Green House Blog

The Visionary Leadership Behind the First PACE Green House homes

Green House homes are dynamic and able to impact innovation in many different settings.  The first Green House homes to be incorporated with a PACE community have opened as part of The Thome Rivertown Neighborhood in Detroit.  It is an honor to be able to open the doors of accessibility for low income elders through this partnership. 

PACE is the acronym of the Program of All-inclusive Care for the Elderly.  PACE programs are government-funded managed care health plans that also provide comprehensive health services for individuals age 55 and over who have health needs classified as “nursing home eligible” by their state’s Medicaid program.  The goal is to keep chronically ill elders independent for as long as possible –preventing avoidable  hospitalizations, emergency visits and stays in nursing homes.

Roger Myers is CEO of Presbyterian Villages of Michigan, and Mary Naber is President/CEO of PACE Southeast Michigan.  They are the leaders behind this innovation, and hold the belief in this partnership to evolve the healthcare system.  “This is the future.  Health is about more than medical care.  To meet the needs of elders, the focus must be holistic, accessible and home based,” Naber says.

The goal of PACE is to keep people as independent as possible and to avoid nursing home stays.  Despite that, nationally 7% of PACE participants still end up spending some time in long term care, according to Naber, “less because of a need for skilled care, and more because they are not safe to stay in their homes.”

“As we know, even the best traditional nursing home does not provide the greatest living experience, and now, for at least 21 people, The Rivertown Neighborhood is able to offer an alternative.  The Weinberg Green House homes meet their needs, support them to thrive and enable them to remain in the community,” says Naber.  “It’s very gratifying to be able to offer this option.  I wish I had 10 Green House homes for people!”

The Green House homes are licensed as Homes for the Aged, a distinction that provides flexibility and enables elders with a high level of need to live in the least restrictive environment possible.   As it happens, many of the people living in these homes have moved there from nursing homes.  The PACE program provides a “wrap-around” so that elders receive all the services they need, enabling The Green House home will be their home for life.

“The great thing about the co-location of the Weinberg Green House homes to the PACE center is that the elders receive all the same benefits as if they were living in their own homes, which they are- Green House homes.  Being right on the PACE campus will keep elders more mobile and socially engaged.  It will also help PACE clinicians stay in touch, and we know that frequent interactions can help prevent ER visits and other medical concerns.” explains Myers.

“Health is not just about medical care, especially when you’re dealing with chronic illness,” declares Naber.  By leveraging an interdisciplinary team rather than the typical doctor-driven model, the team at the Weinberg Green Houses are able to care for the WHOLE person: body, mind and spirit.

PACE Southeast Michigan is a 501c3 not-for profit government funded unique health plan and comprehensive care provider.   It is a jointly owned by Henry Ford Health System, one of the early PACE innovators, and Presbyterian Villages of Michigan.

The Thome Rivertown Neighborhood includes Independent Living, Assisted Living, the PACE Center and now The Green House homes.  Not everyone who lives on the campus is a part of PACE, but it is built as a continuum to enable low income and highly frail people to stay in their community as their health status changes.

Integrating residential living with PACE is proving to be an effective development that will hopefully spread throughout the country.  PVM led the development effort for this supportive neighborhood during the recession, and the idea was so compelling that they were able to achieve their goals.  A $2 million grant from the Baltimore-based Harry and Jeanette Weinberg Foundation provided much of the support to make their vision to add Green House homes to the community a reality.

 

 

‘The Program of All-Inclusive Care for the Elderly’ and The Green House model: An Innovative and Cost-Effective Partnership for Comprehensive Care

Lori Gonzalez is a PhD researcher at the Claude Pepper Center of Florida State University who studies alternatives to traditional nursing care and social inequality.

The first Green House homes included in a Program of All-Inclusive Care for the Elderly (PACE) partnership will open in early February, joining together two of the nation’s most promising long-term care models.  The Harry and Jeannette Weinberg Green House homes, located in the Thome Rivertown Neighborhood in Detroit, Michigan will serve approximately 21 lower-income older adults who are otherwise able to live safely in the community, but who are currently residing in skilled nursing facilities.  According to Capital Impact Partners, serving these older adults in Green House homes with the support of PACE, compared to providing care in a traditional nursing facility, is expected to save the state’s Medicaid system about $130,000 per year.

