Green House Blog

Disparties, Racism & Ageism Amid COIVD-19

The Elevate Eldercare podcast this week is most timely given the headlines concerning protests about social injustice in Wisconsin. Susan Ryan, Green House Senior Director, interviewed Karyne Jones, the president & CEO of the National Caucus and Center on Black Aging (NCBA). It was amazing the wide variety of topics they covered – everything from COVID-19 and the health disparities that exist among people of color to the devastating impact of social isolation, our shared humanity, and implicit bias.

For those of you are not familiar with NCBA they are the preeminent national organization on issues impacting African Americans age 50 & over. They have three areas of focus: employment, health and wellness and housing. I was struck by Karyne’s description of their mission to provide affordable housing and their philosophy with health and wellness. Many of their concepts match the work we do at The Green House Project. We want Green House homes to be available to all regardless of their ability to pay. We believe elders should direct the life they live in the home and the importance of their voice at the table. In fact, NCBA was established 50 years ago as a result of leaders from a few African American nursing homes who wanted the voice of black communities included in the creation of the Older Americans Act. President Nixon agreed and their successful participation in that work made them decide they should form an organization to address all kinds of issues that affect older African Americans and older poor people who want to improve their life – thus, NCBA was formed.

And while none of us like the pandemic, for Karyne and their organization it has shined a light on the health disparities for those in poor, racial communities. In terms of the issues around police brutality she explained that racism, – and classism are things they have dealt with over the years. The good thing now, she explained, is that people are asking NCBA for ideas, on how can they address the problems – and she said, “we welcomed that”.

Both Marla and I teach a class that discusses how important self-awareness and self-management are to each person. What are the biases we might have? What judgements do we hold? So, it wasn’t a surprise to me that Marla took at special interest in the discussion of implicit bias. It’s not a term we all use, and the information is good to have during these times, especially if you are looking to learn more about yourself. Marla shared information on a unique graph by a doctor entitled “Becoming Anti-Racist”.  Take a look at the graph and assess yourself. Be honest and take this opportunity to grow!

Karyne also talked about our need to help others and stated, “It’s our humanity to make sure that we help people”. To me that is such a beautiful phrase. What better feeling can you possibly have than when you offer your assistance to someone who could use your skills or talents – it’s such a wonderful gift. When you have one community suffering, she went on to say, it drains another community. There’s an opportunity for us to shift from being independent to understanding our interdependence of one another. Some might consider that a real paradigm shift for our humanity, to embrace compassion, to be empathic and support other people, I believe we are capable. I feel Shahbazim in a Green House home do it every day. They give to the elders and the elders give back. There is such a wonderful “interdependence” in the home.

One final word about NCBA – they have one awesome newsletter. Seriously, it is filled with such good information, it’s worth taking a look at it. Hope you’ll listen to both podcasts, Elevate Eldercare with Susan and Karyne Jones and Let Me Say This About That with Marla and me. Enjoy learning and growing!

How They Made the Mold

We had a trip down memory lane and the inside scoop from two innovative

The first Green House home in Tupelo, MS.

leaders on the most recent Elevate Eldercare episode. Susan interviewed the creator and founder of The Green House Project, Dr. Bill Thomas, MD, and the CEO of Methodist Senior Services (MSS), Steve McAlilly. MSS pioneered the first Green House homes on the campus of Traceway Retirement Community in Tupelo, Miss., in 2003.

It almost didn’t happen at Traceway. MSS had dedicated funds, to the tune of 12 million dollars, to build what would have been a pretty traditional facility. Emboldened by the vision Bill cast, Steve persuaded the board to take a leap of faith. We often talk at Green House about building the bridge as we walk across it. I guess that DNA harkens back to when Traceway “made the mold,” to quote Bill.

Among our favorite questions at Green House are: “Would you have it at home?” and “Would you do it that way at home?” These questions were birthed years ago as the Tupelo team wrestled through what should go into those first homes.

There is this constant pull between Real Home, a Green House core value and an institutionalized way of doing things, which we call institutional creep and often refer to it as the institutional dragon always lurking just outside the home. Bill said, “it is always, always, always easier to do things the usual way…. The pressure to conform to the traditional system is enormous and it never lets up.” But pushing the easy button doesn’t ultimately get us to how Steve describes Green House homes: “a vessel that enables life and living and loving and learning together.”

