Green House Blog

Tomah VA Medical Center Opens Two New Green House Homes

The Green House Project is proud to say that two new Green House homes have opened in Tomah, Wisconsin at The Tomah VA Medical Center. On August, 13th The Tomah VA celebrated their home openings with a Ribbon Cutting Ceremony.

Mario V. DeSanctis, the Medical Director at Tomah VA Medical Center remarked, “This is the future of skilled nursing care and we are proud to join the Danville VA (Ill.), Lovell Federal Health Center (Ill.) and Milwaukee, Wis., in providing this new concept of care for Veterans.  We believe this transformation of care will dramatically enrich our Veterans lives and the lives of the next generation of Veterans.”

Tomah VA Medical Center has named their homes Patriots’ Place and Heroes’ House. These  two homes will serve veterans in need of skilled nursing care.  Veterans will move in during the month of September.  You can read more about the Ribbon Cutting Ceremony for the Tomah VA Medical Center here.

The Ribbon Cutting Ceremony was also highlighted on WKBT News, you can see the news clip here.

Thought Leaders in Aging Gather at the 2014 Pioneer Network Conference: THE GREEN HOUSE® Project Leadership Among Those Presenting

“Journey to the Heartland” was the theme for the 2014 Pioneer Network Conference held last month, and many indeed made the journey!  Over 1,200 people made the trip to Kansas City for a chance to network and learn with others who are deeply committed to the cultural transformation of long term care.  The Green House Project is a true trailblazer in this movement and we are strong supporters of the conference.  Green House team members, David Farrell and Susan Frazier were presenters at two different sessions during this national event.

Nurses have a critical role to play in supporting deep transformation within aging services.
“Nurses Building Relationships for Organizational Transformation” was a session co-led by Susan and former Green House team member, Anna Ortigara who is now with PHI.  Both Susan and Anna are nurses and can speak first-hand about nurses engaged in culture change.  The session discussed the need to build effective communication strategies that will engage both the Elders and direct care staff members.  The discussion also explored how nurses as leaders, partners, gerontological specialists and teachers are faced with many more opportunities to enhance quality of life and quality of care.   The Green House model is designed to support Clinical Support Team Members, which includes nurses, in developing partnerships with individuals and self-managed work teams.

“THE GREEN HOUSE Model –Delivering Quality of Life and Bottom Line Results” was the special research session delivered by David to attendees.  He confronted the myth that The Green House model is not viable—with over 150 Green House homes operating in 25 states, the innovators who adopted the model are happy with their consumer satisfaction and their bottom lines.  David shared data from operating Green House homes that demonstrates an excellent return on their investment, and their decision to build even more Green House homes.  He told the group that Green House homes are delivering the results that Accountable Care Organizations (ACOs) in health care reform are looking for today.

 

"Gaming the 5 Star System"

It was disheartening to read the NY Times story this week about the CMS 5 Star rating system. Such reporting leaves both the providers and the consumers asking, “If a 5 Star nursing home isn’t a 5 Star nursing home … then does that mean that a 1 Star nursing home isn’t a 1 Star nursing home?” “Hip, hip hooray,” say the 1 Star homes. “I told you that those 5 Star homes weren’t better than us. They just game the system.” Wow!

The article asserts that nursing home leaders game the 5 Star system in two ways – 1) By falsely documenting better clinical outcomes via the Quality Measures; and 2) By staffing up during the survey and then reducing staff after the inspectors are gone. I would like to address both.

Regarding the accusation of gaming the Quality Measures (QMs) – consider that the QMs are calculated from each of the residents’ Minimum Data Set (MDS) assessments. The MDS is part of the federally mandated process for clinical assessment of all residents in Medicare and Medicaid certified nursing homes. MDS assessments are required on admission and then periodically throughout their stay. The participants in the assessment process are licensed healthcare professionals including RNs, therapists, dieticians and social workers. MDS assessments are legally signed by these professionals and submitted electronically to CMS. So … are these professionals falsifying the coding of the MDS in order to game the QMs? No way!

Regarding the accusation of staffing up – it may be happening. Let’s start collecting payroll data in order to ensure accurate reporting and that nursing homes are consistently, appropriately staffed.

Another solution is for providers to adopt innovative, evidence-based models like The GREEN HOUSE® model. One of the essential elements of the model is higher direct care staffing than traditional nursing homes. Traditional SNFs average about 2.50 C.N.A. hours per resident, per day (HPPD) compared to Green House homes that average 4.00 HPPD. Green House homes are able to provide this consistent, high level of staffing by utilizing a versatile caregiver service approach. And organizations that follow The Green House staffing and organizational model can deliver high quality care at a cost that is no more than a traditional institutional nursing home.

The elders depicted in the article were in need of short-term rehabilitation with a plan to get back home. Green House homes focused on short-term rehabilitation are achieving great results. Elders rehabilitating in Green House homes experience fewer rehospitalizations and typically get back home 10 days sooner than the elders in traditional, post acute SNFs. The Green House model, with its’ unique approach to care and staffing, plays a key role in these outcomes.

The vast majority of Green House model adopters are 4 and 5 Star nursing homes and they deserve the high ratings. But, if the goal of the Five Star rating system is to guide consumers to the best performing homes, perhaps CMS should add a specific mark of excellence designed to identify providers that have adopted innovative, evidence-based models like The Green House model.

CMS currently cautions consumers to be wary of certain nursing homes that have had consistently low performance via a Special Focus Facility designation next to their name on the CMS site. I’m sure consumers appreciate the chance to steer clear of the lowest performers. Let’s find a better way to direct them to the best.