Green House Blog

Coaching Corner – Approaching the Difficult Conversation: Self-Awareness

As a coaching Guide, team member, and partner in Green House homes we constantly have opportunities to communicate and build relationships with team members.  Time spent in getting to know and trust each other is essential for team effectiveness and success.  But sometimes a particular conversation is uncomfortable, unsettling, or just plain difficult!  Self-awareness is one of the four foundational coaching skills and directly applies to identifying and understanding that a difficult conversation has presented itself.

What makes a conversation a difficult conversation?

A difficult conversation is anything you find hard to talk about.  There are many reasons why a conversation may be difficult for you, including:

-You care deeply about the issue

-The topic is controversial (i.e. religion or politics)

-The outcome is uncertain

-You feel vulnerable or your self esteem is implicated

-You care deeply about the people with whom you are discussing the issue

When a difficult conversation occurs, spend a little time considering what really happened.  There are generally three levels of conversation:

The “What Happened?” Conversation:  Often there is a basic disagreement about the facts of the situation. Who said and did what, what it meant and who is wrong or right.  This creates an immediate disconnect between the people in the conversation.

The Feelings Conversation:  Every difficult conversation involves feelings.  Am I right or wrong; are my feelings appropriate and valid? How about the feelings of the other person?  Do feelings belong in the conversation or should I ignore them?  Unfortunately feelings are part of the equation. 

 The Identity Conversation:  We figure out what the conversation means to ourselves.  In this conversation many judgments happen: are we right or wrong, a good or bad person, competent or incompetent?  These judgments affect our self-esteem and self-worth.  

Here are some ways to reframe the situation for greater understanding and alignment:

  1. Pull back from arguing about who is right.  Be open to exploring the other person’s story.  The pull back will help to reframe the conversation, and look with real curiosity into what the person understands and believes about the “what happened”.
  2. Don’t assume they meant it!  Intentions strongly shape our views and judgments about the impact of the situation.  By putting aside blame and judgment, we open up the possibility of a very different outcome of the conversation.
  3. Choose to not focus on blame.  Sometimes one person is clearly the cause of something that has gone wrong.  Focusing on blame is not helpful because it inhibits our ability to learn what’s really causing the problem and find insights and answers to correct it.  The impulse to blame often comes from our own concern of being blamed.

This is only the beginning of an exploration of difficult conversations.  The book Difficult Conversations: How To Discuss What Matters Most is a terrific resource to strengthen communication and to build trust and respect among team members.

Stone, D.,  Patton, B., Heen, S.  Difficult Conversations: How To Discuss What Matters Most. Penguin Books, New York, NY. 2000.

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California Senate Committee approves a new nursing home licensing category that would allow Green House homes in the state

via CaliforniaHealthline.org 

“It puts the ‘home’ back into nursing home.”  That’s how California Senator Elaine Alquist (D-San Jose) described SB 1228 when addressing the Senate Committee on Health this week.

The bill would create a new health facility licensing category for a small house skilled nursing facility that is either a standalone home or consists of more than one home providing skilled nursing care in a noninstitutional setting.

David Pierce of Mt. San Antonio Gardens, a continuing care center in Pomona, explained that his organization has been pursing approval to build a Green House home for years.

Find out what needs to happen next for full approval in California and let us know what you think!

Thrive Research: Multi-group benefits for an evidence-based model

The Green House Project has partnered with the Robert Wood Johnson Foundation’s THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care.  Supported by the Robert Wood Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will compose the largest research effort undertaken to date in Green House homes.  Each month, a member of the THRIVE team will contribute a blog post to the Green House Project website.

 

Let’s be honest—when someone comes along and says, “Wouldn’t it be great to do a research study to learn about how well Green House Homes function and the impact that they have on residents?” It won’t sound like a good idea to everyone, especially those who are asked to spend time and effort on the study.  The time needed for site visits and data collection will lead some people to ask, “Is it really worth the time and energy?”

