warm environment with a focus on community, relationships, well-being and happiness — where there is a true “heart” to the home.

 

The opportunity to age in community with the needed resources, including skilled nursing care, allows the elder to remain connected to the place and people that they have loved throughout their lives, and changes the paradigm of long term care. The AARP article highlights, The Eden Alternative, The Green House Project, and The Village models as alternatives to Long Term Care that are changing the landscape of what it means to grow old.

To read the full article, and gather additional resources, click here.

Woodland Park, Virginia's First Green House Homes, Break Ground in Harrisonburg

 

VMRC Groundbreaking

The imagery was especially powerful at the January 5 Groundbreaking at Virginia Mennonite Retirement Community (VMRC) in Harrisonburg for the first three of 10 homes for Woodland Park.

The Groundbreaking Ceremony included various displays of resident-centered philosophy. Two residents of VMRC’s current long-term care community lifted soil with shovels which were decorated by residents. Residents baked cookies for the reception following the event. And residents assembled commemorative pouches of soil from the site with packets of wildflower seeds which were given to all attendees.

VMRC President and CEO Ronald Yoder summarized the significance of building Woodland Park:

“VMRC’s vision to pursue this project … is rooted in our desire and commitment to respond to the deep yearnings of elders, their children, nieces, nephews and siblings to offer a different choice for long-term care – one that enables elders to continue their normal patterns of daily living and one that responds to the desires and expectations of family members and caregivers.”

And before inviting persons to the site for the Groundbreaking, Ron added, “The small action with a shovel represents a shift from people viewing long-term care as an undesirable destination to a place to continue living and enjoying life as they wish.”

The theme of building a foundation was carried throughout the ceremony. Especially reinforced when attendees were asked to place small stones they had been given into the walls of a 4×4 model of a Woodland Park home. Residents, caregivers, spouses, employees, and donors participated in this part of the program.

Visit VMRC’s photo album on Facebook and at www.vmrcharrisonburg.

Blog Post Contributed by Maureen  Pearson, Director of Communications, VMRC

Woodland Park, Virginia’s First Green House Homes, Break Ground in Harrisonburg

 

VMRC Groundbreaking

The imagery was especially powerful at the January 5 Groundbreaking at Virginia Mennonite Retirement Community (VMRC) in Harrisonburg for the first three of 10 homes for Woodland Park.

The Groundbreaking Ceremony included various displays of resident-centered philosophy. Two residents of VMRC’s current long-term care community lifted soil with shovels which were decorated by residents. Residents baked cookies for the reception following the event. And residents assembled commemorative pouches of soil from the site with packets of wildflower seeds which were given to all attendees.

VMRC President and CEO Ronald Yoder summarized the significance of building Woodland Park:

“VMRC’s vision to pursue this project … is rooted in our desire and commitment to respond to the deep yearnings of elders, their children, nieces, nephews and siblings to offer a different choice for long-term care – one that enables elders to continue their normal patterns of daily living and one that responds to the desires and expectations of family members and caregivers.”

And before inviting persons to the site for the Groundbreaking, Ron added, “The small action with a shovel represents a shift from people viewing long-term care as an undesirable destination to a place to continue living and enjoying life as they wish.”

The theme of building a foundation was carried throughout the ceremony. Especially reinforced when attendees were asked to place small stones they had been given into the walls of a 4×4 model of a Woodland Park home. Residents, caregivers, spouses, employees, and donors participated in this part of the program.

Visit VMRC’s photo album on Facebook and at www.vmrcharrisonburg.

Blog Post Contributed by Maureen  Pearson, Director of Communications, VMRC

Green House Homes Are Coming to Ohio

On a cold day in mid-December, staff from Mennonite Memorial Home in Bluffton, Ohio gathered for a much anticipated Green House kick-off meeting.  Laura Voth, CEO, could hardly hold back her tears as staff shared how they were feeling about reaching this milestone.  “Because we have been at it for so long, it was so exciting,” she exclaimed.  “The kick-off meeting signifies that change is really coming and this is a very positive thing.”

