Green House Blog

Nancy Fox to speak to the Imperative of Hope in Leadership

Nancy Fox is a nationally-recognized culture change consultant, and as a Green House adopter, we are especially delighted that she is going to be the closing plenary speaker at The 6th Annual Green House Meeting and Celebration. This event is exclusively for Green House organizations and serves as a venue for learning, networking and celebration!  Nancy’s long-term care career began in the 1980’s, serving at both the facility and regional levels.  Nancy served as the first Executive Director of The Eden Alternative. Nancy is a well-known speaker and educator and regularly conducts training on the Eden Alternative, Culture Change and Leadership. Her book, The Journey of a Lifetime: Leadership Pathways to Culture Change in Long-Term Care, was published in March, 2007. She currently oversees person-directed philosophy of care for Vivage Quality Health Partners.

Nancy believes that leadership is a behavior not a position. In fact, all leadership is volunteer work! Leaders bring hope into the world. In order to shift the leadership paradigm, we must work to redefine accountability. This is a challenge because, most of human behavior is driven by things happening on a sub-conscious level, and leadership requires self-awareness. At The Green House Annual Meeting, Nancy will distinguish between leadership in an institutional model and leadership in a person-directed model of care. Through this presentation, Green House adopters will be inspired to adopt new leadership behaviors.

September as World Alzheimer’s Month

The effects of Alzheimer’s disease hit close to home for many people and remain a global issue effecting over 35.6 million people worldwide. This September, World Alzheimer’s Month focused on global advocacy with researchers in all parts of the world working to help people affected and their families in not only finding a cure, but also a way to help prevent the disease. Although the month is over, these efforts have continued.

As strenuous as Alzheimer’s and other dementias may be on elders and their families, the financial burdens of covering treatments and other medical costs that come along with it can be more exhausting. According to the Alzheimer’s Association, payments for treatment and overall healthcare costs for Alzheimer’s and other dementias will increase from $203 billion in 2013 to $1.2 trillion in 2050. More than half of these payments will come from either middle-income or low-income countries whose citizens face other financial struggles along with the added Alzheimer’s treatment costs.

As these statistics continue to rise, it’s vital that those affected by Alzheimer’s disease be seen as whole people, who are deserving of meaningful lives.  The Green House Project has consistently recognized the unique needs of every Elder, including those living with dementia related illnesses. Residents of Green House homes experience a real home setting with smaller groups of 6-12 Elders. This feeling of being at home helps Elders to remember familiar patterns of behavior thus helping to reduce any anxiety or uneasiness they may have. A highly trained staff works alongside elders and caters to their every need. Specially trained with an additional 128 hours of education beyond what’s typically required for the CNA certificate allows the staff to put more emphasis on person-directed dementia care.

Earlier this year, researchers in Sweden were able to detect changes within nerve cells which occur during the early stages of Alzheimer’s disease. By discovering this, researchers may be able to fight the disease using new approaches and may possibly be able to create new treatments. More recently, researchers at the University of California Los Angeles found links between different proteins responsible for characteristic plagues and tangles in aging brains which may lead to Alzheimer’s.

It goes without saying that these findings and those of other researchers around the world are due in large part to the donations and funding they receive. On September 21st, the World Alzheimer’s Action Day sought to bring awareness and knowledge to this pressing global issue, emphasizing areas in which both time and monetary donations can help with Alzheimer’s research. There is much that can be done to help with awareness campaigns and the growing need for increased research funding. Whether you wish to help at a local level or play your role in spreading global advocacy, there is plenty of opportunity available. Contact your local Alzheimer’s organization or visit the Alzheimer’s Foundation of America or the Alzheimer’s Association.

Alzheimer’s Foundation of America:

Alzheimer’s Association:

A Pre-Conference Intensive for Shahbazim at The 6th Annual Green House Meeting and Celebration: A Day to Explore the Coordinator Roles and Relational Coordination in Green House Homes

On the day a Green House home opens the Shahbazim become the managers of the home as well as partners to the Elders.  It requires a deep understanding of the systems that support the home. The core functions include the Food, Scheduling, Care, Team, and Housekeeping systems and the Coordinator Roles each Shahbaz fills on a rotating basis.  These functions are the guts of the home and to be successfully carried out require strong relationships and excellent communication.  If the systems work, the days go smoothly. Without good systems, respectful relationships and high communication it can be a rocky road!

This preconference day will explore the Coordinator Roles and the core systems around Food, Scheduling and Care.  It will ask participants to identify what makes for good relational coordination; meaning shared vision, shared knowledge and mutual respect.  The best thinking and lessons learned will be the basis for conversations on how to sharpen and improve the core systems and relationships of the homes.  