We think it is — and let us tell you why.

Many groups of people benefit from studies of the Green House model. The first group is–naturally–the residents of the homes.  Sharing best practices across homes is sure to help care and resident well-being. When researchers look at best practices they don’t just look at one home with a good idea, they look across a number of homes to see if the practice works in various settings or could work in various settings, or instead whether it’s a one home phenomenon.

The second group to benefit is the homes that want to move to the Green House model, or to adopt some of its best ideas. They need evidence that this model will be worth the effort it takes to make change. Within the homes, the staff who make the changes need evidence, and so do their bosses.

The third group is the agencies who foot the bill. Whether it’s a government program or a foundation, “payers” want to know the facts. Stories of success are important, but only information collected in a standardized manner across a number of homes will provide them with the evidence they need.

Participating in research does take some time, but what can be learned by thoughtful, experienced researchers is useful not just to those they study but to the field overall. Participating in research is an act of giving to your residents, their families, and caring staff all over the country. Thank you for all that you do.

 

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.

Stadium Place Manifests Hope for Low and Moderate Income Elders

U3_Green-House-Stadium-Place-Watercolor-not-on-sheet_1000x800-428x320“We used to have home plate,” Baltimore City Councilwoman Mary Pat Clarke told the crowd at Thursday’s opening ceremonies of The Green House Residences of Stadium Place . “Now we have home sweet home.”
The Grand Opening of Stadium Place, built on the site of Memorial Stadium, had all the festivities of opening day at the ballpark, complete with hot dogs, and a ceremonial first pitch thrown out by Dr. Bill Thomas and elder, Shirley Dickens. It was a wonderful culmination to a long and winding journey with strong partners. The Green House Project is built on relationships, and this project, the first in Maryland, highlighted that core value. GEDCO’s steadfast vision partnered with NCBCI and RWJF’s creative and innovative financing to create a home where Catholic Charities, with a long history of compassionate care, could create real home, in the community, for the community!Stadium-Place-1

In addition to the Oriole Bird, the media were present to document this moment that propels Baltimore to the forefront of providing cutting edge services for low income elders. The Baltimore Sun covered the Stadium Place grand opening with a great story about the elders and background on the project. A couple TV stations attended the festivities and WBAL Channel 11 broadcast this excellent story featuring Stadium Place’s administrator Nate Sweeney GEDCO Executive Director, Mitch Posner and others. A blogger from Kaiser Health News also attended the gala and wrote a post touting the research proving The Green House Project model. WYPR 88.1 FM’s Maryland Morning with Sheilah Kast interviewd Dr. Bill Thomas about the urgent need to provide long term care to underserved populations he was joined by Brown University assistant professor Zhanlian Feng, who has led ground-breaking research about the changing ethnic and racial make-up of nursing home residents.
Stadium-Place-4-478x198This event was one of those beautiful days, where everyone in attendance is filled with hope, and happiness.

The Green House homes at Stadium Place Answers Nursing Care Need in Baltimore

Stadium Place, developed by Govans Ecumenical Development Corporation (GEDCO), is the first certified Green House project in the state of Maryland. It is also the first in the nation to take advantage of special financing for Green House projects aimed at low-income elders under a joint initiative of the Robert Wood Johnson Foundation and NCB Capital Impact. This project received significant additional support from The Harry and Janette Weinberg Foundation, the state, the City of Baltimore, and private donors.

“Regardless of income, everyone should have the opportunity to age with dignity and receive the highest quality of care,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation.

“By thoroughly redefining what a nursing home should be and placing elders at the center of all they do, Green House homes help residents live happier, healthier lives,” continued Lavizzo-Mourey. “Stadium Place is a milestone for Baltimore and a model for what every city should be doing.”

The Stadium Place project will be operated by Associated Catholic Charities. It will include four small homes that will serve up to a dozen seniors per home, and at least sixty percent of the rooms in the Green House homes will be reserved for older adults who are eligible for Medicaid. Stadium Place has also been built to obtain LEED Silver certification.

