Green House Blog

Thought Leaders in Aging Gather at the 2014 Pioneer Network Conference: THE GREEN HOUSE® Project Leadership Among Those Presenting

“Journey to the Heartland” was the theme for the 2014 Pioneer Network Conference held last month, and many indeed made the journey!  Over 1,200 people made the trip to Kansas City for a chance to network and learn with others who are deeply committed to the cultural transformation of long term care.  The Green House Project is a true trailblazer in this movement and we are strong supporters of the conference.  Green House team members, David Farrell and Susan Frazier were presenters at two different sessions during this national event.

Nurses have a critical role to play in supporting deep transformation within aging services.
“Nurses Building Relationships for Organizational Transformation” was a session co-led by Susan and former Green House team member, Anna Ortigara who is now with PHI.  Both Susan and Anna are nurses and can speak first-hand about nurses engaged in culture change.  The session discussed the need to build effective communication strategies that will engage both the Elders and direct care staff members.  The discussion also explored how nurses as leaders, partners, gerontological specialists and teachers are faced with many more opportunities to enhance quality of life and quality of care.   The Green House model is designed to support Clinical Support Team Members, which includes nurses, in developing partnerships with individuals and self-managed work teams.

“THE GREEN HOUSE Model –Delivering Quality of Life and Bottom Line Results” was the special research session delivered by David to attendees.  He confronted the myth that The Green House model is not viable—with over 150 Green House homes operating in 25 states, the innovators who adopted the model are happy with their consumer satisfaction and their bottom lines.  David shared data from operating Green House homes that demonstrates an excellent return on their investment, and their decision to build even more Green House homes.  He told the group that Green House homes are delivering the results that Accountable Care Organizations (ACOs) in health care reform are looking for today.


THRIVE: Understanding the Language of Research

The Green House Project has partnered with the Robert Wood Johnson Foundation’s THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care. Supported by the Robert Wood Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes. Each quarter, a member of the THRIVE team will contribute a blog post to the Green House Project website.

As the THRIVE research projects head toward completion later this year, our research team has developed plans to share our research findings.  In addition to publishing articles in a special issue of the journal, Health Services Research, we also will share findings through conference and webinar presentations and blog posts.

Because some commonly used research terms may sound like jibberish to non-researchers (after all, who really knows what a p-value is?), we will devote our next few blog posts to explaining a few terms that will help non-researchers better understand the THRIVE articles, presentations, and posts.  We’ll start by reviewing Quantitative and Qualitative research designs.

When people think of research, they’re usually thinking of a Quantitative research design, which essentially measures and compares things.  Quantitative research asks questions like “How many residents in one nursing home have falls compared to residents in another?” or “Does providing one type of care work better than providing a different type of care?”  A quantitative research design allows a researcher to establish “how much”, whether one thing is related to another (such as whether falls are less frequent when certain care is provided), and also – depending on the details of the design – to establish cause and effect.  The data collected are usually in numerical form, and findings are expressed in terms including percents, means, and p-values (to answer the earlier question, a p-value denotes whether or not a number is or isn’t significantly ‘different’ from another…..we’ll come back to this in a future blog post).

Qualitative research designs essentially answer “how” and “why”.  Qualitative research asks questions such as “Why are so many falls occurring?” or “What conditions are necessary for a nursing home to provide a certain type of care?”  A qualitative research design permits a researcher to better understand events and the circumstances under which they occur and vary.  The information gathered in these types of studies are usually textual, and include the researchers notes and observations, as well as in-depth interviews and quotes from people who have knowledge of the event being studied.  This information is analyzed by looking for common themes across all of the information collected and reporting these findings – often contextualized using exemplative quotes.

The THRIVE team is using both quantitative and qualitative methods in their research, which is considered mixed-methods.  This is the best of both worlds, and is allowing us to answer questions such as:

Quantitative:    What was the annual turnover rate for shahbazim over the past two years?
Was this turnover rate statistically different (higher or lower) than that found
among CNAs in other nursing homes?

Qualitative:      What was the role of the Director of Nursing in the Green House homes?
How might variations in this role relate to shahbazim turnover?

Stay tuned for the next THRIVE blog post.  In the meantime, if you have questions about this post, or suggestions for future ones, please let us know.