Encountering several setbacks and obstacles throughout this journey has not deterred this organization from moving forward with their goal of building two Green House homes.  Although they already deliver excellent person-centered care, the Green House model further raises the bar. “It is a transformation from the old way of delivering care into a better way,” stated Voth.  Every time she drives by the homes under construction, the significance of the change strikes her.  The small size of the homes is drastically different from the larger buildings that so many are accustomed to seeing.  For staff and the Bluffton community at large, it is really sinking in that the Green House model is so different.

THRIVE Research – What does this mean for Green House Homes?

THRIVE Research – What does this mean for Green House Homes?

 

You’ve probably heard about the THRIVE  research studies aimed at learning more about how the Green House model works and how it differs from other models of care.   You might be curious what this means for the Green House projects over the next few years.

 

Many of the Green House projects will be getting calls over the next year to discuss participation. Research team members from Pioneer Network, University of Wisconsin-Madison, University of North Carolina, and Health Management Strategies will be contacting several projects to ask them to participate in one or more parts of the study.

 

Here are some terms you might hear or see:

 

Questionnaires: These are paper or electronic surveys staff complete on a topic.

 

Site Visit: Several Green House projects will be asked to host a visit by a small team of friendly researchers (usually 2-4 people).  The purpose of the visit is to collect information on what life is like in the Green House homes for shabhazim and elders and how care is provided.

 

Interviews: Interviews are one way researchers get to know details about how things work in the Green House homes. Interviewees will be asked questions that allow them to tell stories and share their experiences.

 

What is a site visit like? 

Enjoyable !  A site visit from the research team is not like a visit from state regulators, in that the intent is to learn and not to evaluate.  It’s a time for researchers to learn about what life and care is like in a Green House, and for Green House staff, shabhazim, and elders to have the opportunity to contribute to what is being learned.  

 

Lori Kinney, Green House Guide at Lebanon Valley Brethren Home, has experienced a few site visits from research teams. “The research team’s communication was great, whether it was through emails or phone conversations. The visits went well… Since we, staff and elders, were prepared for the visits from the research team, things moved along swiftly and elders always appreciate visits from ‘new’ people that enjoy listening and talking with them.”

 

The researchers understand that the Green Houses are the elders’ homes and intend to minimize disruption as much as possible. The researchers are flexible and know things can “pop up” that make it difficult for staff to attend to the research needs during the visit. Elder’s needs are always the top priority.

 

The research team looks forward to working with the Green House homes! Questions about THRIVE can be directed to Lauren Cohen (lauren_cohen@unc.edu or 919-843-8874).

 

 The THRIVE research studies are funded by the Robert Wood Johnson Foundation.

Ask Dr. Bill: Flattened Hierarchy in Green House Homes

Flat is Good

 

Flat tires are bad. Flat cakes are bad. Flat organizations, can be, good. So, what makes an organization “flat?”

All human organizations have leaders and followers. One thing that defines a free society is that people can be a leader in one organization and a follower in another.  All of us are part-time leaders and part-time followers. Some organizations create an enormous distance between leaders and followers.  For example, the United States Army has a very steep and very large hierarchy that separates the lowest recruit from the highest general. An army private has very little chance of every becoming a general and generals never get busted down to private. The Army is the opposite of a “flat” organization.

 A steep hierarchy is good for things like fighting wars and flying to the moon but steep organizations are pretty cold and very impersonal. 

 Flat organizations have a much smaller distance between leaders and followers. These two groups are able to challenge each other’s ideas. Green House homes are meant to be Flat organizations because the Elders need for all of us to work together.  Everyone in The Green House home has ideas and insights and everyone can contribute to the conversation.

 How can we tell if a Green House home is losing its “flatness?”

