Green House Blog

A Pre-Conference Intensive for Shahbazim at The 6th Annual Green House Meeting and Celebration: A Day to Explore the Coordinator Roles and Relational Coordination in Green House Homes

On the day a Green House home opens the Shahbazim become the managers of the home as well as partners to the Elders.  It requires a deep understanding of the systems that support the home. The core functions include the Food, Scheduling, Care, Team, and Housekeeping systems and the Coordinator Roles each Shahbaz fills on a rotating basis.  These functions are the guts of the home and to be successfully carried out require strong relationships and excellent communication.  If the systems work, the days go smoothly. Without good systems, respectful relationships and high communication it can be a rocky road!

This preconference day will explore the Coordinator Roles and the core systems around Food, Scheduling and Care.  It will ask participants to identify what makes for good relational coordination; meaning shared vision, shared knowledge and mutual respect.  The best thinking and lessons learned will be the basis for conversations on how to sharpen and improve the core systems and relationships of the homes.  

If you are a Shahbaz at an open or soon to be open Green House home, plan on attending THE GREEN HOUSE®  Annual Meeting and Celebration in Boston on November 18th.   Leave with new ideas, new insights and many new friends.  Register at the Peer Network website.  For more information about the program contact

Please note:  The Green House Annual Meeting & Celebration is an event exclusively available to Green House adopters for sharing, learning, and celebrating the growth of The Green House model.  The Annual Meeting honors organizations for their commitment to create real home, empowered staff, and meaningful lives for elders. Sessions provide peers with an opportunity to reflect on lessons learned, revisit skills for coaching leaders, and build relationships to support sustainable change

The Pioneer Network Conference: Hear the Voice, Honor the Choice

The Pioneer Network once again is calling. The annual conference held each August has become tradition for many who are deeply committed to cultural transformation, and also serves as a big brother/sister for those just starting the journey. It’s a place of kindred souls, of networking, of listening and of sharing about person-directed living and transformation. Old and new friends gather to build roots into the transforming world. The aura of the conference is almost legendary— beyond all the learning opportunities folks report a magical renewed resolve, merely by being present and absorbing the energy and passion found there. So come join the transformation as we explore this year’s theme, Hear the Voice, Honor the Choice. We’ll be meeting in the beautiful northwest this year—August 11-14 in Bellevue, WA.

-Anna Ortigara

Resource Director, The Green House Project

President of the Board, Pioneer Network

THE GREEN HOUSE® performance on Quality Measures

Eighty percent of Green House homes serve Elders with skilled care needs. The model strongly supports Elder choice and relationships but Quality of Care is also important to support meaningful lives in real homes. The case needs to be made for quality clinical outcomes from deeply transformative models like The Green House Project.

EQUIP for Quality* is the quality tool used for clinical benchmarking by The Green House Project and all skilled Green House Projects are encouraged to participate in data collection.

This report represents the MDS 3.0 data from 10 skilled Green House Project organizations from third quarter 2012. This is a snapshot in time, but very important in understanding quality of care in Green House homes. Below are Quality Measures where these homes performed significantly better than national benchmarks:

• Percent of Residents Who Self-Report Moderate to Severe Pain (Long Stay)
• Percent of Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine (Long Stay)
• Percent of Residents Assessed and Appropriately Given the Pneumococcal Vaccine (Long Stay)
• Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder (Long Stay)
• Percent of Residents Who Have Depressive Symptoms (Long Stay)
• Percent of Residents Who Received an Antipsychotic Medication (Long Stay)
• Percent of residents who have behavior symptoms affecting others (Long Stay)
• Percent of Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine (Short Stay)
• Percent of Residents Who were Hospitalized in the last 100 days (Long Stay).

Other Quality Measures were similar to national nursing home benchmarks.

Two measures that are particularly targeted in long term care today are re-hospitalizations in the previous 100 days and the use of antipsychotic drugs. These show significantly better performance during this period of time and are considered areas of both high cost and clinical significance in understanding and managing care transitions. All indicators are important to guide the understanding quality of care in Green House homes. Having regular data provides deeper understanding of the model and sharper targeting for education and process redesign within the model. For more information contact

*EQUIP for Quality, Leading Age New York

Elders Rule: Really

It is not a story until it is told.