If you are a Shahbaz at an open or soon to be open Green House home, plan on attending THE GREEN HOUSE®  Annual Meeting and Celebration in Boston on November 18th.   Leave with new ideas, new insights and many new friends.  Register at the Peer Network website.  For more information about the program contact

Please note:  The Green House Annual Meeting & Celebration is an event exclusively available to Green House adopters for sharing, learning, and celebrating the growth of The Green House model.  The Annual Meeting honors organizations for their commitment to create real home, empowered staff, and meaningful lives for elders. Sessions provide peers with an opportunity to reflect on lessons learned, revisit skills for coaching leaders, and build relationships to support sustainable change

Summer Fun 2013

This summer, Elders across the country in Green House homes took advantage of all that summer time has to offer.  There were old fashioned picnics, gardening, barbecues, concerts, car shows, and quality time spent relaxing on the porch in good company and good music. Elders in the Green House homes did it all.   Summer might be over, but you can still get a glimpse into the fun through the Summer Fun 2013 photo album.

Tell us about what you did this summer!



Seniors Aid New Hampshire at the Pioneer Network Conference

Last month, at the Pioneer Network 2013 Conference, a session entitled “Networking Elders to Provide Them with a Greater Voice,” engaged audience members by inviting Elders themselves to talk about their peer networking and advocacy work.  These Elders were introduced as members of an organization called “Seniors Aid New Hampshire” (SANH). They are a community of Elders that live in Nursing Homes, Assisted Living and Independent living settings throughout their state. With the help of a conference call line, they have joined together each month over the past seven years to host senators, state representatives and members of government agencies in addition to advancing their own community organizing and advocacy agenda. As a result of their organizing, these Elders even provided video testimony in a Senate Committee hearing regarding medication administration.

SANH began in the summer of 2006, when Elders living at different Nursing Homes and Assisted-Living communities in New Hampshire determined that it was “unacceptable for people to go to bed hungry.” The group was assisted by the  New Hampshire Health Care Association in creating a forum for fund-raising and communication to occur. In the early years this group called themselves “Seniors Feed New Hampshire” and in the first year alone raised $42K to assist the New Hampshire Food Bank. In later years the group gained momentum, changed their name and began to focus on other areas of interest that provide opportunities for meaningful resident work and creating communication between Elders living in different long-term care residences across the state.

The session at the Pioneer Network Conference was facilitated by Darlene Cray, a Long-Term Care Ombudsman and Statewide Volunteer Coordinator in New Hampshire and Mark Latham, Administrator of Pleasant View Center, a Nursing Home in Concord, New Hampshire.  In addition to the panel of SANH members, Kathleen Otte from the Administration for Community Living also joined by phone, as well as Jennifer Hilliard, Public Policy Attorney from Leading Age and representatives from Senator Larsen’s office. During the session, Darlene Cray reminded attendees that “When we focus on the ability of the individual, we see Elders.”

The American Healthcare Association and National Center for Assisted Living (AHCA/NCAL) named Seniors Aid New Hampshire as their 2012 National Group Volunteer of the Year.

New Toolkit to Help Communities Personalize Care in Nursing Homes

In November we will be celebrating the 6th Annual Green House Meeting and Celebration in Boston, MA.  THE GREEN HOUSE® Annual Meeting & Celebration is an event exclusively available to Green House adopters for sharing, learning, and celebrating the growth of The Green House model!  The Annual Meeting honors organizations for their commitment to create real home, empowered staff, and meaningful lives for elders. Sessions provide peers with an opportunity to reflect on lessons learned, revisit skills for coaching leaders, and build relationships to support sustainable change. One of the thought leaders presenting at the meeting this year is Dr. Kimberly Van Haitsma and we are pleased to share the below information on her latest project.

Kimberly Van Haitsma, Ph.D. is Vice President of Research at the Madlyn and Leonard Abramson Center for Jewish Life, North Wales, PA. After working as a nursing assistant in a nursing home, Dr. Van Haitsma decided to focus her career as a clinical psychologist on developing ways to improve quality of life for older people. For the past 20 years, she has directed research on understanding the needs and preferences of older adults living in their own homes and in long-term care communities. Most recently, she collaborated with the Advancing Excellence in America’s Nursing Homes campaign to design and test the new Person-Centered Care Toolkit described here.

 The New Toolkit

In May 2013, Advancing Excellence in America’s Nursing Homes, a national long-term care collaborative aiming to improve quality of care, launched a toolkit to help communities provide more personalized care for their residents (  The toolkit makes it easier for staff to learn about resident preferences, see how well care aligns with resident wishes, and problem solve when there are gaps.