“Stadium Place is helping to change the face of long-term care,” said Terry Simonette, president and CEO of NCB Capital Impact. “It demonstrates that it is possible to provide the best care to the people who need it most, at the same cost as a traditional nursing home.”

The Green House Residences are an integral part of the holistic continuum of care GEDCO is developing at Stadium Place. They are integrated into a larger mixed-income urban retirement community that currently includes four apartment buildings for low and moderate-income seniors, a YMCA facility, Memorial Field at the Y, ThanksGiving Place and a community-built playground.

Click here to view the full press release

BALTIMORE ANSWERS SKILLED-NURSING CARE SHORTAGE WITH GROUNDBREAKING GREEN HOUSE PROJECT AT STADIUM PLACE

FOR RELEASE:
April 19, 2012

CONTACT:
Eric Antebi, 415-279-0748, eantebi@fenton.com
Kelly Osmundson, 415-901-0111, kosmundson@fenton.com

BALTIMORE ANSWERS SKILLED-NURSING CARE SHORTAGE WITH GROUNDBREAKING GREEN HOUSE PROJECT AT STADIUM PLACE

Opening marks first Green House project in Maryland

Baltimore, Maryland — With a looming shortage in long-term care options in poor neighborhoods around the U.S., Baltimore is leading the way today with the opening of The Green House® Residences at Stadium Place, which will provide the area’s low-income seniors with a radically different, skilled-nursing home on the site of the former Memorial Stadium.

Stadium Place, developed by Govans Ecumenical Development Corporation (GEDCO), is the first certified Green House project in the state of Maryland. It is also the first in the nation to take advantage of special financing for Green House projects aimed at low-income elders under a joint initiative of the Robert Wood Johnson Foundation and NCB Capital Impact. This project received significant additional support from The Harry and Janette Weinberg Foundation, the state, the City of Baltimore, and private donors.

“Regardless of income, everyone should have the opportunity to age with dignity and receive the highest quality of care,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation.

“By thoroughly redefining what a nursing home should be and placing elders at the center of all they do, Green House homes help residents live happier, healthier lives,” continued Lavizzo-Mourey. “Stadium Place is a milestone for Baltimore and a model for what every city should be doing.”

The Green House Model
Green House homes provide an environment in which residents receive nursing support and clinical care without the care becoming the focus of their daily lives. By altering the facility size, interior design, staffing patterns and methods of delivering skilled services to residents, the Green House model provides residents greater health and lifestyle benefits compared to residents of traditional nursing facilities.

Early results show that Green House residents report higher satisfaction levels, less physical decline and less depression — at a cost that is comparable to traditional nursing facilities. Last year, AARP called the Green House homes “a model for aging that promotes growth.” Long-Term Living magazine also recently named it one of the decade’s Top 10 Senior Design Innovations, and Provider Magazine has called the Green House model “the pinnacle” of culture change in long-term care.

The Stadium Place project will be operated by Associated Catholic Charities. It will include four small homes that will serve up to a dozen seniors per home, and at least sixty percent of the rooms in the Green House homes will be reserved for older adults who are eligible for Medicaid. Stadium Place has also been built to obtain LEED Silver certification.

“Stadium Place is helping to change the face of long-term care,” said Terry Simonette, president and CEO of NCB Capital Impact. “It demonstrates that it is possible to provide the best care to the people who need it most, at the same cost as a traditional nursing home.”

The Green House Residences are an integral part of the holistic continuum of care GEDCO is developing at Stadium Place. They are integrated into a larger mixed-income urban retirement community that currently includes four apartment buildings for low and moderate-income seniors, a YMCA facility, Memorial Field at the Y, ThanksGiving Place and a community-built playground.

The Growing Crisis of Long-term Care
In 2011, the first baby boomers turned 65. By 2030, one in five will be at least 65 — nearly doubling today’s numbers. Over that same period, the number of 85-year-olds will increase by 50 percent.