Questions about THRIVE can be directed to Lauren Cohen ( or 919-843-8874).

National Nursing Home Week® 2014 Success Stories

Green House adopters and enthusiasts across the country came together last month during National Nursing Home Week to educate their local communities and policymakers about The Green House difference. This year, the American Health Care Association used the Hawaiian theme, “Living the Aloha Spirit,” for the week. The Green House model’s core values of Meaningful Life, Empowered Staff, and Real Home, aligned closely with this year’s theme and we were excited to invite communities across the country to see the difference that our model offers for elders and their families.

Here are just some of our success stories from that week:

  • From February 2014 to today, we have gained 220 followers on Twitter totaling 1,635
  • From April 2014 to today, we have received 73 new likes on Facebook totaling 2,483
  • Two templates were added to our Support the Movement page
    • Sample Letter to the Editor
    • Sample Letter to a Policymaker
  • Editorial from the Guide at The Green House Homes at VA Illiana Health Care System in Danville, IL was printed in two local papers
  • The Guide with the Green House homes at Mirasol in Lakewood, CO wrote an editorial
  • Three policymakers site visits occurred in conjunction with National Nursing Home Week:
  • Photos like the one you see above from St. Martin’s in the Pines in Birmingham, AL were shared and added to our Flickr account

A big thank you to all who participated!

Want to learn more? Visit our Support the Movement page and use our policymaker site visit letter and editorial sample and share these tools with your Green House home friends and colleagues.

Contact Meaghan McMahon at ( with your questions or comments.

Sr. Director of THE GREEN HOUSE® Project, David Farrell, Honored by California Medical Organization

Citing his extensive work in transforming long-term care in California, the California Association of Long Term Care Medicine (CALTCM), honored our own Sr. Director, David Farrell with their 2014 Leadership Award.

CALTCM is the professional organization for California physicians, medical directors, nurses, pharmacists, administrators, and other professionals working in long-term care.  CALTCM is the state chapter of the American Medical Directors Association (AMDA).  It is an organization that advocates quality patient healthcare, provides long-term care education and seeks to influence policy within the industry.

The Leadership Award presentation took place at the CALTCM 40th Annual Meeting for group.  Prior to joining The Green House Project, David served as a nursing home administrator and regional director of operations in California.  As many of you know, David has long been a strong advocate for person-directed care and culture change within long-term care.

Click here to read the full announcement.

We congratulate David on receiving this award!

Anna Ortigara, MSN, Honored by Long-Term Living Magazine

We’re not surprised…but we are very pleased to hear that our colleague and friend Anna Ortigara is one of the four people selected this year to receive Long-Term Living Magazine’s 2014 Long-Term Living Leaders of Tomorrow award.

The award honors individuals who are “…making a difference in their towns and states while serving as exemplar model for others across the country” as leaders in the long-term and post-acute care field.

For the past six years Anna was the Resource Director for The Green House Project.  She was a passionate and driven team member who played an integral role in developing our educational program including countless tools and resources.

Earlier this month, Long-Term Living Magazine published a profile of Anna and the incredible work that she has done over the years, including her work before Green House and the role she holds now as an organizational change consultant with the Paraprofessional Healthcare Institute (PHI).  In the article, Anna talks about the importance of educating others about communication and team-based problem-solving skills and says, “I’ve come to really believe that using a coaching approach to leading change as the model or framework creates the capacity, the possibility of all the rest of the transformation for the organization.”

Talk about The Green House Project during National Nursing Home Week® 2014

Are you interested in spreading the word about the Green House model and bringing Green House homes to your community? You’re invited to join Green House adopters and enthusiasts across the country during National Nursing Home Week from May 11-17 to educate your local communities and policymakers about The Green House difference.

This year, the American Health Care Association is using the Hawaiian theme, “Living the Aloha Spirit,” for National Nursing Home Week. According to their website, the aloha spirit means that “… the people of Hawaii are encouraged to treat others with deep care, respect and humility, leading to individuals creating a better world.” The Green House model’s core values of Meaningful Life, Empowered Staff, and Real Home, align closely with this year’s theme and we are excited to invite communities across the country to see the difference that our model offers.

Want to get involved next month? Here’s how:

Write an op-ed in your local paper in support of the Green House model & share with us!

