Green House Blog

Person-Centered Regulations Discussed at Pioneer Network’s 2012 National Conference

The Pioneer Network’s National Conference in Jacksonville, FL, challenged participants to build a bridge to a new culture of aging. Skip Gregory, retired Bureau Chief at the Agency for Health Care Administration (AHCA) in Florida, is building that bridge with patience and regulatory resourcefulness.
Nearly every new neighborhood, small house and Green House home is impacted by codes. Building codes, fire codes, and design codes alike, “exist to provide minimum protection,” said Gregory. The August 6th all-day intensive Defining the future of long term care included a discussion on how regulations are “transforming to better support person-centered care.”
The 2012 NFPA Fire Code now allows for furniture in a nursing home’s eight foot corridor. And, gas fireplaces are OK in sleeping areas (though not in bedrooms). Alternate Methods Section 104.11 of the International Building Code (IBC) supports creative approaches to design and equipment. ADA code section 2.2 affords “wiggle room” that includes smarter bathroom design for Elders and their care-partners.

Green House adopters should connect with their Project Guide and architect to learn more about how new codes support their vision for real home. For more information on The Green House Project and its regulatory successes, please visit

What’s your favorite culture change book?

Yesterday the world got its first opportunity to own Bill Thomas’ Tribes of Eden. As we celebrate a new book that’s been inspired by Culture Change advocates, we had to wonder – what book has inspired you? What text would you recommend to others to provide different insight into the world of aging? Dementia? Person directed care? What books have led to lively discussions? Tell us about your good reads so we can share those titles and genres with our Green House network of readers.


What's your favorite culture change book?

Yesterday the world got its first opportunity to own Bill Thomas’ Tribes of Eden. As we celebrate a new book that’s been inspired by Culture Change advocates, we had to wonder – what book has inspired you? What text would you recommend to others to provide different insight into the world of aging? Dementia? Person directed care? What books have led to lively discussions? Tell us about your good reads so we can share those titles and genres with our Green House network of readers.


Partnering with Regulators for a Better Future in Long Term Care

Is there a time where you found institutional rules and practices getting in the way of an Elder’s quality of life? Have you ever wished you could ask CMS a question to gain clarity on how to best serve an Elder while meeting the regulations? If so, stop rubbing that genie bottle because your wish has been granted!

Earlier this morning, deputy division director for the Nursing Homes Division at the Centers for Medicare & Medicaid Services (CMS), Karen Schoeneman ,challenged us all to brainstorm questions we have around culture change.  In her role with CMS, Karen and her team administer the long-term care survey process, the interpretive guidelines and the Quality Indicators Survey process. In addition, Karen and her colleagues commit to publishing a Q&A letter that tackles hot topics in culture change.

As champions of The Green House model and the appreciative inquiry approach, what would you like to see addressed in their next publication? (Don’t worry about Life Safety Code, as that issue is being addressed in a separate response.) We’ll collect all of your thoughts and send them to Karen ASAP!

‘Tis the Season to be Warm, Smart, and Green

During the holidays and always, Green House homes embody warm, smart, and green principles. As discussed in Bill Thomas’ What Are Old People For?, warm organizations are rich in optimism and trust, and exude the spirit of generosity. Doing good deeds without the expectation of return is the most effective approach to warming people and organizations. Smart homes embrace technology that serves to foster the well-being of Elders and those who work with them. Green organizations provide an environment where Elders have close and continuing contact with the living world. Any sanctuary for Elderhood should demonstrate a true concern for safe and sustainable use of natural resources.
‘Tis the season to go green by reducing waste, saving energy, and renewing your commitment to green living. Here are some easy ways in which you can be warm, smart, and green this holiday season:
• Save paper by wrapping gifts with children’s artwork, maps, calendars, newspaper, a scarf, or fabric remnants. According to the Sierra Club, if every family wrapped just three gifts with reusable materials, it would save enough paper to cover 45,000 football fields.
• Consider green gifts constructed from recycled materials, a homemade gift of photos or pottery, or even an experience like tickets to a show or sporting event. Order online and save gas – and patience!
• Receive a new computer, TV, or phone? Recycle old electronics or donate to a local non-profit and extend the life of valuable products.
• Install low flow aerators on sinks and low flow showerheads in the bathroom. You can reduce 40% of water used just by upgrading 2.5 gallon per minute (gpm) to 1.5 gpm fixtures.
• Support local farmers and add healthy produce to your holiday meal.
• Purchase energy-saving LED holiday lights and use 90% less energy than conventional lights. Light timers will also help conserve energy.

