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

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…








Awe and Gratitude Amid COVID-19

Audrey Weiner
Audrey Weiner
Former President & CEO
The New Jewish Home

On behalf of the entire Board of Directors, Vice Chair Audrey Weiner delivered some very heartfelt remarks to Green House partners last week as they gathered virtually to share updates about their work during the COVID-19 pandemic. We thought her very eloquent words were worth sharing with everyone, as her message applies across all of senior living:

“First, good afternoon or good morning to each of you. And many thanks for taking time out of your day. Each day, I am sure, is becoming increasingly more complex for each of you.

“My message, on behalf of the board of directors, is really a very simple one. It is one of awe and gratitude to each of you for all that you are doing.

“While we have all lived through uncertainty and crises, hurricanes and tornadoes, horrible fires, economic downturns, blackouts and civil unrest, September 11th, flu, SARS, H1N1, and for some, the AIDS crisis, nothing in my view has prepared us for this pandemic. We are simultaneously desperately wanting to do the right thing for elders, the individuals who work in our organizations, our volunteers, and the community, while also being concerned about our families, knowing that the demands across communities are extraordinary and complex.

“In some cases, some of you have parents who are older and in at-risk groups. In other cases, you have children who are concerned that you are going to work every day and what you might bring home. There are new babies, new grandchildren, and every day, greater unknowns.

“There are the realities of supplies, concerns about the shortages of medications and antibiotics, challenges in physician visits, challenges in providing rehab, and attempts by government to do the right thing around telehealth, testing, and survey. There are heartbreaking stories about visitors restricted amid moments of death.

“But what is clear to me is that the values of The Green House Project, the ways in which living, care, and relationships are structured in Green House homes, provide what seems like the strongest framework for the best outcomes.

“As I read about nursing homes around the country, especially in the state of Washington, and the surprise on the part of the press that staff are rotating throughout facilities, the issue of inadequate staff, staff working in multiple facilities and multiple shifts, I wonder if anyone has really been listening to the concerns about providing the best possible care of elders.

“I do hope, on a macro level, that there are lessons we will learn as part of this pandemic, and hopefully there will be lessons that allow us to strengthen the long-term care system not only in America, but around the world.

“So, I end where I began, which is with awe and inspiration for all you are doing every day and how you are juggling myriad responsibilities. On behalf of the board, we are endlessly grateful for your intellect, your heart, your inspiration, and your values.

“Please know that we want to be there for you in any way we can be helpful. Above all, please do try to take time to care of yourselves.”








Dementia Care: Reminiscence versus Real

A senior housing operator approached me recently about endorsing his

Anne Ellett, NP, MSN, Dementia Specialist

new memory care development. It sounded lovely—he said it was designed to feel like a neighborhood—the residents living with dementia could wander down the street to visit friends and partake in different activities going on throughout the neighborhood. He spoke of the effort and expense put into the design with the goal of offering the residents more choice and access to real experiences.

When I visited, however, it felt a little eerie. It wasn’t a street, but rather an indoor lobby and hallway area with facades from the 50s and 60s. Bobby Darin’s “Mack the Knife” played over the hidden speakers and there were framed posters of Jackie Kennedy and Dean Martin on the walls. Residents could wander from the old-fashioned soda counter to the baby-doll room with bassinets and doll clothes to the plastic bowling pins set up at the end of the hallway. Pretend mailboxes were placed along the hallway.

Residents were playing pool, and few more sat around watching them. Female residents were encouraged to go into the doll room and hold the dolls or write postcards to put in the mailboxes. The tour guide said that the families were thrilled there was such a nice place for their loved ones with dementia to live.

While I can appreciate the desire to create a nice environment for people living with dementia, I challenge us to spend our time—as well as creative expertise and even money—toward offering real experiences and real life.