More than just a history lesson on Green House homes, the conversation moved us to consider how to not waste a pandemic. I love that Steve said, “It is a sin to not do as much as we can as fast as we can; the real sin is apathy. The sin is accepting the status quo and not acting to change it.”
The pandemic has shed a light on long-term care and rather than vilify “traditional” nursing homes we need to seize this moment to do something different. Both Mary and I resonated with what Bill described as, “big house, small life, small house, big life.”

When it comes to the deep knowing of elders, reciprocity, interdependence, building community, and autonomy and control, smaller is better. I think there is opportunity for any long-term care organization to consider how they might take bigger sections of their homes and make them smaller.

On our podcast I got to share one of my favorite books, “Community: The Structure of Belonging” by Peter Block. Whether you work in long-term care, are a part of a church, social group, or a neighborhood, there is application to you. Bottom line—we need to be intentional about creating community. It doesn’t just happen.

In 2008, Block wrote that we live in an age of isolation. That is even more true in this pandemic era. What Thomas, McAlilly, and Block teach us is that we can author a different future for our elders and for ourselves if we seize upon this opportunity to shift the paradigm once again.

For even more insights and takeaways, take a listen to the original interview and then join Mary and me for, “Let Me Say This About That.”
>>Listen HERE on Apple Podcast
>>Listen HERE on Spotify
>>Listen HERE on Stitcher








A Nurse Says, “Safety Third”

We could entitle the latest “Let me say This about That,” Nurse-Speak for Dummies as Mary Hopfner-Thomas, my co-host, and I (two non-nurses) unpack the conversation between two nurses, Green House Senior Director Susan Ryan and Tammy Marshall, chief experience officer at Thrive Senior Living. Tammy said, “There is a way of knowing that nurses have…that is unique to our profession…it is the gift of this time, because it is addressing the invisible needs of a person.” Their discussion, on episode 3 of Elevate Eldercare, echoes a guest column in McKnight’s in which Tammy said that nurses will see us through the pandemic. The focus of the conversation was not on the technical skills of nurses, but rather how to couple the technical skills with the human element—to see each person and support their individual needs, the task of nurses and non-nurses alike. 

Tammy Marshall, chief experience officer, Thrive Senior Living

As Tammy shared, COVID-19 has given us a magnifying glass and exposed the good things as well as the challenges in economics, leadership, long-term care, and basic humanity. 

Mary and I reflected on their conversation as a discussion in contrasts: Pathogenic vs salutogenic, adaptive vs technical leadership, and certainty vs ambiguity. I was fascinated to learn new terms from Tammy and then dive deep into the origins and applications in today’s world. Pathogenic is the treatment of the disease and it’s the most common way healthcare is delivered in our Western society. But Tammy reminded us that the U.S. is the most flagrant user of pathogenic model with regard to COVID-19. It would appear we keep using the same method and expect different results. Isn’t this the definition of insanity?

I was fascinated by Tammy’s mention of salutogenesis, so I did a deep dive into it. I learned that Microsoft Word does not recognize as a real word, as evidenced by the red squiggles appearing each time I type the word. Salutogenesis is defined as the “origins of health.” It was coined by Aaron Antonovsky in the 1979 book, Health, Stress and Coping. The chief question in the salutogenic model is “what makes people healthy?” Tammy answered this with a harken back to the basics of nursing a la Florence Nightingale: good nutrition, fresh air, sunlight, sleep, and movement. 

Mary was particularly struck by the simplicity and yet brilliance of this basic approach, and we agreed that a good question we can all ask is, “What would Florence do?” Imagine if long-term care providers approached care by seeking to answer the question, “What is the most healing environment for each elder?” and “How might things be different?” These questions move us into what Tammy described as “adaptive leadership.” It’s about asking the right questions and believing there is more than one right answer. It pushes us toward creativity. 

As Tammy described the steps she and her team took communicate with elders and staff, she noted that “we crave certainty.” COVID-19 has given us a lot of uncertainty and ambiguity. What is open or not open, how do we best stay safe, will schools open or not, should we or shouldn’t we do X, when will this end? I loved how Thrive Senior Living developed a compulsive communication strategy to give as much certainty as they could, with a measure of openness and transparency.

