Green House Blog

The Skilled Nursing Development Opportunity – Aspiring to Something More

I read with interest a recent article in Senior Housing News- Developers See Opportunity as Old Nursing Homes Become Obsolete. It’s great to see not only that people recognize that the stock of 40+ year old nursing homes is not going to cut it, but to hear the sentiment that the replacement of old nursing homes is an opportunity. But when we think about replacing nursing homes, what are the key considerations? Are we making the most of this opportunity by re-thinking them, or are we simply sprucing up the same institutional approach?

For nursing home providers considering a significant renovation, the article makes the point to do your homework. “Given the relative aging of the post-acute care facilities, some providers are finding that it’s more cost-effective to develop new facilities rather than redesign multiple decades-old properties.”

Also think about the long-term value of your renovation investment – a renovated facility will look good today compared to what’s available, but how will it look against the competition in 20 years? How will it fare as consumer demands continue to evolve?

What I love about the nursing home model discussed in this article is that it’s designed to be a community gathering place. Most current designs and locations segregate their older population from everyone else. This is bad for everybody – Elders don’t get to interact with anyone other than other older people. And younger people don’t have the opportunity to appreciate Elders and to benefit from everything they have to offer. Creating a space that is inviting to the surrounding community, families and friends is a great idea.

On the other hand, I got the sense that at their heart, these facilities are potentially the same old institutional nursing home in a prettier box. In addition to community space, this design will have examination rooms, because that’s what physicians want. As I hear providers embrace the “hospitality” model, with cafes, wireless and flat screen TVs, I wonder if anyone has asked Elders what they want.

I’m also wondering about how these new nursing homes will actually work. Will the design make it easier for people to get around or will it still have long hallways filled with workers hurrying from place to place (albeit on nice carpet)? Will the culture put people first, or will it simply be the same institutional approach? Will the people who work there develop real relationships with the Elders who live there? Is it designed to maintain dignity and create meaningful lives?

There’s no doubt that these new nursing homes will be a huge upgrade over what’s currently available to most people. They’ll be more attractive, and more comfortable than facilities built in the 1960’s, but will the experience really be that different?

If you ask people where they want to spend their last years, they’ll tell you “home.” When Elders are admitted into institutional skilled nursing facilities, they want to go “home.” If an Elder is in long term care, being physically at home is no longer an option. So what can “home” mean in that context? First off, I’m pretty confident it doesn’t mean something that looks like a hotel. I think it means a place that is comfortable and is familiar, and allows them to continue to live their lives as they would if they were living independently. It means having opportunities to make the choices we all expect as adults – when to get up, when to have meals and what to eat, how we spend our time. It means being able to do the things that make life meaningful, and to be respected and known as individuals.

So when we invest in new skilled nursing development, don’t redesign something based on today’s nursing homes. Start with the mission and important values. Think about a design that will work better for Elders and the people who work there. Let’s not squander the opportunity to create something new. Let’s aspire to something better than more attractive institutions.

BBC Reporter Visits Penfield Green House homes in Rochester, NY

I was contacted by Sally Magnusson, a news anchor from BBC Glasgow and author, whose parents were both pioneers in UK broadcasting. She wrote a book called, Where Memories Go, about her mother’s journey with Alzheimer’s; and she is now planning a book about Alzheimer’s and music. She contacted Dan Cohen (Music and Memory) to visit a home in NYC that’s using iPods, and he suggested she contact me, so she wrote to ask if she could fly up and visit during her trip.

We got together Saturday night to talk about my work on Dementia Beyond Disease and I had suggested that she visit Penfield Green House homes while she was in town. Green House guide, Kris Angevine and the elders/staff nicely accommodated us on Sunday morning for tea. We stopped at Malek’s, my favorite bakery, and got a couple of chocolate babkas, as well as bringing copies of my book for the homes.