 The main symptom is a decrease in problem-solving conversations and an increase in “problem-solving” by the leaders.  In The Green House, leaders are not supposed to solve problems. In The Green House, leaders are supposed to help others solve problems.

 The loss of “flatness” can become a big problem if people are not aware that it is happening.  So, here is my challenge for you: Have a conversation about the flatness of your Green House home because when it comes to warmth and compassion, “flat is good.”

Community Partnership Key To Maryland's First Green House Project, Baltimore Sun Reports

In light of the final stretch of construction for The Green House® Residences at Stadium Place, The Baltimore Sun recently posted an article highlighting the unique community partnership that has contributed to the success of the first Green House homes in Maryland. Govans Ecumenical Development Corporation (GEDCO) and Catholic Charities have created a strengths-based collaboration to achieve their shared vision to create better lives for Elders receiving skilled nursing care in Baltimore. In an interview with GEDCO Executive Director, Mitchell Posner, he explained the significance of each organization in the partnership:

“GEDCO operates its other housing complexes, including the Venable and Ednor apartment buildings at Stadium Place, on the site of the old Memorial Stadium. But, since the Green House will require skilled nursing care, GEDCO is handing the management reins over to Catholic Charities, which has experience in that part of the health care industry.”

The collaboration has amplified the community involvement in and commitment to the project, as the Stadium Place team has demonstrated the importance of all perspectives, resources, and experiences. Nate Sweeney, Green House Guide at Stadium Place, acknowledged that the homes will ensure that each elder “has a place at the table”. Similarly, GEDCO and Catholic Charities have modeled this value by bringing complementary strengths to table in preparation for the homes to open in April 2012.

Community Partnership Key To Maryland’s First Green House Project, Baltimore Sun Reports

In light of the final stretch of construction for The Green House® Residences at Stadium Place, The Baltimore Sun recently posted an article highlighting the unique community partnership that has contributed to the success of the first Green House homes in Maryland. Govans Ecumenical Development Corporation (GEDCO) and Catholic Charities have created a strengths-based collaboration to achieve their shared vision to create better lives for Elders receiving skilled nursing care in Baltimore. In an interview with GEDCO Executive Director, Mitchell Posner, he explained the significance of each organization in the partnership:

“GEDCO operates its other housing complexes, including the Venable and Ednor apartment buildings at Stadium Place, on the site of the old Memorial Stadium. But, since the Green House will require skilled nursing care, GEDCO is handing the management reins over to Catholic Charities, which has experience in that part of the health care industry.”

The collaboration has amplified the community involvement in and commitment to the project, as the Stadium Place team has demonstrated the importance of all perspectives, resources, and experiences. Nate Sweeney, Green House Guide at Stadium Place, acknowledged that the homes will ensure that each elder “has a place at the table”. Similarly, GEDCO and Catholic Charities have modeled this value by bringing complementary strengths to table in preparation for the homes to open in April 2012.

British Parliament Takes a Look at The Green House Project

From the ChangingAging Blogstream

The Green House Project isn’t just making waves in the U.S. The model’s innovative transformation of nursing home care was the the subject of a British Parliamentary hearing this week on the future of caregiving in the UK.

A British researcher who recently visited the United States testified before the Parliament Health Committee Tuesday, Jan. 10, that Britain should look at the Green House model as the future of nursing home care.

Dr. James Mumford, a senior researcher for the Centre for Social Justice, told Parliament that it was “absolutely vital that we dream a different future for residential care, particularly nursing care,” and “The Green House model presents a new way of doing that.” The Centre for Social Justice is a British think tank focused on finding effective solutions to poverty and Mumford leads research focused on low-income older adults in the UK.

“The (Green House) model was invented by Dr Bill Thomas but it is not just a brainchild; it actually exists. There are 127 Green Houses in the U.S. with 250 in development,” Mumford said.

In Britain, policymakers are currently too focused on delivering services that help elders remain in their homes longer, Mumford said. He warned that the growing population of adults with dementia and other chronic conditions means the need for nursing homes (which the British call “care homes”) is not going away and such settings need to be reformed.