As part of our discussion on surplus safety, Mary and I shared one of our favorite Atul Gawande quotes from his book, Being Mortal: “We want autonomy for ourselves and safety for those we love.” As Tammy notes, safety needs to come in third, not first, as is the case in so many nursing homes. That discussion got me thinking—I’m blessed to be a grandmother to a wonderful almost one-year-old. A couple weeks ago I babysat her, and she crawled to her favorite end table with the coasters she loves to bang on the table. She was standing, but not quite an independent walker. She lost her balance, fell, and hit her toothless gums on the table. There was a looong silence before the heart wrenching wail. And there was blood. Never, ever, ever did I want I my precious granddaughter to experience pain or injury. But I do want her to walk independently, to gain confidence in herself, to know that if something happens, I will be there to love and support her. My job as grandma is to love her, foster her growth and development, and keep her safe. Safety third. 

How can we get more comfortable with that kind of an approach with elders? I know there are so many things about how the one-year-old and the frail 90-year-old are different. And yet, they, like all of us, may not be as different as we want to believe. In my opinion, safety third could be a gamechanger in long-term care. The Green House Project’s Best Life approach to supporting elders living with dementia calls this embracing the dignity of risk. 

On “Let Me Say This About That,” I introduced Tammy as a thinker and as someone who challenges me to think. She certainly delivered on that account and I hope Mary and I will likewise challenge you to think deeply about these important topics. In fact, you may want to go back the original Elevate Eldercare podcast and listen to the Susan and Tammy discussion one more time!

Listen to the podcast here:

Apple Podcast): https://lnkd.in/dxMNKrB

Stitcher: https://www.stitcher.com/podcast/elevate-eldercare

Spotify: https://open.spotify.com/show/6Exvwt070aeATvAC0uxFmo…

Marla DeVries is director of resource development for The Green House Project and cohost of “Let Me Say This About That,” the Friday Recap of the Elevate Eldercare podcast.

Dementia-ism, Grace, and the Value of the Outdoors

In our Friday recap of this podcast, “Let Me Say This About That,” Marla and I take a wonderful journey to further explore what Dr. Wright would like to accomplish. We discuss how he will use his voice and why we see his 25 years of experience as a way to help pave the path toward a better lifestyle for all elders.

A tragic and overwhelming loss of more than two dozen elders at a nursing home in Virginia due to COVID-19 propelled its medical director to use his voice to educate the media—and to crystalize his goals for a unique community designed for elders living with dementia. Dr. James Wright is that medical director. I believe you’ll be impressed by his passion and determination to set the record straight and his candid explanation that we live in “a society that feels that they can ignore their elders, warehouse their elders, especially those that are poor, especially those that have dementia.” Strong words, but he is ready to be the advocate that uses a devasting situation to significantly enhance the life of elders, especially those living with dementia. COVID-19 for Dr. Wright was a back-handed gift to provide that sense of urgency for him.

He has three distinct principles that guide his vision, and some may surprise you. Why would outdoors be on the list? And why might he suggest that federal/state surveyors, often the group of people who only seek out what is not being done correctly, be the group that should become mentors and guides to support the staff at nursing homes? Can you imagine welcoming surveyors to your community instead of being concerned about their arrival? Oh…and what about community integration at a community for people living with dementia? We are not talking about just childcare on campus, or a café, but what about a brewery and lots and lots of open acreage? Not what most would envision when thinking about a community to support the growth and care of elders…especially those with dementia. However, you might find yourself asking “Why not?” They are all part of Dr. Wright’s vision for the future.

In addition to exploring the meaning of grace, Marla and I delve into the devaluation of elders living with dementia. Dr. Wright, who also has a degree in theology (a nice combination for a medical doctor wouldn’t you say?), took time to explain how society values youth and power and undervalues the poor, the dependent, and those with dementia.  

As we examine the stigma of dementia, we discuss what Dr. Wright calls the last acceptable form of prejudice: “dement-ism.” 

So, grab some coffee or tea and take a listen to both podcasts. Episode 3 is the interview with Dr. Wright and episode 4 is the “Let Me Say This About That” recap that offers insights from Marla and me. I believe you will find it enlightening.