If we offer props or facades of the real thing, aren’t we assuming that a person living with dementia won’t know the difference? That they are incapable of participating in real relationships and real experiences? What if we instead invest our time and financial resources toward offering real life—wouldn’t that offer more dignity?

There is a lovely video of a memory care community in Australia known as Starrett Lodge. This short film, entitled, “Finding the Why; Enabling Active Participation in Life in Aged Care,” shows great examples of real experiences and real engagements for people living with dementia.

I hope you’ll take a few minutes to enjoy it: https://youtu.be/hZN1CyEiFNM.

If you are interested in hearing more about this topic, I will present a webinar that addresses the issues of “real vs. fake” on April 9 for The Green House Project. You can register for it here: HERE.

Let’s offer real life, and the belief that people living with dementia can participate, can contribute, and can enjoy real experiences.

Anne Ellett, NP, MSN

Dementia Action Alliance (DAA) Conference

Anne Ellett, N.P., M.S.N. Green House Dementia Specialist

It was a pleasure to be able to attend the DAA Conference in Atlanta last month. The Dementia Action Alliance is a non-profit national advocacy and educational organization striving to support people living with dementia to lead normal lives. One of the DAA’s goals is to educate about the stigma and misperceptions that are prevalent regarding people living with dementia. With that goal in mind, I was able to represent the Green House Project (GHP) in two presentations at the DAA conference.

GHP is partnering with Embodied Labs, an innovative company that uses virtual reality to develop educational experiences. Embodied Labs and GHP have collaborated on a making the Best Life Approach more meaningful by adding the virtual reality experience to the dementia training. I shared with the DAA Conference attendees this cutting-edge collaboration of virtual reality with the Best Life training.

Michael Belleville
DAA Advisory Board

I also participated in a panel discussion about the use of robotic pets and baby dolls in nursing homes with people living with dementia. Michael Belleville and I presented the view that interactions with real pets and real children provide opportunities for meaningful relationships that can’t be duplicated by robotic animals or dolls.

Miles – Green House Cottages of Belle Meade in Paragould, AR

We were pleased to be able to share the story of the joy that Miles, a dog who lives in the Green House Cottages of Belle Meade in Arkansas, has been able to bring to the elders there.








A New Chapter Begins

When Mississippi Methodist Senior Services opened the first Green House homes in Tupelo, Miss., back in 2003, we really believed that they would be game changers in the field of aging services. But we had no idea at the time that some 15 years later, the movement to deinstitutionalize nursing homes and humanize care for elders would sweep the globe.

McAlilly is chair of the Center for Innovation, The Green House Project’s umbrella organization.

With some 284 homes built in 32 states, and many more on the way, The Green House Project (GHP) can rightfully claim its position as the leader in small-house design and person-directed, relationship-rich living.

As one of the original pioneers of those first Green House homes, I am proud to announce that I have recently taken the helm as chair of the Center for Innovation (CFI), the umbrella organization of GHP. My election to chair of CFI is joined by the addition of nine new board members, comprising a “dream team” of experienced and talented senior living leaders who are poised and eager to take this movement to the next level.

The collective passion and dedication of the new board is palpable as we look forward to the next 15 years and beyond. Together with a stellar GHP team of staff members, we will continue to build bridges, foment revolution, and spread innovation in new and better waysAt our initial board meeting last month, you could feel that this group of people were ready to help write the next chapter of this story!

The expansion of our board of directors is part of a recently launched initiative known as Green House 2.0, which encompasses a host of innovative partnerships and efforts designed to improve the lives of people at many ages, abilities, and levels of care.

Among these endeavors is Best Life, GHP’s approach to help organizations support people living with dementia (PLWD) to live rich and rewarding lives. The tools of Best Life are available to memory care, assisted living, and nursing home communities as standalone education and training.

On GHP’s reenergized website you will find more details about Green House 2.0. I’m sure you will find that we have a lot going on—all with the intention of making long-term and post-acute care better for all people. I invite you to take a spin around the site and let us know what you think.