– If you’re already an adopter, invite local policymakers to “see the difference” by visiting your Green House home during that week and sharing photos with us

– Help us launch a “Get Connected” campaign and share your National Nursing Home Week stories and photos using social media and connecting with us on Facebook and Twitter using #EldersRule

Need a template to get started? Visit our Support the Movement page and use our policymaker site visit letter and editorial sample and share these tools with your friends and colleagues. Contact Meaghan McMahon at ( with your questions or to share success stories, photos and editorial letters.

Early Research Findings from THRIVE

The Green House Project has partnered with the Robert Wood Johnson Foundation’s THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care. Supported by the Robert Wood Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes. Each quarter, a member of the THRIVE team will contribute a blog post to the Green House Project website.

Early findings from the THRIVE research collaborative were published in The February 2014 Gerontologist supplement, Transforming Nursing Home Culture: Evidence for Practice and Policy, a themed issue providing evidence to inform practice and policy related to culture change.  The full articles can be accessed at and are summarized here.

A paper entitled “A “Recipe” for Culture Change? Findings from the THRIVE Survey of culture change Adopters” provided information from a survey that assessed which components of culture change – and in what combinations – have been adopted by nursing homes.  The survey was completed by 164 nursing homes that had already adopted culture change.  Results showed that adopted components of culture change varied across the type of nursing home model (i.e., small house, household, traditional unit).  As one example, respondents from small houses reported a significantly higher rate of direct care workers preparing meals (79%), but these were some of the least adopted practices for other adopters (22% of households and 13% of traditional units).  Results also showed that some traditional environments have been able to implement certain culture change components without large capital investments.  For instance, respondents reported similar rates of practices related to educational support and quality improvement regardless the nursing home model.  Taken together, these findings suggest that although practices do vary by model, some components of culture change are attainable for homes that have fewer resources to invest in large-scale renovations or reorganization.

A paper entitled “Who are the Innovators? Nursing Homes Implementing Culture Change” focused on the organizational factors associated with culture change implementation.  Using a sophisticated analytic process, information from 16,835 nursing homes was used to determine which resident, facility, and state characteristics related to a nursing home later being identified by experts as having implemented culture change.   These characteristics included being nonprofit, larger in size, and with fewer Medicaid and Medicare residents. Implementers also had better baseline quality with fewer health-related survey deficiencies and greater licensed practical nurse and nurse aide staffing. These findings suggest that nursing homes are in a better position to implement culture change if they start out with more resources and fewer challenges.   In a related article entitled “Culture Change and Nursing Home Quality of Care”, analyses examined how culture change implementation related to later nursing home quality.  This study found that nursing homes identified as culture change adopters later had fewer health-related survey deficiencies, but there was no improvement in the MDS-based metrics of quality.  These finding may suggest that culture change improves nursing home processes of care, and/or that surveyors recognized the homes’ culture change efforts in their ratings.  The lack of impact on MDS outcomes may suggest that either the early focus of such efforts has not been on clinical outcomes, or that because nursing homes adopting culture change already had better outcomes, there was less room for improvement.

Finally, a paper entitled “Developing the Green House Nursing Care Team: Variations on Development and Implementation” explored the roles of the nurse and the Shahbazim in the Green House model, focusing on how variations in the nursing team related to clinical care practices. Data were collected through observations and interviews with nurses, Shahbazim, Guides, and Directors of Nursing, and found that implementation of the nursing role within the Green House model varied both within and across sites.  Four nursing model types were identified: Traditional (nurse manages both care and non-care activities); Parallel (nurse manages care, Shahbaz manage non-care activities); Integrated (nurse and Shahbaz collaboratively manage care and non-care activities); and Visitor (Shahbaz manage care and non-care activities, with input from nurse as requested).  Care processes, Shahbaz skill development, and worker stress varied across each model, and although the Integrated model presents considerable challenges in terms of clarifying boundaries, it seemed to offer the greatest benefits in the areas addressed in this study.  

The THRIVE team will be expanding upon these and other findings in 2014, and will be sharing those with you and others via conference presentations, webinars, blog posts, and more journal articles.  As always, we invite your feedback about the best ways to keep you informed of the latest findings.

Questions about THRIVE can be directed to Lauren Cohen ( or 919-843-8874).


