Green House Blog

A Sage’s Testimonial of Short Stay Rehabilitation in a Green House home

For the last few years, I have served as a Sage (volunteer who supports and advises the self managed work team) at The Green House homes of Mirasol.  Recently, my role was reversed, when I moved in to recover after an extremely taxing and debilitating surgery.  These homes are listed as 5 Star by Medicare and Medicaid, a wonderful professional endorsement.  I can tell you, however, that the essence of what I experienced, goes far beyond that checklist, and their stellar outcomes reflect something much deeper and more comprehensive.

The Green House homes were the only attractive option for rehab within 20 minutes from my home.  Because I know how popular The Green House homes are, I was worried that there would not be space for me.  I was delighted to be able recover in a Real Home. I knew that being a volunteer would be very different from being a guest in the community, but I couldn’t have predicted how impressed I would be, or the gratitude I would feel.

The Green House team ensured that the process was smooth and dignified from the very beginning.  They managed all the hospital paperwork, follow-up appointments and coordination, which in my mind already goes leagues above 5 stars!  The driver’s vehicle enabled me to sit comfortably up front, and he even offered me clip-on sunglasses, my choice of music and a warm blanket (an important touch on a freezing Colorado day).  We quickly fell into a comfortable chat and discovered many things that we had in common.

When I arrived, I was greeted warmly, like a long-lost, favorite uncle!  The Shahbazim (direct care staff) offered me the choice of going to my room for a rest, or staying at the table for a meal.  Having already having discovered my dietary preferences, they offered to make something special, just for me.  The whole home smelled scrumptious when I came in the front door! Just being there made me feel better, and I had a renewed appreciation for the airiness of the dining area, the good smells of the kitchen, and the warm, inviting fireplace area.

We went to my room – private room with private bathroom, thank goodness.  As I was oriented, I was reminded that no room is more than six doors from the hearth, and this was confirmed the next morning by the aroma of breakfast wafting into my bedroom.  How refreshing to recover without the long and disorienting corridors lined with carts of stale food or unmentionables waiting to be taken out back.  At no stage
was I “parked” anywhere in the house, as I have seen in other nursing homes, left alone to wait.  To be treated like a person, rather than an object; what this did for my well-being, I can’t begin to measure.

Dinner was a very communal event, and I felt very welcomed by my fellow elders at the table.  Some required help with eating, which the Shahbazim did casually and warmly with considerable skill and NO DEMEANING BIBS.  It immediately felt like the elders were interested in me as a fellow member of the house and its extended family of elders, staff and family members. The feeling of family was beautifully illustrated, as one elder spontaneously went over to another elder, who seemed unhappy, and simply gave him a hug.  It was then that I was brought to tears, so moved by the atmosphere of support and caring. The elders are empowered to care and support each other, creating a community of reciprocity, where everyone has something to offer.

The hearth in the center of the house is a place where elders and Shahbazim could naturally get to know each other more deeply, creating mutually supportive relationships as our stories are shared. What a realization to know that the more deeply we know each other, the more we are valued.  These relationships enable the elders and Shahbazim to go beyond medical needs, and become connected, helping each other to live the best life possible.

The staff appeared to be encouraged to stop over each day and chat for a while just to get to know me better.  I felt understood, and like the things that were important to me, were important to them.  If I had a visitor (like my wife of 51 years) or was engaged elsewhere, my nurse would ask if I would prefer she come back later. She put me in the driver seat of my care, and made me feel like she honored my privacy and dignity. The Shahbazim seemed to anticipate my needs, incorporating what they learned about me from our conversations, and providing personalized care that went well beyond my physical needs.  Team members would stop by at the end of their shift to just chat about their plans for the rest of the day, to ask advice, or to ask me about my life stories.  This genuine caring, was something that I hadn’t experienced in other nursing home/rehab settings, and it was so gratifying and replenishing.  To be known and truly valued, this is better than the best medicine.

What a phenomenal rehabilitation experience, delivered by wonderful people who love their
job, love the people they work with and the elders they serve.  The Green House homes provide opportunities for these open-hearted people to grow and develop their already extraordinary gifts.  I am honored to be able to share my experience as a testimonial to others who are seeking a place where they can recover, not only physically, but holistically.  It is because of this experience that I healed so rapidly, with caring and the preservation of my dignity.

Learn more about The Green House homes at Mirasol>>

 

Reflections from the Director: Changing Times / Changing Measures / Changing Behavior

Changing performance metrics can catalyze a dramatic improvement. I recall the story of Walgreens in the book “Good to Great” by Jim Collins. Collins and his research team describe Walgreens as nothing more than a sleepy retail pharmacy chain that limped along for years before a dramatic rise to great results that lasted for over 15 years. The researchers examined what triggered the change and discovered that Walgreens had deviated from the industry norm of measuring their performance. All retail pharmacies, including Walgreens before their rise to greatness, had used one key performance metric to measure their performance – revenue per square foot per store. When Walgreens began measuring their own performance with a new measure – revenue per customer visit – their dramatic acceleration began. Gradually, all other retail pharmacies followed suit and began to use this new performance metric and it changed the retail pharmacy industry forever. The change in this one performance metric led to new systems, improved staffing and re-designed stores. In fact, when Walgreens reset their measure they set a new goal. The goal was $40 per customer visit. My wife consistently exceeds that goal.

In the Skilled Nursing profession, for over 45 years, we have all measured our performance by, generally, a single measure – our annual department of health inspection results. Recently, my Dad shared with me a newspaper article that described 5-Star nursing home closing its’ doors in Massachusetts and the article kind of shook me up. After all, the whole intent of the 5-Star rating system is to drive consumers to the best performing SNFs. So…why do 5-Star homes close and 1-Star homes remain full? Perhaps the 1-star home is actually a better performer than the 5-star home. The answer lies outside of our one key performance measure.

The metrics of SNFs are shifting – and this bodes well for the profession as a whole. Two performance measures are taking hold that will surely help to separate the star performers from the rest of the pack. The two we are speaking of have been hammered away at the nursing home professionals nationwide – reduce or eliminate the off-label use of antipsychotics and reduce the avoidable re-hospitalizations. Just like Walgreens, the improvements in these two measures will require improving the systems of care, enhanced staff composition and competence, and changing the physical environment of SNFs.

Reducing or eliminating the off-label use of anti-psychotics triggers providers to get serious about delivering person-centered care. Organizations will need to reduce their C.N.A. to resident ratios and de-institutionalize their physical environments (and we are not talking about simply new wallpaper). Enhancing the competence of the entire staff through a significant increase in education hours that are focused on caring for those living with dementia will be foundational to their success.

Reducing re-hospitalization rates leads SNF leader’s to raise the bar on increasing clinical competence and adding talented and compassionate RNs to their staff. Also, this new measure forces leaders’ to re-examine their turnover rates and absenteeism because staff instability does not allow for consistent assignment and diminishes communication. Clearly, the health of the relationships among the staff of each SNF is reflected in their re-hospitalization rate. Therefore, better systems of communication and new job descriptions are needed to strengthen staff relationships. Today, many providers can see that their current physical environment – an average of 85 elders living together in tight quarters, shared rooms, shared bathrooms, shared shower rooms – is perfectly designed to spread infections among the elders and staff. Private rooms with private baths and showers for each elder will become the new norm. A smaller and better designed environment is critical to both clinical outcomes and a dignified quality of life.

Of course, a SNF’s performance on their annual department of health inspections is important and always will be. It has to remain a key measure with the other 5-Star metrics. Examined next to a SNF’s performance on these two measures will provide consumers, operators, surveyors and policy makers a way to more clearly identify where elders should flock to for their care.