The committee called on Mumford to report findings of his visit to the U.S., including a tour of Green House homes at The Eddy in Albany, N.Y. Mumford testified that the key innovations in the Green House model are achieved through reforms in design and staff ethos:

These Green Houses are self-contained buildings for nine to 12 people with about two staff members looking after each home. Their kitchen is not downstairs or siphoned off but is actually at the heart of the home. There are no clinical corridors and the rooms are off the central area.

The design is half of it. The second half of the innovation is around the staffing ethos. Basically, by cutting out middle management, the key thought is this: the staff in the care home context are bigger than the roles that they have.

By empowering the staff to actually take responsibility for the way that that particular Green House is run, and by also allowing them to take charge of cooking the meals and doing the laundry, you make huge staffing efficiencies, so that there is not actually any more hour per resident in terms of the staff labour cost, but it is for the same cost.

“They have seen extraordinary results from what they have achieved because of these two dramatic innovations at the heart of this new form of care,” Mumford testified. “As I said, this is not just a bright idea, it is being backed and rolled out across the US.”

Watch the full Parliament hearing here (Mumford’s Green House testimony begins 28 minutes into the hearing):

You can read the full transcript of Mumford’s testimony after the jump.

Continue reading “British Parliament Takes a Look at The Green House Project”

Forbes Magazine, NCB Capital Impact Finds Opportunity in Innovative Initiatives like The Green House Project

Capital Impact, COO, Annie Donovan, is interviewed in Forbes Magazine, to talk about the work that Capital Impact does to support people and communities to live to their highest potential at every stage of life, “Our overarching goal is to improve access to high quality health and elder care, healthy foods, housing and education in low-income communities.”

The purpose of NCB Capital Impact is to “make capital available in underserved, low-income markets; to go where traditional banks would not, either because they didn’t understand the risks, or they thought the returns were not commensurate with the risk.”

At Capital Impact, we’ve taken that initial $25 million in equity capital and grown it and stretched it in every way imaginable resulting in $1.7 billion invested to date in low-income communities, most of which are highly distressed. We’ve financed the creation of 35,000 units of affordable housing; 200,000 school seats for low-income children in high quality charter schools; 3 million square feet of health center space that provides for more than 1 million patient visits annually; 9,000 units of affordable assisted living; healthy food retail in over 60 locations; and more than 26,000 jobs for low-income people. We think that’s an excellent return on taxpayer investment – and we’re not finished yet.

Money alone will not solve societal problems, there are problem solving, educational and innovative components that create the impact. Ms. Donovan speaks about The Green House Project as an example of the marriage between creative financing and innovative implementation,

We are currently diffusing a disruptive innovation in the nursing home market called The Green House Project (GHP)www.thegreenhouseproject.org. GHP is a complete remake of the skilled nursing environment, from an institutional setting concerned with efficiency and medical care to a warm, nurturing, small-scale home that cares for the whole person, allows elders to age with maximum control and dignity, and does so at operating costs on par with typical nursing homes. Our role in financing for these initiatives is important, but has been secondary to that of developing them.

The Green House Project has big goals over the next few years to expand our development to communities across the country.  Being a part of Capital Impact, a company who sees every challenge as an opportunity, will make our audacity for change, an attainable reality. 

To read the full article in Forbes Magazine, click here

The Green House Project research study: “Prove it works.”