The toolkit has two major parts. The first is an interview protocol that staff, including direct care workers, can use to ask residents about their preferences for personal care and recreational activities, as well as to gauge how satisfied residents are with the way their important preferences are addressed. The interview builds on information already collected as part of MDS 3.0 – Section F (Preferences for Customary Routine and Activities), by adding new questions that ask residents how satisfied they are with fulfillment of “very” or “somewhat” important preferences.

In the second part, staff record this information in a user-friendly, pre-programmed Excel workbook. This tool produces color-coded graphic displays showing when a resident’s preferences are being fully met (in green) and when preferences require further follow up (in yellow or red). Staff can use the results as the basis for discussion and problem solving during individual care planning conferences.

Also, the Excel workbook can show preference gaps affecting many persons residing together in a household. The tool allows staff to see “at a glance” particular preferences that are not being met for several individuals who live in a common location. Staff then can collaborate on strategies for improvement.

A final feature of the workbook is that it automatically calculates four person-centered care quality indicators. One measure shows the percentage of “preference congruence” (the extent to which a resident is satisfied with the way important preferences are met) for an individual, household or facility during a given month. Three other measures show the percentage of care conferences attended by residents, family or friends, and direct care workers in a one-month period.

The Advancing Excellence Person-Centered Care toolkit is available for free download at

Pilot Testing the Toolkit

Before Advancing Excellence rolled out the new toolkit nationally, Dr. Van Haitsma and her team led a pilot study in which 12 nursing homes tested the interview protocol and software and reported on their experience. The study offered a first look into rates of preference congruence, which averaged 67% for short-stay and 75% for long-stay residents across the nursing homes. 

What Do Providers Say About the New Toolkit?

Overall, pilot sites gave the toolkit strong positive ratings. In a follow up survey and interview, site coordinators said that the components were easy to use, and they would recommend the toolkit to others. Providers found many benefits:

Acceptability for residents, family and staff 

  • Nursing home residents valued the opportunity to give input about their preferences and satisfaction levels.
  • Families were impressed with communities’ commitment to quality of care, as demonstrated by taking the time to ask about a loved one’s preferences.
  • Social workers, recreation staff and direct care workers all found the tool easy to use.
  • CNAs enjoyed the experience of interviewing residents, and learning about their preferences before providing care.

 Enhances individual care planning and delivery

  • The toolkit increased understanding of person-centered care – interview protocols and data displays make this abstract concept more concrete.
  • The interview provided a conversation starter and a systematic way to get to know more about what is important to each resident. Ultimately, this can enhance relationships between residents and staff.
  • The software made it easier to share resident preferences with the whole care team, and the colors and graphics showed clearly what needed to be done for individual residents.
  • Quarterly interviews help providers stay up to date with changes in resident preferences or satisfaction levels.

Assessing care at the individual and household level

  • The toolkit’s graphic displays provided a useful visual resource to help communities know “what we are doing well and what we need to keep working on”. 
  • With new information in hand, staff identified previously unknown areas of preference incongruence at the resident level (e.g., desire for a bath versus shower) and household level (e.g., in one household, residents were dissatisfied with their access to the outdoors in good weather).

Already over 500 long-term care communities have downloaded the new tool. Dr. Van Haitsma and the Advancing Excellence team will study user experiences, and promote sharing of best practices across communities to strengthen person-centered care for residents nationwide.

For more information, contact Dr. Kimberly Van Haitsma,,  or visit the Advancing Excellence website at

Congressional Commission on Long-Term Care is told that Direct-Care Workers may be the Best Leaders of Interdisciplinary Senior Care Teams

via McKnights Long-Term Care News

For those of us steeped in THE GREEN HOUSE® Project core values, we have long recognized and honored the critical role that direct care workers provide every day.  Now members of the Congressional Commission on Long-Term Care have also learned about their vital importance.  Experts told the group during a public hearing in late August, that healthcare professions from different disciplines must develop teamwork skills—another foundational aspect of The Green House model:  Clinical Support Teams working with our Shahbazim as care partners. 

In response to a question from the commission  asking who is most suited to leading an interdisciplinary geriatric care team; the experts explained that doctors are “not necessarily” most suited for the task.  Panelist Tracy Lustig, DPM, MPH, senior program officer at the Institute of Medicine stated, “When it comes to long-term care, that’s not where the rubber meets the road, it’s really the people that are there on a daily basis.”

Click here to read the full article, and then tell us what you think…where does the rubber meet the road?