PACE began in California in the 1970s as an alternative to institutional long-term care.  A group of Chinese, Italian, Filipino, and other immigrants held cultural views about caring for their loved ones that departed from the larger culture of aging in nursing homes.  They formed “On Lok” meaning peaceful, happy abode.   By 1986, On Lok developed the nation’s first comprehensive model of coordinated care and by 1997, the program became a permanent provider under Medicare and a state option under Medicaid.  Today, PACE operates 116 programs in 32 states and serves over 30,000 older adults, most of whom are dually eligible for Medicare and Medicaid.  PACE operates with the belief that, “it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible.”  With the assistance of the PACE program, 90% of participants who might otherwise enter a nursing home are able to live in the community.

PACE provides comprehensive care to those who are eligible for the program.  PACE eligibility includes being 55 or older, certified by the state to need a nursing home level of care, residing near a PACE care center, and having the ability to live safely in the community. When an individual enrolls in PACE, they (and their family) meet with a team of care professionals including social workers, nurses, primary care physicians, and nutritionists to help craft a plan to serve an elder in the community.  PACE participants visit a PACE care center routinely where they, depending on their plan of care, might receive a flu shot, dialysis, dental care, respite care, a hot meal, physical therapy, transportation, or participate in social activities.  Family members who visit the center receive counseling or advice on how to care for their loved one.

Green House homes also provide quality care and quality of life, but in a residential setting.  In Green House homes, “elders and others enjoy excellent quality of life and quality of care; where they, their families and the staff engage in meaningful relationships…” and when licensed as ALFs, they provide a community-residential setting for elders that is expected to exceed the quality provided by other ALF models.  Green House homes are not just homelike, they are places where elders call home.

The goals and values supported by PACE and The Green House model are similar and their partnership will honor elders’ preferences to avoid a nursing home and to live in the least restrictive care setting possible. Green House homes provide high quality residential living and PACE provides the physical health, mental health, social health, and family support for both acute care needs and long-term care needs.  Furthermore, PACE and Green House value the belief that all elders should have access to quality care and a good quality of life. PACE serves mostly dual eligible, frail elders and Green House homes are meant to be available to all, regardless of income or wealth.  The Green Houses at Rivertown Neighborhood, along with PACE will support these values by serving 21 low-income elders.

Aging in place is highly desired by older adults, but sometimes financially out of reach.  The Thome Rivertown model demonstrates that creating a Continuing Care Retirement Community for lower income individuals is possible and that when PACE and Green House are integrated into that community, high quality, cost-effective care is achievable.

Notes from The Green House Director: Achieving the Triple Aim of Long Term Care: Quality, Health, Affordability

Recently, I was honored to speak at the Michigan LANE (Local Area Network for Excellence) conference in East Lansing that was attended by close to 300 dedicated leaders of skilled nursing facilities.  It was there that I was reminded of the Centers for Medicare and Medicaid Services (CMS) Triple Aim –

1.) Improve the persons’ experience of care – both quality and satisfaction

2.) Improve the health of people and the community’s health

3.) Reduce the cost and wasteful spending

I feel confident that The Green House Model addresses all three of these goals.  And we have a significant amount of independent research to support this feeling.   Thanks to the support of The Robert Wood Johnson Foundation, The Weinberg Foundation and AARP, model is spreading and Green Houses nationwide have the outcomes that hit these marks and outpace traditional SNF’s.

After the LANE event, I stayed in Michigan and I saw an excellent example of how visionary leaders in Michigan collaborated in order to hit the CMS Triple Aim while helping to revitalize downtown Detroit.  I had the opportunity to tour the new Rivertown Neighborhood, an affordable senior community that will provide over 770 seniors access to desperately needed housing and supportive services.   The grand opening is April 12th.

Presbyterian Villages of Michigan (PVM), in collaboration with Henry Ford Health System and United Methodist Retirement Communities, have creatively adapted an old dilapidated pharmacy plant and expanded The Center for Senior Independence (CSI) program (nationally recognized as PACE).  Two Green Houses serving 20 – 24 elders will be an integral part of the Rivertown Neighborhood.

At the end of the tour, Roger Myers, the President and CEO of PVM, and his incredible team of partners, brought us into bottom floor of a cold, open space of a four-story brick building attached to the beautifully renovated building.   None of the floors were in the building so that you could look up to the ceiling that was 4 stories up.  This is where a huge vat of cough syrup used to brew and this is where the two Green Houses will sit on two floors above a café.

The Rivertown Neighborhood demonstrates how we can tackle complex social factors that effect elders’ heath and their well-being.   Over 200 employees (and Shahbazim) at Rivertown will address the social determinants of health, and the healthcare, of hundreds of the community’s seniors every day.  In so doing, they will give peace-of-mind to thousands of the elders’ family and friends.   Its’ an exciting project and am thrilled the Green House Project is a part of it.