You wouldn’t buy an expensive medication without confidence that it works, would you?  Because the Green House model requires an investment, people are asking for evidence that it works and to understand why it works.  In response, the Green House Project has partnered with THRIVE (The Research Initiative Valuing Eldercare), funded by the Robert Wood Johnson Foundation, to learn more about how the Green House model works and how it differs from other models of care.  The THRIVE team is launching a series of projects comprising the largest research effort undertaken in Green House homes.  Many of the THRIVE team members have previously researched the Green House model, and their earlier work in part shaped the questions that THRIVE will be answering.  Here is some of what is known from previous work:

  •  Do specific components of the Green House model relate to better outcomes for elders?   THRIVE members Sheryl Zimmerman and Lauren Cohen (University of North Carolina at Chapel Hill) reviewed research literature and found strong support that certain components of Green House homes seem to relate to better outcomes — such as that private rooms and bathrooms and communal dining relate to less infection and better intake.  However, they also found that little research has been done regarding many other components of Green House homes, so several questions remain as to which components matter in terms of better quality of life for elders. 
  •  How does daily practice of front-line caregivers differ in Green House homes compared to traditional settings?  THRIVE members Siobhan Sharkey, Sandy Hudak, and Susan Horn (Health Management Strategies and the Institute for Clinical Outcomes Research) observed that elders receive more direct care time per day in Green House homes than do similar residents in traditional nursing homes – about 20 additional minutes more per day, in fact.  They also found that elders in Green House homes maintained their ability to perform activities of daily living, such as dressing and eating, to a greater extent than those living in traditional nursing homes.   It is not clear, though, what it is about the Green House model that might relate to better outcomes. 
  • How does the role of the nurse differ in Green House homes?  Work by Barbara Bowers and Kimberly Nolet (University of Wisconsin-Madison) found that Green House homes have used different models for how Shahbazim and nurses work together to provide care for elders.   Each model had meaningful consequences for both staff and elders, but it is not clear why there were such differences across homes. 

These three studies left us asking, “Are Green House homes helping elders more than are traditional nursing homes, and if so, which specific elements and practices are making the difference?”  The THRIVE team will be answering this question, and also looking at other topics including staff turnover, who is adopting the Green House model, and costs.  Participating sites will help answer these questions, and also will receive confidential feedback about their organization.  It’s an exciting opportunity for researchers, Green House homes, and other nursing homes to work together toward improving care.

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

Green House Living in Wyoming Prepares To Welcome Elders

Green House Living for Sheridan

The nation’s first grassroots-organized Green House Project homes will open their doors to welcome elders on January 31st in Sheridan, Wyoming.

Nearly five years in the making, Green House Living in Sheridan has completed construction on two of four planned Green House cottages at the newly created Village at Cloud Peak Ranch. Two more cottages will be completed by mid-February, serving a total of 48 elders, and a grand opening celebration is scheduled for March.

Green House Living in Sheridan President Doug Osborn shared the news Dec. 30 and said the community-based initiative would not have been possible without support from volunteers and contributors from every level of local government and walk of life.

“The Scott Cottage, the Watt Cottage, the Whitney Cottage, the Founders Cottage… will introduce this change in nursing home care to the state of Wyoming and help other communities as they consider providing the kind of care and fulfilling lives our elders deserve,” Osborn said.

Green House Living in Sheridan will provide 24/7 skilled nursing care but it is not a nursing home or assisted living facility. Elders have their own private room with bathroom and shower, and each cottage has a spa room near the kitchen. Up to 12 elders share a cottage and a central living and dining area. Each cottage has a household team of Shahbazim who care for, cook for and eat with the elders.

“We have a table where everyone sits together and experiences what we call convivium, which is the experience of eating together, just like in a real home,” said Green House Living administrator Chris Szymanski in an interview with Sheridan Media posted online here.

What really sets the model apart is the philosophy and organizational structure. The Shahbazim and all medical and support staff are trained in a circular organizational structure centered around the elders, creating an environment for them to grow and thrive, like in a “green house.”

The model is designed to transform the experience for both the elders and the staff. Sheridan just completed the first round of training Shahbazim for the Scott and Watt cottages and will begin training the second round later this month.

“Especially gratifying is watching our new employees in training, wrapping their minds and souls around the concepts and methods which define the Green House model,” Osborn said.

Visit SheridanGreenHouse.org for more information, photos and updates on Wyoming’s first Green House Project.