>>Listen HERE on Apple Podcast

>>Listen HERE on Spotify

>>Listen HERE on Stitcher

We Thought It Was Time for a Podcast that Elevates Eldercare: So We Made One!

The Green House Project has launched a podcast! It’s called Elevate Eldercare and we hope you will listen, as well as subscribe, so you can hear it each Wednesday and Friday on your favorite platform (Apple, Stitcher, or Spotify). On Wednesdays, Senior Director Susan Ryan brings enlightening,  Marla and Mary
provocative, and sometimes uncomfortable conversations with thought leaders who offer diverse perspectives aimed at elevating eldercare.

On Fridays, Director of Resource Development Marla DeVries and Project Manager Mary Hopfner-Thomas present “Let Me Say This About That,” a quick and witty recap episode that we asked Marla and Mary to explain here:

Marla: “Clifton Keith Hillegass is a hero of mine, even though I was unaware of his name until today (thank you Google). However, I was very familiar with his work. Clifton, a college graduate who worked at a campus bookstore in Nebraska in the 1950s, met Jack Cole, the publisher of the Canadian study guides, Cole’s Notes. Cole suggested to Hillegass that American students would welcome a U.S. version of his eponymously named publication. In 1958, CliffsNotes launched with 16 Shakespeare study guides. He sold 58,000 copies that first year.

“In the late 1980s CliffsNotes was a lifesaver to this high school student. I loved the bite-sized summary and identification of key themes. Certainly, there were times I didn’t read the original work, but often, oh okay, sometimes, I read the book and reviewed the CliffsNotes, as they helped me think through things on a deeper level.

“So, with a nod to Clifton, we are happy to bring you “Let Me Say This About That,” a CliffsNotes version of our newly launched Elevate Eldercare podcast. Each Wednesday, GHP Senior Director Susan Ryan brings us a captivating interview with a thought leader as they discuss relevant and often provocative topics. Each Friday, Mary and I highlight key aspects of the discussion; things that stick out to us as especially important.

“I love words and often look up their definitions, so you’ll likely hear me throw in some vocab review as well. We will also add in some additional facts, bits of our own research, and things we’ve learned in our combined 44 years in long-term care, such as key aspects of the Green House model and how they can be applied to other settings.”

Mary: “So, if you’re wondering why our Friday CliffNotes episodes are called ‘Let Me Say This About That,’ I can assure you it was not in the initial list of potential names: ‘Reflection Friday,’ ‘Rising Up,’ ‘Like It Is,’ and ‘In Our Words’ were among the contenders. For me, the title is all about passion concerning a topic. In fact, I am inclined to emphasize the words this and that for the title.

“My colleagues are well aware of how I use the statement when we are in a team meeting discussing options about a certain topic. I will start off by saying, ‘well, let me say this about that!’ And to be honest, often I say it with a little attitude. It’s my way of highlighting what I see as the issue and what I see as an option to improve the situation.

“When I emailed Marla to suggest it as one name for the podcast it was almost done in jest. Yet, now when I think about it the name resonates. The show reflects our passion about what hits in the Wednesday episodes, and we want to share that with our audience.”

Marla: “I don’t have the broadcast experience my friend Mary does. But my roots are deep in advocacy, cutting my teeth as a long-term care ombudsman. And I love how Susan describes the podcast as an opportunity to speak up and speak out about real issues. I hope we do that.

“Although we don’t have the answers and it’s not a polished, perfect presentation, we will raise the issues and wrestle through complicated topics. In addition, we will keep our eye on practical ways to take action, in ways that we might not only think differently, but also do differently.

“We will also have some fun along the way. Mary and I enjoy working together, we are quick to laugh, and we both have a passion for transforming eldercare—one person and one system at a time. We hope you enjoy, ‘Let Me Say This About That,’ and join us in wrestling through these timely, thought-provoking, and action-invoking issues.”

Listen to the original Elevate Eldercare podcast each Wednesday then join us on Fridays for “Let Me Say This About That.”

Listen here on Apple Podcast:
https://podcasts.apple.com/…/elevate-eldercare/id1524700411…

Listen on Spotify here: https://open.spotify.com/episode/53ldGsdYWxd6W6eD8xz4kx

Listen on Stitcher here: https://www.stitcher.com/podc…/elevate-eldercare/e/76428729…