The Power of Language in Culture Change

The institutional “dragon”  is too big to swallow in one mouthful. If we really commit to understanding the depth associated with institutional creep (sliding back into medical model practices), it’s important to start small with dragons that are manageable. One such deeply rooted institutional practice includes language; what we say and how we say it makes a significant impact on those with whom we work, and those for whom we hope to create a life worth living. Since words have the power to make or break someone’s day, it’s imperative to explore their impact on transformational success.

The Green House Project is certainly not the first, nor will it be the last, to challenge the language of long-term care. In her article entitled, “Mayday: The Language of Culture Change,” Karen Schoeneman, Deputy Director at Center for Medicare and Medicaid’s Division of Nursing Homes, explored the barriers hidden in words commonly used in nursing homes. “Part of transforming long-term care practice is finding new words to describe staff, programs, parts of the building, and the ‘industry’ itself.” Person-centered language allows us to do just that, as its goal is to acknowledge and respect residents (elders) as individuals. Sometimes, as Karen states, it’s “as simple as reversing common phrases to put the person first and the characteristic second.” In one such example, “a feeder” becomes “someone who needs assistance with dining.”

So, what can you do today in your organization to combat traditional language? First, work as a team to discuss and understand the power of language. There’s magic in synergy, and teamwork produces an overall better result than if each person was working to the same goal individually. Next, continue sharing ideas and tools to help direct conversation. (One decision making tool we embrace is the learning circle, as it provides everyone with an equal voice.) Lastly, ask yourselves questions to really challenge the reasoning behind the words we use. Examples include, but are not limited to, “What do the elders say they want?” and “How does this drive the standard forward?”

Although policy and regulation are often the most referenced barriers to true culture change implementation, one of the real obstructions is closer than we think. I, you, our colleagues – the language each of us uses creates a barricade that separates us from them. Whether it is staff v. elders, leadership v. care givers, or yet another division of people with and without power, we need to sharpen our awareness of what we say and how we say it, or words will continue to separate worlds. And that’s no world where we would choose to be.

This article is based upon a presentation by Melissa Honig, Project Guide, at The Green House Project’s 2009 Annual Meeting and Celebration in Kansas City, Missouri.

Leading a Strengths Revolution

Pop quiz: Write down all of your personal strengths and weaknesses. Have a lopsided list? So did participants at this October’s Leading Age Annual Meeting & IAHSA Global Aging Conference in Washington, DC.
Attendees were asked to complete a similar reflection on personal strengths and weaknesses.

A show of hands illustrated that while most of us have little sense of our talents, we have become experts in our flaws and how to repair them. According to Marcus Buckingham, co-author of First, Break All the Rules, our strengths often lie dormant and neglected while our managers, teachers, and parents guide us to become experts in our weaknesses. Select general sessions at Leading Age’s 50th Celebration reminded leaders of this unique perspective: motivating staff to build on their strengths rather than correcting their weaknesses is a successful management strategy to develop and retain people.

The Green House Project was created to do just that – grow people – elders and staff alike. One core philosophical belief is the acknowledgment of good in every person, every organization, and heck, even every policy and procedure. Appreciative Inquiry (AI) is the search for the best of. Unlike a cookbook approach, it’s a view and a process for facilitating positive change. And, like cupcake bakeries, it’s becoming widespread.

Appreciative Inquiry to Foster Change featured Schlegel Villages, a senior living organization with 11 communities in southern Ontario, and their evolution from institutional to social models of living. In partnership with the Research Institute for Aging at the University of Waterloo, their collaborative process examined the best of what exists, a stark contrast to discussions about what doesn’t work. Using the Appreciative Inquiry 4D cycle (discovery, dream, design, and destiny) over the course of two years, residents, families, and Schlegel team members are living their vision of the future.

Has the cynic in you kicked in? Until you do it, there’s no way to discover AI’s practicality. Don’t worry if you don’t have a major change program established. The process begins with a simple question at the end of a meeting: what did we do well?

The Green House model, like Schlegel Villages, mobilizes change through reflection and action. Wherever you are on your journey, involving all stakeholders is one of the most effective culture change initiatives. Appreciative Inquiry reminds us that our focus becomes our reality; we have the power to bring forth the best in people and in our own organizations.