Each elder is rich in life stories just waiting to be heard.  Three elders from Porter Hills Green House homes came and shared their stories at the 5th Annual Green House Meeting and Celebration in early September at the Amway Grand in Grand Rapids, MI.  Elders, Ota Champaign, Betty Hechman, and Shirley Farley agreed to talk about their current lives in the homes.  And I hoped to hear the rich nuances of Green House life.  Indeed they shared the joys of reading books in real privacy in their own bedroom.  And knowing staff and other elders deeply and with real affection is a meaningful part of each day.  Ota spends almost unlimited time in the garden,  right now getting the garden ready for winter…

But almost immediately the conversation moved to the stories of their lives, to the experiences  and adventures of lives well lived.  Educators all, memories of teaching Macbeth to high school students in Detroit,  traveling across the country and finding teaching positions to support deep wanderlust,  or working in post-war Tokyo for General MacArthur were the adventures of these women’s lives.   I am honored they agreed to share their journeys with all of us.

Thank you Ota Champaign, Betty Hechman and Shirley Farley!

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Video: Larry Minnix, CEO of Leading Age, speaks about the high standards for long-term care he experienced while visiting The Leonard Florence Center for Living

Larry Minnix of LeadingAge visits The Green House Homes at The Leonard Florence Center for Living in Chelsea, MA.

Watch the below video to hear Larry’s insights and reflections related to this innovation for adults living with ALS and MS.

Coaching Corner – Approaching the Difficult Conversation: Self-Awareness

As a coaching Guide, team member, and partner in Green House homes we constantly have opportunities to communicate and build relationships with team members.  Time spent in getting to know and trust each other is essential for team effectiveness and success.  But sometimes a particular conversation is uncomfortable, unsettling, or just plain difficult!  Self-awareness is one of the four foundational coaching skills and directly applies to identifying and understanding that a difficult conversation has presented itself.

What makes a conversation a difficult conversation?

A difficult conversation is anything you find hard to talk about.  There are many reasons why a conversation may be difficult for you, including:

-You care deeply about the issue

-The topic is controversial (i.e. religion or politics)

-The outcome is uncertain

-You feel vulnerable or your self esteem is implicated

-You care deeply about the people with whom you are discussing the issue

When a difficult conversation occurs, spend a little time considering what really happened.  There are generally three levels of conversation:

The “What Happened?” Conversation:  Often there is a basic disagreement about the facts of the situation. Who said and did what, what it meant and who is wrong or right.  This creates an immediate disconnect between the people in the conversation.

The Feelings Conversation:  Every difficult conversation involves feelings.  Am I right or wrong; are my feelings appropriate and valid? How about the feelings of the other person?  Do feelings belong in the conversation or should I ignore them?  Unfortunately feelings are part of the equation. 

 The Identity Conversation:  We figure out what the conversation means to ourselves.  In this conversation many judgments happen: are we right or wrong, a good or bad person, competent or incompetent?  These judgments affect our self-esteem and self-worth.  

Here are some ways to reframe the situation for greater understanding and alignment:

  1. Pull back from arguing about who is right.  Be open to exploring the other person’s story.  The pull back will help to reframe the conversation, and look with real curiosity into what the person understands and believes about the “what happened”.
  2. Don’t assume they meant it!  Intentions strongly shape our views and judgments about the impact of the situation.  By putting aside blame and judgment, we open up the possibility of a very different outcome of the conversation.
  3. Choose to not focus on blame.  Sometimes one person is clearly the cause of something that has gone wrong.  Focusing on blame is not helpful because it inhibits our ability to learn what’s really causing the problem and find insights and answers to correct it.  The impulse to blame often comes from our own concern of being blamed.

This is only the beginning of an exploration of difficult conversations.  The book Difficult Conversations: How To Discuss What Matters Most is a terrific resource to strengthen communication and to build trust and respect among team members.

Stone, D.,  Patton, B., Heen, S.  Difficult Conversations: How To Discuss What Matters Most. Penguin Books, New York, NY. 2000.


Free McKnight’s Long-Term Care News Webinar: Reducing Avoidable Hospital Readmissions: An Opportunity for SNFs

Sign up for this free webinar on Thursday, March 15th at 1 p.m. EST/10 a.m. PST, to learn:

  • Why readmissions are a pressing issue for all healthcare providers
  • What critical role SNFs play in preventing hospital readmissions
  • What SNFs can do to reduce hospital readmissions

Register now or visit for more information.

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