As this effort launches over the coming days, weeks, and months, I hope you will consider joining us in our movement to eradicate institutional models, destigmatize aging, and humanize care for all people.

 

Steve McAlilly is the president and CEO of Mississippi Methodist Senior Services in Tupelo. He led the development and opening of the first Green House Home in 2003.








Ryan Addresses International Alzheimer’s Conference

Photo credit: LaCour Images

Being seen goes deeper than recognizing the visible attributes of a person. When a person is truly seen their inner complexities shine and all labels associated with them (such as Alzheimer’s disease) are shed. Their preferences in everyday life are understood and their uniqueness is honored.

This was the message that Susan Ryan, The Green House Project senior director, brought to the stage at the 33rd International Conference of Alzheimer’s Disease International (ADI), held July 26-29th in Chicago, Ill. Ryan delivered a keynote presentation and participated in a panel discussion with the goal of ‘power washing’ conventional thinking in today’s dementia care.

The Alzheimer’s Disease International Conference is the the longest running and one of the largest international conferences on dementia, attracting delegates from around the world. Ryan was among a range of international expert speakers, making up a unique program that enables participants to learn about the latest advances in the prevention, diagnosis, treatment, care and management of dementia.

The concept of being seen (#SeeMe) applies especially to a large percentage of people living in long-term care settings, who are defined by their diagnosis of dementia. Their diagnosis assigns them a label that emphasizes what they can’t do and what’s been lost. Ryan’s message was a call to destigmatize and humanize those living with dementia, in order to see the whole person first.

To see this in action, Ryan encouraged the audience to take a deeper look at how the symptoms of dementia are presented to the outside world. She noted that the Behavioral and Psychological Symptoms of Dementia (BPSD) is a term used to describe the following “symptoms” that occur in people with dementia: agitation, aberrant motor behavior, anxiety, elation, irritability, depression, apathy, disinhibition, delusions, hallucinations, and sleep or appetite changes. According to a 2012 study in the Frontiers of Neurology, about 90 percent of people with dementia have BPSD. Ryan noted that while this finding is not surprising, it is presented in a way that categorizes people with dementia even further.

Instead of following common thinking, Ryan said, what if instead the finding was that 90 percent of people living with dementia will find themselves in a situation where their well-being is not adequately supported? Attendees were encouraged to take it a step further and think through how this revolutionary way of thinking would change the way that providers and other stakeholders “#SeeMe.”

The good news is that this is already happening, Ryan noted. The Green House Project has developed Best Life, a memory care program that is built on the initiative’s core values of Meaningful Life, Empowered staff, and Real Home. Best Life is a process to transform the paradigm and defy the stigmas associated with dementia, she explained.

Ryan concluded by imploring her international audience to “lead the way, address the stigma surrounding dementia, and support caregivers with the skills to see each elder as a unique individual, and to connect them to a meaningful life.”








Fed Ex, Manager of Global Citizenship, Speaks at Green House Annual Meeting

Change is the law of life. And those who look only to the past or present are certain to miss the future. –John F. Kennedy

The 7th Annual Green House Meeting and Celebration provided not just the opportunity to grow and learn from each other but also to draw on the wisdom of leaders in other fields. Our conference was held in Memphis, TN—the home office of FedEx and we were honored to hear the inspirational words from Rose Flenorl, Manager of Global Citizenship. Green House adopters with impressed with her message about leadership and change.

In her speech, Rose built upon the theme of the conference, “Leading with Heart and Soul.” She reflected on the founder and CEO of Fed Ex, Frederick W. Smith, and how he was leading with his heart and soul when he fought against the naysayers, all the critics who called him crazy, to start a little airline, then called “Federal Express.” He had total and resolute faith that this country needed an overnight package delivery service, and he was the one to make it happen. Rose enforced the point that growth and success is not possible without a deliberate focus on adapting to change. In fact, Mr. Smith is often quoted as saying that “managing change is the key to a successful future.”