When we arrived, Wendy Bacon-Stopani, one of the wonderful Shahbazim, was making a birthday cake, as well as some chicken cordon bleu for lunch. She explained the Shahbaz role to Sally and the collaborative nature of the work, with everyone pitching in to help out. Wendy said she wasn’t a natural chef, but had learned a lot at the home, and it showed!!

We sat at the dining room table sharing coffee, tea, and babka with several elders, including Lou, Martin, Don, Frannie, Marguerite, and Sarah. We shared stories, and we got a house tour from Dorothy who is a great hostess. Lexi, the new house dog also joined in the visit — what a wonderful dog she is!!

Although Sally’s original plan was to talk to the elders about their experiences with music, it was really just more of a social visit and a non-directed conversation. Sally found everyone to be delightful and loved the home. It was a whirlwind tour of innovation stateside, that will surely be remembered by this BBC reporter.

For-Profit Provider Shares The Benefits of Choosing The Green House Model

“Why would you do anything else?”

That was the question posed by John Ponthie, Member of Summit Health Resources, a for-profit skilled nursing provider in Arkansas, who has embraced The Green House model on two campuses, and is about to start development of a third. He believes that the differentiation, risk mitigation, long term financial benefits, and culture change support from The Green House Project make the decision a “marriage of passion and economics.”

I recently had the opportunity to visit John’s beautiful campus in Magnolia, Arkansas along with a for-profit group looking to develop Green House homes in Missouri. After a tour and a delicious Arkansas barbecue with Elders and the staff, we sat down to learn why a for-profit operator would build Green House homes.

John’s Green House homes are located in a rural area of Arkansas where Medicaid is the biggest payer source, and his private pay rate is $15 less per day than Medicaid. He didn’t want to have to spend “his whole life attracting residents.” The decision to build Green House homes has been rewarded with occupancy rates in the high 90% range compared to a state average of 70%.

Risk mitigation was another reason for developing Green House homes. After careful consideration, he concluded that occupancy was his most significant risk. After a big investment in this business, he didn’t want another organization with a newer building or a better concept, to “trump” him. Green House homes are the pinnacle of skilled nursing innovation, and so highly differentiated from the competition, he believed that the model and its benefits protected the business from new entrants.

But what about the costs of Green House homes versus traditional skilled nursing facilities or other models? The team at Summit Health Resources focused on ways to manage development costs without cutting corners, keeping capital costs low. The key is finding someone who really knows construction, according to John. “Most people don’t know construction. And you have to come up with a design that makes sense.” The incremental cost of Green House homes, when amortized over 20 or 30 years, and taking into account the benefits, “is a no-brainer.”

According to John, The Green House culture and organizational change are the “magic.” The Green House Project helped create a culture focused on caring for Elders, and providing them with a meaningful life. Families spend more time with their loved ones, and are extremely involved with the activities in the home.

For the staff, the benefits are enormous. They are empowered to do their best for Elders. They feel a sense of pride, and that they are a part of something special. “Their commitment goes way beyond their job description,” according to John. In addition to having very satisfied employees, he’s been rewarded with very low turnover.

It was great to see the “magic” created in Magnolia first hand, and to hear John’s story. It’s truly a case of “doing good, while doing well!”

Veterans Service Representatives Welcomed by The Green House Project and Stadium Place

As policy makers discuss improvements in how health care is provided for our nation’s Veterans, the need for greater option for long-term services and supports is greater than ever.  The aging of the Veterans population will require a new vision.   Many of our Veterans require 24-7 care skilled nursing care.   In 2013, nearly 36,000 veterans resided in skilled nursing care facilities on a long-term basis.  Another 4,000 Veterans received skilled nursing care on a short-term basis.   In response to this growing need, Green House Homes are becoming increasingly available to Veterans.

