Green House Blog

A New Research Article by Bowers and Nolet: Empowering Direct Care Workers

A basic tenant of THE GREEN HOUSE model is that an empowered, self-managed team of direct care workers will improve the quality of life and care of elders in long-term care settings, as well as the quality of life and job satisfaction of the people providing that care. While this has been a long-held belief of not only THE GREEN HOUSE model, but also other small-house models and the culture change movement in general, it has been difficult to substantiate in a quantitative fashion. A recent study by Barbara Bowers, PhD, RN and Kim Nolet, MS of the University of Wisconsin-Madison, published in the of Seniors Housing & Care Journal has attempted to do just that.

This study focused exclusively on THE GREEN HOUSE model, examining 14 Green House homes with site visits to 11 of them and in-depth interviews with 68 direct care workers (Shahbazim), 29 licensed nursing staff and 8 directors/assistant directors of nursing.
Here are some of their findings.
Selecting Workers / Implications for Empowerment
• Shahbazim have clear beliefs about the criteria that should be used when selecting new workers and this differs from the criteria most managers used in their selection process.
• Considerable variation exists in how direct care workers were selected to become Shahbazim. Few homes included direct care workers in the selection process. For those that did, the nature of their involvement varied across organizations.
• Management has a generally insufficient appreciation of the impact nurses have on direct care staff empowerment and the difficulty of implementing the model without the support and understanding of the nurses.
Meaning of Empowerment
Shahbazim were clear in how they defined being empowered.
• Not having someone looking over their shoulder, checking up on whether they’ve done what they were already planning to do and what is part of their everyday routine.
• Control over the prioritization of the work day – i.e. not getting pulled from a task underway to attend to some other matter.
• Ability to talk directly to family members about elder care. Being able to initiate such discussions during family visits or by phone is considered to be an important aspect of empowerment by the Shahbazim.

Benefits of an Empowered Worker Model
The benefits of being empowered played out in several ways:
• Learning to work as a team, responsible for all of the house and elders, not just “my elders”.
• Development of new work skills such as budgeting, mentoring and management that they would not have an opportunity to develop and use as CNAs in a traditional nursing home.
• Bringing natural talents and abilities to their work, such as baking, craft-making, music, photography, etc.
Sources of Variation in Empowerment Implementation
• Organizations have approached empowerment in different ways with varying degrees of obstacles and success.
• Variation was greatest in the homes that were among the first to be involved in the Green House culture change. Those that joined after the change in orientation that integrated nurses and included Shahbazim in the selection of new Shahbazim experienced more consistency in implementation strategies and a greater sense of empowerment of the direct care workers.
• As the model matured and the bringing of nurses and Shahbazim together from the beginning to discuss what empowerment means and how it relates to the roles each play resulted in greater comfort and satisfaction of both Shahbazim and nurses.

These findings are important to consider as Shahbazim, nurses and the entire teams in Green House homes and other household models continue to develop and evolve.  Click here to read theNIC_2011_Journal_Bowers

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