As Manager of Global Citizenship at FedEx, Rose is a part of the team that demonstrates the heart and soul of the company. She works with non-profit organizations to make a difference in people’s lives. Whether it is disaster relief, pedestrian and road safety, education or the environment – Fed Ex supports hundreds of charitable groups and causes through grants, sponsorships, in-kind shipping and volunteerism.

She leveraged her experiences with change and growth to highlight the changes that are occurring in the health care field, particularly with the aging Baby Boomer population. Through a moving and personal story about her mother, Rose became vulnerable, and connected her story with the work of Green House adopters, “I, for one, don’t want to be a burden on my family. I hope that if/when I get to a point where I need long-term care that I have a nurturing, warm, home-like place I can live complete with a caring and competent staff.”

In preparation for her talk, Rose visited Ave Maria home in Bartlett, TN. She spoke openly about how she felt when she was in The Green House homes, from the clean, warm environment, to the friendliness of the staff and the peaceful, content elders. She said that she never thought that there would be a place where she would feel comfortable bringing her mom to live, until visiting Ave Maria, and now she has hope that things can be different for people who need skilled care.

Because The Green House model centers around the elders, the staff is empowered to do whatever is necessary to create the best home possible, enabling a meaningful life for and with the elders.

Rose left the audience with these thoughts, “You are contributing a social impact, giving back to our communities in a way by providing better jobs for direct care staff, and a better quality of life for elders. It’s all about leadership, wise leadership requires passion, and when you lead with heart and soul, you make significant impacts.”

Thank you, Rose Flenorl, for speaking from the heart, through personal stories, professional experiences and wise words to help Green House organizations grow and stretch beyond our field and comfort zone.








The Wall Street Journal Exposes Common Myths of Aging

A recent article in The Wall Street Journal exposes many common myths of aging. Some of these myths have become so common, they could easily be mistaken for the truth. Have you ever heard someone say, “depression is a normal part of aging” or “cognitive impairment is inevitable with age”? This article clears the air for six big myths about aging.  You can read more here.

For many people, the myths of aging may have come from observing what Dr. Thomas calls the three plagues of long-term care: loneliness, helplessness, and boredom.  Fortunately, the culture change movement is showing us what aging is really all about – another stage of growth and development for all people.








New photos available from the first Green House Home at the Zablocki VA Medical Center

 Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin welcomed Elders into their first Green House home in November, 2014.  This is the first of three Green House homes planned for this VA medical center.

These Green House homes will serve Veterans in need of long-term skilled nursing care, including veterans living with cognitive impairment and mental illness.  The medical center looks forward to welcoming veterans into their next two Green House homes when they are completed in the spring of 2015.








Joan Lunden on Planning for the Future and Finding Resources for our Elders

The American Society on Aging’s bi-monthly newsletter, Aging Today, interviewed Joan Lunden about her work with A Place for Mom and the need for having a plan in place for your aging parents. Lunden uses her platform as former Good Morning America host to advocate for senior care.

Aging Today asked Lunden about her mother and the obstacles she faced while caring for her:

I was so unprepared, and had no plan in place. I’m sorry to say that I think [that’s] typical. It’s just part of human nature—we want to think of ourselves as kids and our parents as in charge, impenetrable decision makers. But there comes a time when they’re not. … The day you have to become a parent to your parent is unnatural, and uncomfortable. You don’t want to burden your parents by asking what their plans are for later life, you don’t want to be presumptive or make them feel awkward, but if we don’t ask, [their care] might financially devastate our own family. And our parents are reluctant to answer, which is also part of human nature because it represents their mortality.

It is important to establish a plan for the elders in our lives, so the people who mean the most to us are taken care of in a healthy setting. Green House homes offer home for life in an empowering environment so that our loved ones experience meaningful life.

Click here to read the full interview.