The Green House Project was thrilled to host representatives from Veteran’s Service Organizations for a home visit at The Green House Residences at Stadium Place on July 14th.   Representatives from the Department of Veterans Affairs, VHA Central Office, Veterans of Foreign Wars of the U.S., The American Legion and Disabled American Veterans came together to learn more about how The Green House model  can serve our veterans with an innovative alternative for long-term care.

A Green House home is a self-contained, skilled nursing home where autonomy and choice are honored, quality care is a priority and people have more satisfying and meaningful lives, work and relationships.  Ten to twelve veterans live in each home.

The people who live and work in a Green House home collaborate to create a flexible living environment where each resident enjoys choice and independence.

Green House homes provide all the same services of a traditional nursing home, delivering an exceptionally high quality of care while keeping the emphasis on the comfort and well-being of the Elder.

The daily operating cost for Green House homes are the same as traditional nursing homes.  And the quality of care improves health outcomes, yielding real savings on healthcare costs.

This summer the Tomah VA Medical Center in Tomah, Wisconsin will become the fourth VAMC to open Green House Homes.  Later this year, the Green House homes at the Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin will open.  Click here to learn more about The Green House Project for Veterans.

Reducing Readmissions and Healthcare Costs: The Green House Solution

In a recent issue of McKnight’s, I saw this headline – “Reducing readmissions should be No. 1 priority for reducing healthcare costs, quality experts say.”    That was a key conclusion of a recent online poll from 300 members of the American Society for Quality (ASQ) , which describes itself as the “largest network of quality resources and experts in the world” and includes prominent long-term care quality consultants.

It doesn’t take a quality expert to realize that reducing preventable readmissions is a great way to reduce healthcare costs.  By definition, “preventable” means wasted money.  In addition to saving money, reducing readmissions improves the quality of life for Elders, by minimizing the stress and disruption hospital admission causes.

Another article in McKnights from a couple of months ago suggests that pressure ulcer stats are the most reliable indicator of the likely readmission rate from a particular nursing home.  Based on an analysis of data from 4,000 hospitals, HSR: Health Services Research found that pressure ulcer prevalence in particular predicts whether a nursing home will readmit residents.

Can Green House homes help reduce readmissions?  The answer is a resounding “yes!”  In preliminary research (a complete study will be available later this year from the THRIVE research team), traditional nursing homes had readmission rates that were 7 points higher than Green House homes.  A related study found that the incidence of pressure ulcers in Green House homes was “significantly lower” than the incidence in traditional homes.

The bottom line?  The THRIVE research team concluded that the “overall difference in total Medicare and Medicaid costs per resident over 12 months (sum of hospitalization and daily care costs (RUG costs)) ranged from approximately $1,300 to $2,300 less for residents in Green House vs. traditional nursing homes” depending on RUG rates in the state.

First Green House Homes in Minnesota Officially Open!

Despite the long winter and flooding in Minnesota this year…the ribbon cutting ceremony at Water’s Edge on June 26th was a real success.  The first Green House homes located in Mankato, Minnesota will be welcoming Elders in mid-July.  Congratulations to all!

The three story project, with an assisted living Green House home on each floor, was developed and will be operated by Grace Senior Services.  Owners, Brad and Heather Bass along with their children and other city officials were all on hand for the grand opening event.

Water’s Edge is located on the Mankato hilltop and will offer wonderful scenic waterfront and woodland views.  Of course every Green House home also offers private bedroom and bathrooms for Elders, a central hearth area, full kitchen with home cooked meals, and a dining room area.  It can be chilly during those Minnesota winters, so Water’s Edge will also include heated bathroom floors and a “four-season sun porch” for each home.

The Director of Operations for Water’s Edge will be Brooke Olson.  The initial team to staff the first home is currently receiving their 128 hours of additional training to their current certification as a nurse, licensed practical nurse or nursing assistant.

The supplemental training is a hallmark of The Green House model of care.  The people who live and work in a Green House home collaborate to create a flexible daily routine that meets and Elder’s needs and preferences.  If they wish, Elders can help cook, and assist with housekeeping or laundry.  There is no predetermined routine, which facilitates independence and an Elder’s ability to pursue individual interests and schedules.  Deep relationships between the Elders and staff are one reason that the Green House model creates dramatic improvements in quality of life and care.

