Green House Blog

The Heart of The Home: Elders and Staff

Last year, when Claremont, CA resident Bill Andrus began to need 24-hour care in their home, he and his wife, Georgeann, chose Mt. San Antonio Gardens’ Evergreen Villas for his new home. The Villas are trademarked  GREEN HOUSE homes, which provides a real home for people needing skilled nursing care. In each of the two villas, the residents are supported by a small, self-managed team of care partners, known as shahbazim, and nurses. Mt. San Antonio Gardens pioneered what are California’s first and only small homes licensed for skilled nursing.

“We wanted Bill to live in a stimulating environment while receiving the care he needs,” says Georgeann. Acknowledging the difficulty of making that decision, the couple feels fortunate that the Villas were an option for them. Georgeann, who served on the Gardens board of directors for six years when The Green House homes were being considered, says, “We are so grateful for Bill to be part of it. It has been particularly heartwarming to see this from the initial concept and then to participate in the reality of seeing it work very well.”

Bill and Georgeann Anrus
Bill and Georgeann Anrus

While Bill was settling in, Georgeann applied to live at the Gardens as an active, healthy independent resident. She moved into an apartment on campus where she takes a quick walk to the Evergreen Villas. Living on the same campus means easy and frequent visits each day. The couple goes together to lectures and performances held at the Gardens or at the nearby Claremont Colleges. “Our neurologist had said to me, ‘Now you can just be a spouse, not the caregiver’, and he was so right!”

“Bill has become physically stronger since his move here,” marvels Georgeann. The special design of the great room has inspired Bill to use his walker, unassisted. The couple also credits the home-like atmosphere and the personalized attention of the shahbazim and nurses to his continued well-being. Because this team works so closely with such a small group of elders, the care partners get to know their personalities and individual needs and preferences intimately. While the shahbazim are also responsible for cooking and maintaining the house, their first priority, Georgeann notes, is always the care of the elders.

“The people are the best thing,” says Bill, who especially enjoys sharing common interests with Registered Nurse (RN) Michael Sansosti. Both are avid readers and love fishing.

Michael and Bill Reading for screen only 100 dpi
Bill and Michael reading

“It’s great,” says Michael. “We trade books and when I have some extra time in my schedule, we’ll spend time talking about them.” The ability to give everyone a little extra attention is very gratifying. Michael, who previously worked in structured hospital environments, enjoys the opportunity he now has to cultivate more personal friendships with the residents he cares for. “Certain people, like Bill, do very well in this kind of setting. It is especially well suited to those who prefer to take the initiative for their daily activities” and who enjoy the interaction and activity that is such an important part of the daily experience in the Evergreen Villas, according to Michael.

Working with the caregivers is also a new experience for Michael. “We work side by side with the shahbazim. While the RNs are in charge of everything clinical, the care partners spend all of their time interacting with the residents, so they can give us feedback on their behavior and needs, enabling us to intervene early.”

 

Amanda, shahbaz, and Michael, nurse, work together
Amanda, shahbaz, and Michael, nurse, work together

“Communication is a big thing here,” acknowledges shahbaz Amanda Phos, who began her training for her role long before the Evergreen Villas opened. With just 10 elders in each of the two Evergreen Villas, the care partners get to know each person personally, from their life stories to their health needs and abilities, their food preferences, and their hobbies and interests. “If you know the elders well, taking care of them is very easy,” says Amanda. “I think that’s the beauty of this place. We base each day’s activities on what they individually want to do. And every day is different. When we all come together around the dinner table, we like to talk about the day’s activities. It feels like a family.

 

“It’s hard work, and it takes a team to make it work so well,” says Amanda. “We’re the heart of the home, and that makes it very gratifying to be here.”

 

End of Life Counseling: Medicare soon to cover the costs of those discussions with your doctor

elder shahbaz hands 1Plans to reimburse doctors for conversations with Elders about what to do about end-of-life care has been talked about for years–and at times a very controversial topic–but it appears Medicare is ready to implement that change.  Currently they are gathering public comments and if approved, would take effect in January.