California Health Report: “This Green House Grows Humans”

Via: California Health Report

When the Green House homes opened in California last fall, there were a number of people who were very happy to see that day come to fruition.  One person who was very pleased to see those doors open was Yolie Zepeda.

Yolie vividly recalls the words of her uncle after he was placed in a state funded nursing home after suffering from a number of health issues.  Her uncle told her that he felt so worthless at the facility, explaining that he could be sitting alone for endless hours in a soiled diaper.  He told her “they actually treat you worse than I’d ever treat a dog.”

Today Yolie is a Shahbaz in the Green House homes, and is happy she can tell a different story.    

Click here to read more about Yolie and her dedication to the Elders in her home…a home that the California Health Report says is “a welcoming vibe that gushes home.”



Read the story behind the man who led the effort to bring those Green House homes to California, President and CEO of Mt. San Antonio Gardens, Randy Stoll.  Some people come up through academic programs, which Randy would eventually do, but first he ventured in another direction.  Click here to read about his journey in aging services.

Happy New Year! THE GREEN HOUSE® Project has some special resolutions for 2014

The beginning of a new year always brings a sense of excitement…a chance to reflect on our accomplishments…a chance to strategize about what improvements can be designed to further our mission or goals in life.  As I turned the day calendar on my desk this morning, I believe the message was perfect:  If we celebrate the years behind us they become stepping stones of strength and joy for the years ahead.

After celebrating our 10th Anniversary in 2013, The Green House Project team and our adopters are most anxious to start our 2nd decade off with a renewed energy to spread the good news about The Green House model and the high quality of care and service that it provides to Elders.

To attain that goal, we’ll certainly be “on the road” with our message at a number of conferences including Impact Texas, AHCA Independent Owners, Environments for Aging and a variety of LeadingAge state conferences including Aging Services of Minnesota in February.  It is especially exciting to speak in Minnesota because, in 2014 our first homes in that state will open in Mankato.

There is also a very special nationwide tour combining the talents of Dr. Bill Thomas, The Green House Project, and others in the works…but you’ll just have to wait to hear more about that in the coming months!

We are also resolving this year to further enhance our Green House workshops, Green House overview webinars and to provide that critical financial information through a series of webinars beginning in February.

We feel strongly that our Peer Network is a huge part of our value proposition.  This group has made significant strides over the past 12 months, and the outlook for 2014 is exciting.  A robust schedule of educational webinars, exclusive to Green House adopters, is already planned through the first quarter of the year. Organizations who have adopted this model, learn about a variety of topics and share best practices, not only with industry leaders, but with their peers.  We will work together to continuously enhance the opportunities to learn, grow and thrive as a movement.  

Our education programs are a critical element in making a successful Green House home, and we are committed to expanding and deepening this imperative offering. Through careful evaluations and Peer Network support, in 2014 we will begin working on additional modules of education for the leaders of our adopting organizations and for the new team members in Green House homes.

Of course with the generous support of The Robert Wood Johnson Foundation and other partners we are working on a number of special projects.  Stay connected to our website, facebook and twitter to for the latest details!

They say that culture change is a journey without a destination, and at The Green House Project we embrace this concept.  Every year we resolve to learn more by working with all of you, to create a world where Elders are seen as creative, resourceful and whole.

Go Small and Go Home — Ingrid Weaver and the Porter Hills Green House Project

Ingrid Weaver, CEO, Porter Hills

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.”

The Green House Facebook Community Grows to 2000 Friends!

Over the past 3 years, The Green House Project has established a robust community on Facebook.  This online gathering place involves, current Green House homes, long term care providers, elders, advocates, family members, policymakers, consumers, and many others that make of the mosaic of this movement.

This page shares posts about a variety of things that make up the culture of The Green House Community:

  • Highlights of the amazing work from Green House homes around the country
  • Updates from the national initiative to create real home, meaningful life and empowered staff in long term care
  • News and current events that help to change the paradigm of aging
  • Fun and inspiration (don’t we all need a dose of that now and again?)

As we grow beyond 2000 friends, are are eager for more people to join in the conversation.  Share your thoughts, dreams, stories and vision of how this world can be a more nurturing place for elders to live, grow and thrive.  Together, we are making a difference!

Click on the icon to join our facebook page: