Green House Blog

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.