It’s a proposal applauded by many because they believe people should have a greater say about how many medical options they want used to stay alive such as a ventilator or feeding tube.

atul-beingmortal-cover3d1-319x479It’s a topic close to the heart for Dr. Atul Gawande, author of the book, “Being Mortal: Medicine and What Matters in the End“.  He challenges people to think carefully about the decisions they make for themselves and their loved ones at the end of life.  In his book, he examines the loneliness, helplessness and boredom so often experienced by those living out the end of their lives in long-term care institutions and he argues that this should not be the norm in our country. He writes that Green House homes are “…designed to pursue that idea that a life worth living can be created…by focusing on food, homemaking, and befriending others.”

A final decision on the proposal is expected by early November.  It would allow qualified medical professionals to be reimbursed for face-to-face meetings with patients.  Read more about the plan using the following links:

New York Times  Medicare Plans to Pay Doctors for counseling on End of Life

McKnights  Providers Applaud CMS Proposal to Cover Advance Care Planning

NPR  Medicare Plans to Pay for Voluntary End-Of-Life Counseling

 

 

 

Buckner Westminster Place Earns National Recognition

 

U.S.wes wells with plague News & World Report awarded two of Buckner’s Green House homes in Longview, Texas with a four-star rating in its annual Best Nursing Homes issue.  Congratulations to all!  The magazine rated almost 16, 000 nursing homes across the country.  The ratings are awarded by looking at the data collected in the homes.

Administrator and Guide for the Buckner homes, Wes Wells, explained that the rating was the result of a number of resident surveys.  “(U.S. News & World Report) didn’t come out here and look at us,” Wells said. “They looked at our measurements based on assessments that we have to turn in.”

cropped buckner celbration pictureA special celebration occurred in late July to show the plagues to all involved and thank everyone for their contributions to the success of the homes.  In fact all staff members were treated to a steak dinner in honor of this special distinction.

Click here to read the entire article from the Longview News-Journal.

Click here to see a video of the celebration from the local CBS affiliate.

 

Washington County Nursing Home in Colorado Breaks Ground On New Homes

grnd brkg 075grnd brkg 113Congratulations to Washington County Nursing Home! They have recently broken ground on four new Green House homes. They took a moment to celebrate with a groundbreaking ceremony at the end of July.  These Green House homes will be a total replacement of the current county nursing home and provide long term care to residents in Washington County, Colorado.

Washington County celebrated this milestone with a ceremonial groundbreaking at the construction site followed by an outdoor barbecue at the current nursing home. This event brought together many of the supporters who are making these Green House homes a reality including county commissioners, board members, nursing home staff, elders and community members all celebrated together. You can read more about the festivities and the Washington County Nursing Home here.

Pioneer Network Highlights The Green House Project as Thought Leader

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Rhonda Wolpert, Rob Simonetti and Debbie Wiegand share Design Lessons Learned

The Green House Project was highlighted as an innovator and thought leader during the 2015 Pioneer Network Conference.  The Pioneer Network is a convener of organizations who are moving away from institutional models of long term care to more consumer-driven models that embrace flexibility, self-determination and a belief that elders are meant to thrive.  During the stimulating days of educational sessions, representatives from the national Green House initiative, and Green House organizations from around the country spoke on various topics to help move the field forward.

Debbie Wiegand, Rhonda Wolpert and Rob Simonetti shared design lessons learned in their session, “Build This, Not That, Lessons Learned from a Decade of Green House Experience.”   Since the first home opened in 2003, there have been variations in layout and design. Through a formal Design Survey, The Green House Project asked every Green House adopter what works and what doesn’t for building design and regulatory challenges, and what strategies worked to overcome perceived regulatory code barriers. Also, insights from newly completed THRIVE research help us understand how the design contributes to sustainability, from operating cost and quality of care perspectives. Listen to this webinar that Debbie and Rob did to help those interested in changing the paradigm of long term care, build environments that support a new way of life.

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Cheryl VanBemden, Marla DeVries, and Susan Frazier take us into the “black box” or Green House

Susan Frazier, Marla DeVries and Cheryl Van Bemden took audience members “Into The Black Box of Green House homes”.  Here they talked about the impact of decision making to reinforce or erode culture change. Utilizing new insights from The Research Initiative Valuing Eldercare (THRIVE), a collaborative of top researchers created to learn more about what contributes to higher quality in nursing homes, this session explored the factors impacting problem-solving in long-term care organizations that lead to reinforcement or erosion of an empowered workforce, and person-centered models. Participants explored the four factors that the research determined to most greatly impact sustainability, while discovering organizational strengths and growth opportunities to create a slip-resistant change.