Despite the growing number of seniors in need of long-term care, the number of beds in skilled-nursing facilities has been dropping significantly over the last decade. Traditional nursing homes that were built several decades ago have been closing due to their age, but also due to shifting consumer preferences. Meanwhile, the financial crisis of the last few years has made building new facilities even more difficult.

While these trends are likely to affect older Americans across the board, low-income seniors are faring the worst. A study published last year in the Archives of Internal Medicine concluded that shortages of skilled-nursing facilities were most likely to occur in minority and poor communities.

”This project will provide the highest quality housing and care for older adults regardless of their financial situation,” said Mitchell Posner, Executive Director of GEDCO. “People who are eligible for Medicaid will be living side by side with other elders who have greater resources because in our eyes, they all deserve the best.”

About the Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable and timely change. For nearly 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.

About NCB Capital Impact
NCB Capital Impact helps people and communities reach their highest potential at every stage of life. As a national, non-profit community development finance institution, Capital Impact provides financial services and technical assistance to help make high-quality health care, healthy foods, housing, and education more accessible and attainable, and eldercare more dignified and respectful. Capital Impact has used its depth of experience, cooperative approach, and diverse network of alliances to generate over $1.6 billion in critical investments that create a high quality of life for low income people and communities. www.ncbcapitalimpact.org

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Jefferson County Creates Home

Jefferson County Green House homes, nestled in the Smokey Mountains, are an ideal place to enjoy life in a tight knit community. Knoxnews.com, recognized that there is something special happening within this organization and took a deeper look:

In the houses, elders, many of whom have dementia, have private rooms; they can bring a recliner and dresser from home. There’s lots of natural light around the airy “common” areas: a hearth area, with conversational seating around a fireplace; a dining room adjacent to an open kitchen, with one large table around which residents and staff eat meals together; and a sitting room with a television and games.

Roger Mynatt, administrator, reflects back on his decision to pursue Green House homes, “it looked like home. It was just such a difference from the traditional institution. The board saw that the elders had better quality of life, and that it was a good situation for the staff, and they wanted it. They thought, ‘That’s what we need.’ ”

Jefferson County Nursing Home is one of two Green House Projects in Tennessee. Ave Maria Home is a Green House Project located outside of Memphis.

Click here to read the full article about how Jefferson County is achieving great results for the elders of their community, and those who love them!

PEAK Leadership Summit Will Converge Strategic Innovators

Wise Leadership is the Lifeblood of any Organization

To make real change in an organization, leaders must cast the vision for change and inspire others to join them on the journey. A culture change journey is one without a destination, and often has many twists and turns along the way and thought of implementing change in an organization can seem overwhelming.  The Green House® Project is a proven model and process that can provide the roadmap. The Green House Project is a national initiative to transform the lives of elders and those working closest to them

Research on this initiative shows that by changing the environment, philosophy and organizational design of skilled nursing care, a financially viable system is created where people living AND working in long term care are happier, healthier and feel a strong sense of purpose.

The LeadingAge PEAK Conference  in Washington, DC April 23-25, is a wonderful venue for organizational leaders to meet with The Green House team members, and learn more about how The Green House Project can amplify an organization’s mission through a comprehensive technical assistance package.  Please See Us at Booth # 702

Highlighting the Green House Project Team: Anna Ortigara, Resource Development Director

Anna began her work as a Registered Nurse in the field of pediatrics, but within a couple of years her focus quickly changed to elders, all thanks to a job with a large corporate firm.  In the early 80’s Proctor and Gamble was unveiling a new product, Attends, and hired RN’s to train nursing home staff on how to correctly use this new item.  Anna traveled across the country in this position visiting many skilled nursing homes. For her, it was “love at first site” with elders and direct care workers.  Anna felt a very special bond with them and at the same time recognized that skilled nursing homes could use some new creative operational practices.  Thus, began her journey in gerontology and culture change.  Anna went back to school for her Master of Science in Nursing, Gerontological Clinical Nurse Specialist and has continued to be a driving force in the aging services industry ever since.

