Buy in bulk, most people say. That’s how you save. So they flock to big box stores and buy big boxes of things to get them on the cheap. Likewise, the companies that serve people buy in bulk—like fast food chains—and the ingredients are cheap and there’s not a lot of variation on the menu but it’s affordable to the people they serve. The companies make money and we save money. And this is how it goes.
And so went elder care. Large institutional facilities housing and caring for large groups of elders was seemingly the only way to make the field of elder care financially feasible—both for the entities offering it and for the seniors needing it.
Ingrid Weaver worked in a large institutional nursing home when she started as a CNA while in college.
“Hurry up, go in, take care of everyone, and get done. It was very task oriented. It was almost like every senior you cared for was a task as opposed to a person. I was taught that way…and it was discouraging,” she said. “For me and for the elders, I’m sure.”
Twenty-five years ago Ingrid took a job at Porter Hills working with elders with irreversible dementia. She discovered that Porter Hills’ care was much more progressive than her previous employer’s. Instead of focusing on what elders couldn’t do, the Porter Hills staff was encouraged to focus on what they could do.
“It was a social model instead of a medical model,” she said. “If someone couldn’t tie their shoes, we got them a pair of shoes they could put on by themselves, with Velcro.”
Still, older buildings provided challenges to making alterations that would have been able to help improve ease of care.
“We had one main kitchen and three dining rooms that had to serve 600 residents. So if we were going to say that everyone could eat whatever they wanted whenever they wanted…it posed a challenge to existing systems,” said Ingrid. “It was all centered efficiencies and what worked well for staff.”
These challenges, combined with the progressive philosophy at Porter Hills, encouraged a dialogue to begin. This dialogue helped develop a foundation for a new type of care community that would cater to smaller groups of people based on their wants and needs. The staff at Porter Hills recognized that culture change was not a one-time event; it’s a process that requires continual transformation and growth.
And that’s when The Green House Project came into view. It not only offered a way forward for the design of the physical buildings and philosophical framework of care. It also challenged the big box, large institutional financial model for care.
In the smaller Green House homes, there was no longer a need for the legacy model of staffing that was necessary in the institutional care facilities. Instead, universal caregivers are responsible for a continuum of care within the home. They do everything from cooking individual meals to housekeeping to activities support and nursing care. As a result, Porter Hills didn’t require as many administrative and managerial staff because the empowered self-managed team worked collaboratively to support the elders and problem-solve issues.
Having fewer administrative staff saved money—as much as $124,000 per year, according to Weaver. It also meant that caregivers would form tighter bonds with the elders. And that meant better care.
“We have one elder who loves being outside,” says Ingrid. “She goes out and tends to flowers in her wheelchair. Because of the design, staff can see her from the windows while still caring for others. Making sure elders are safe while still having autonomy—this is much more difficult to offer in a traditional nursing home. And just that freedom…it’s meaningful to her.”