JHL
Tammy Marshall, Mirian Levi and Lori Grossman from Jewish Home Lifecare

Tammy Marshall, Lori Grossman and Miriam Levi shared their experience of implementing person-centered care principles across Jewish Home Lifecare, a large organization with multiple sites.  Tammy Marshall facilitated a second session with Sonya Barsness.  They spoke about the importance of research to support “culture change” and “person-centered care.” They shared research that is being done at Jewish Home Lifecare, and how others can access research, translate it to those who need it most, and identify opportunities for additional research.

Marla Speaking
Marla DeVries speaking about Research and Sustainability

Finally, the team from Lutheran Homes of Oshkosh shared a special session called, “Honoring the Spirit Within Through Namaste Care: An End-of-Life Program for Persons with Dementia”.  Namaste Care takes its name from the Hindu word meaning “to honor the spirit within.” The program was developed for elders with advanced dementia and strives to maintain their highest quality of life. It includes simple and practical ways for care partners to create opportunities for connection, meaning, and joy.

This conference is always an energy boost, knowing that the movement to transform long term care, and what it means to age, is growing, evolving and gaining momentum.  The Green House Project is honored to be a leader of culture change and will continue to pursue evidence based excellence, that is based in deep knowing relationships, meaningful life and empowerment for all.

 

 

 

 

Short Term Rehab in The Green House Model – A Case Study

Leonard Florence Center for Living

6x7X3CrHokb6SwAIWDKUKSWCpdd6M78Ay_XOPVuW9LcThe Green House model  was originally designed as a long term care solution where  elders could live for the remainder of their lives. Leonard Florence Center for Living (LFCL) has expanded their Green House homes to include three short term rehab homes within their ten home building in Chelsea, MA. In the webinar, Short Term Rehab in the Green House Model – A Case Study, Ina Hoffman, Director of Admissions, and Jill Tura, Director of Rehabilitation, describe how short term rehab can be delivered in a real home environment, and highlight their positive clinical and financial outcomes. Their decision to incorporate short term rehab into their Green House homes outlines how providing this service has made them   a preferred provider in the community and creates a highly attractive environment that increases consumer demand.

In order to provide high quality care to elders and those who living with diseases such as  Multiple Sclerosis or Amyotrophic Lateral Sclerosis, LFCL needed to create a financial situation that  would enable them to serve Medicaid recipients, while managing organizational needs.   Incorporating short term rehab into their Green House homes provides financial balance to their building and allows individuals to receive short term CF00eJRB_q1f5bqRESlaGAnrAXs_IbIOBlU-ZcNFcTYorthopedic, cardiopulmonary, neurological, or medical rehabilitation in a real home environment. Currently, LFCL has up to 30 individuals receiving short term rehab at any given time, averaging 45 admissions per month. Through strategic marketing, seeking connections with Boston area hospitals and Accountable Care Organizations, and referrals from elders and their families, they became a choice provider of short term rehab in their community – and a reputation that proves it.

 

“There are not many places that can do what we do.” Ina says when describing short term rehab in a Green House home as an “Occupational Therapist’s dream.” Rather than stimulating home-like environments, functional, practical therapy is provided seven days a week in a real home to ensure maximum safety and success upon discharge. Those who come to LFCL for rehab  practice activities of daily living with their core rehabilitation team in the common areas of the home, while more personal tasks such as bathing, dressing, and toileting can be done in the privacy of their own bedroom and bathroom. The Green House environment fosters a sense of community and family within the home.  The members of the house encourage each other during therapy sessions, discuss therapy goals and frustrations over meals, and exchange telephone numbers when they return to the community to keep in touch beyond their stay. Because LFCL is within the larger Chelsea Jewish Foundation, when a person is ready to transition to in-home care, they can continue to receive therapy from the same core team, allowing for a continuous, efficient transition of care.

 

By incorporatingD_YEvbOIK7ASoF2DEyGTUyKUR795WiRz3exvUwkEzps short-term rehab into their Green House homes, LFCL created a financial strategy that “keeps the building going.” Short-term rehab created an opportunity to stay true to their mission while providing high-quality, integrated care with positive outcomes, including decreased length of stay, higher overall satisfaction, and decreased rehospitalizations.

 

Interested in learning more about short-term rehab in Green House homes? <<Listen to the webinar recording here>>