Capital Impact Partners was critical in the development and funding of Water’s Edge.  They provided $1.5 million in financing for the project:  One million from the Robert Wood Johnson Foundation’s program-related investment (PRI) and $500,000 from the AARP Foundation PRI funds.  Capital Impact Partners, a congressionally chartered, non-profit community development finance institution provides financial services and technical assistance nationwide to help make high-quality health care, healthy foods, housing and education more accessible and attainable, and eldercare more dignified and respectful.  Water’s Edge owner Brad Bass was most pleased to work with Capital Impact Partners, “You have a great program and excellent staff.  I could never have done this without all of your extensive resources!  Not to mention the funding that was really the igniter to get this development going”.

We wish the team at Water’s Edge only the best as they welcome their Elders into the Green House homes during the upcoming weeks!  Again, congratulations to all!

Technology: Where do we go from here?

Via: Long-Term Living Magazine

Many of us are always trying to determine what technology makes the most sense for our organization…it’s an important issue for day to day operations and of course it has real financial implications.

The Long-Term and Post-Acute Care Collaborative has announced its 2014-2016 Roadmap for technology adoption.  In light of a world filled with devices to keep us connected, it isn’t surprising that many parts of the roadmap deal with that specific issue:  staying connected!

The roadmap was unveiled on the final day of the Long-Term and Post-Acute Care Health IT Summit.  There are five key sections: connected workers, connected partners, connected residents and caregivers, connected health intelligence and connected business imperatives.

Click here to read the full story!

Dancing Reduces Pain

If you have knee pain, try dancing the aches away. As reported in Mcknight’s, Saint Louis University’s School of Nursing released a study of elders who complained about knee pain or stiffness in their joints. The results showed that those who danced reported less pain.

“The researchers separated the senior residents into two groups — one group that danced for 45 minutes up to two times a week and another group that did not receive any kind of dance therapy. On average, those in the dance group attended 21 out of 24 sessions.

Results showed that participants in the dance group were able to walk faster and reported less pain. In addition, residents in the dance group took 39% less pain medication while participants in the non-dance group took 21% more medication.”

Although this was a small study consisting of 34 participants, with an average age of 80, “the dance therapy sessions became a regular program after the study was finished.” They plan to continue researching the benefits of dance on the body’s joints.

Click here to read the published study, and don’t stop dancing!

Registration Open! 7th Annual Green House Meeting & Celebration

 

Dust off your cowboy boots, brush up on your Elvis impersonation and save room for some of the country’s best BBQ!  The 7th Annual Green House Meeting and Celebration for Green House adopters is going to be in Memphis, Tennessee on November 17-19. 

This year’s conference will take place at the historic and incredibly beautiful Peabody Memphis hotel. The Peabody Memphis is located near Beale Street, a melting pot of delta blues, jazz, rock ‘n’ roll, R &B and gospel. That’s where music legends like Louis Armstrong, Memphis Minnie, Muddy Waters, and B.B. King made their mark.  It’s no surprise that Memphis is known as Blues City.

Our site visit this year will be to Ave Maria in Bartlett, TN where there are four Green House homes- St. Francis, St. Anne, St. Joseph and St. Mary. These homes replaced an aging nursing home wing (circa 1956) and have allowed Elders to thrive in real homes that offer meaningful life and empowered care partners.

This year’s theme, Leading with Heart and Soul, will flourish amid this magnificent mecca where musical legends combined soul with talent and passion to become the pioneers for American musical genres.

The Green House Annual Meeting & Celebration is an excellent opportunity to connect with fellow Green House pioneers, to learn, grow, and leave inspired to lead well, as we continue to champion change that meaningfully impacts the lives of Elders.