At the Green House Project, Anna is currently the Director of Innovations, where she oversees the development of resources and tools to successfully implement the Green House model.  Here are just a few highlights of her work in aging services:

  • Completed Dementia Special Care Survey Protocol and Pilot Test – Joint Commission on Accreditation of Healthcare Organizations
  • Developed  Preparing Leaders for the Future of Dementia Care: A Dementia Special Care Unit Directors Certificate Course – Rush University Medical Center
  • Established the Celebrate the C.N.A. Annual Conference
  • Vice-President, Executive Committee, Board – The Pioneer Network

In addition, Anna is a Fellow of the American Academy of Nursing; is on the Editorial Board of Alzheimer’s Care Quarterly; and is the primary author of LEAP for the 21st Century LTC Workforce, a Mather Institute of Aging and Life Services Network Workforce Initiative.

Anna was born and raised on the south side of Chicago and is the aunt to 18 nieces and nephews.  She loves the theatre, musicals, reading and international travel!

What's your favorite culture change book?

Yesterday the world got its first opportunity to own Bill Thomas’ Tribes of Eden. As we celebrate a new book that’s been inspired by Culture Change advocates, we had to wonder – what book has inspired you? What text would you recommend to others to provide different insight into the world of aging? Dementia? Person directed care? What books have led to lively discussions? Tell us about your good reads so we can share those titles and genres with our Green House network of readers.

 

What’s your favorite culture change book?

Yesterday the world got its first opportunity to own Bill Thomas’ Tribes of Eden. As we celebrate a new book that’s been inspired by Culture Change advocates, we had to wonder – what book has inspired you? What text would you recommend to others to provide different insight into the world of aging? Dementia? Person directed care? What books have led to lively discussions? Tell us about your good reads so we can share those titles and genres with our Green House network of readers.

 

Thrive Research: Culture Change Sustainability in the Green House Model

The Green House Project has partnered with the Robert Wood Johnson Foundation’s THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care.  Supported by the Robert Wood Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes.  Each month, a member of the THRIVE team will contribute a blog post to the Green House Project website.

 

One of the broad concepts that long term care researchers, practitioners, and consumers are interested in is culture change. It’s hard to find a long-term care setting that doesn’t claim to be engaged in culture change in some way.  Many see it as a shift from the traditional institutional “one-size fits all” model of providing care to one that focuses on “person centered” care.  But are people walking the walk, or just talking the talk?  What extent of change is necessary to really change the culture?

The Green House is one model of culture change that uses a comprehensive approach to culture change, including creation of specific environmental features, alteration of traditional care practices, and re-organization of staff roles.  Alternately, some nursing homes have changed by adopting a single practice, such as consistent assignment of staff, or resident choice about what time to awake  in the morning. Some have changed the environment to offer private rooms, more intimate dining rooms, or more private lounge spaces.  Also, environmental changes using a “hotel amenity” approach are becoming particularly common to attract people who need short-stay rehabilitation.

Does any or all of this equal “culture change”? Can smaller changes achieve the same outcomes as more extensive changes? Are there specific practices or environmental changes that are necessary to achieve certain outcomes?  When are changes sufficient to suggest that culture change has occurred?  Is all culture change equal? 

Research suggests that change in an organization occurs only when a new way of doing things is generally accepted throughout an organization, and when policies, procedures, and routine practices are aligned with the new way of operating.  So, when implementing culture change, it’s important to ask:

1)     Do we generally agree about what is important?

2)     Are we all moving in the same direction, toward what we believe is important?

3)     Do our policies and procedures support this new way of operating or are they at odds with where we say we’re going to do?

The THRIVE research team will be exploring some of these questions with culture change organizations, many of which are Green House homes, and strives to understand how culture change is achieved and sustained within these organizations.

 

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