Green House Blog

Real Home and Real Relationships are Positive for People Living with Dementia (and all people)

At a recent Leading Age Luncheon, CEO of Virginia Mennonite Retirement Community (VMRC), Ron Yoder, shared a story that illustrated the power of home over institution to support those living with dementia

In 2000, VMRC had a secured Alzheimer’s neighborhood in its nursing center. The layout is semi-private rooms on both sides of a middle corridor and a sitting area at the entrance to the neighborhood. When the carpet needed to be replaced, the residents were moved to an assisted living neighborhood during the day while the workers were laying the carpet.

The assisted living neighborhood is “homelike” — private rooms and private baths surrounding common/shared spaces consisting of a dining room, living/sitting room, and residential kitchen.

The first day the residents were in the assisted living neighborhood their caregivers reported that the residents were more alert and active. At the end of the day residents asked, “can we stay here?” and not return to the Alzheimer’s neighborhood.

I remember reflecting that if a “homelike physical environment” has that profound of a life giving impact on residents with Alzheimer’s disease compared to an “institutional environment,” it creates a moral imperative to change.

Several years ago the Alzheimer’s neighborhood in the nursing center was closed. We now have three memory care neighborhoods in the assisted living community for residents with various types of dementia. Residents with dementia who require 24-hour complete living care (need assistance with all ADLs) live throughout the nursing center rather than in a dedicated neighborhood.

The Green House Model takes this concept to the next level through a real home environment, person-centered focus, and deeply knowing relationships that create an ideal space for a person with dementia to thrive.   As a thought leader in the field of aging, The Green House Project recently participated in a TEDMED Great Challenges Series on the growing challenge of dementia. Through this online panel and twitter (#GreatChallenges) conversation, many innovative ideas were shared, with a focus on person-centered care, increased training for staff, and support for caregivers.

Intergenerational Engagement at White Oaks Cottages

Charlene, a nurse at White Oaks Cottages, brings her daughter in to spend time with the elders.  In this video, Charlene shares two endearing stories about the joy that comes from real relationships between elders and children.  You are not going to want to miss these stories, they are guaranteed to bring smiles to your day.


VA Partners with the Green House Project to Provide Care for Milwaukee Veterans

Milwaukee, WI, will soon join two other VA sites in providing Green House homes for veterans. With one Green House home currently in construction, and plans for three more, the Milwaukee VA is adopting an evidence-based model of long-term care for elders.

The Milwaukee VA Center recently wrote about the construction of the Green House homes and what it means for their veterans. From the article:

“This takes the institutional setting out of nursing home care, which is something we have been moving toward since 2006,” said Mary Pfeiffer, who also serves as co- divisional manager in RECC, but has a nursing background.

“Our current Community Living Center and the Green Houses will operate at the same time, and both serve a specific need. Because the Green Houses are cozier with private rooms, front porches and sun rooms, it will be much easier for people to adapt to that environment. They’ll offer more quiet and individualized care, which is ideal for those patients who have dementia or those who fare better in a quieter environment.”

Certified Green House homes accommodate up to 12 residents and have a “real home” look and feel. They also have highly-trained staff that provide individualized care for elders. Research shows that elders receive 4 times more meaningful interaction with staff members than in a traditional nursing home, and this results in people being happier and healthier.  It is the deep-knowing relationships that create an environment where people’s natural rhythms and preferences are honored and respected.

Why I Love My Job…

Shahbaz Sarah Hoffman from The Green House homes at Lebanon Valley Brethren Home shares why she truly loves her position: 

Every Thursday in the Legacy building of our facility, they have bible study. As the elders are filing into the area, we have a pianist playing prelude, often one of our independent living volunteers. For various reasons our regular pianists could not make it yesterday, so activities’ staff asked one of our green house elders if she’d be interested. She agreed, but as it came time to head down, she expressed some reservation about not knowing what to play. I reassured her to just play from her heart.  I assisted her to the piano, adjusting the bench to her liking. For nearly half an hour, without any sheet music she began playing. And then started singing. I watched from the sidelines as her entire face lit up…she was beaming, proudly playing hymns she’d grown up with. The room began singing along with her…it was truly a beautiful moment. A couple of hymns were requested from the audience that she didn’t remember right away. I sang the first line and she picked it up and ran with it!
Sure, there may have been a few missed notes along the way and she may have played a couple hymns twice or thrown in a non hymn here and there…but in that moment, at that piano, she was THRIVING.

And my heart was smiling.

Please share your comments!

Leading Age names The Green House Project a Leadership Program to Watch in 2013

To expand the world of possibilities for aging, LeadingAge members and affiliates touch the lives of 4 million individuals, families, employees and volunteers every day. The work of LeadingAge is focused on advocacy, education, and applied research. CEO, Larry Minnix, shared an inspiring blog about how far our field of aging has come, and he asks the question, “So, how did dramatic change occur over the generations? Did it happen spontaneously? No, it happened because of the leadership from members, many of whom have served their communities for generations!”

Just as Eden Principle #10 states, “Wise Leadership is the lifeblood of any organization”, Larry Minnix calls out a few programs whose leadership is moving our field forward. The Green House Project, with a commitment to research, including a business case, is honored to be named as a leader. Leonard Florence Center for Living was also named as a leader to watch. As the first urban Green House Project and with incredible use of technology to create meaningful lives for those living with ALS and MS, this project is beyond cutting edge.

Thank you to Leading Age for this honor and for the work that you do to support and advance our field.

New Book written to help caregivers and elders navigate resources

FACT: There are over 44 million family caregivers caring for aging family members.
When the dust settled after two intense years of managing her mother’s care, caregivers, and finances, Faye Levow was determined to create a comprehensive resource so that no one would ever again be lost in a whirlwind of caring for aging family members. Her upcoming book, OMG! My Parents Are Getting OLD! is the result of that determination.
OMG! My Parents Are Getting OLD! is the definitive resource for families on what to do when caught up in the whirlwind of dealing with unprepared, aging parents. It will also give readers tips on how to prepare for their elder years, so life will easier for them and their families.

OMG! My Parents Are Getting OLD! weaves readable chapters from more than 50 professionals who work with seniors every day in a wide variety of capacities and fields, and the lessons from more 70 family caregivers who have “been there,” along with the dramatic, true story of caregivers, theft, finances, and family gone awry during the last years of a loved one’s life.

OMG! My Parents Are Getting OLD! has a comprehensive resource section and will be fully indexed, making it very user friendly.

“My mission is to make it popular to talk about the issues presented in the book and get people out of denial, so they start preparing for elder years well in advance. This will help both elders and their families to deliver better care with less stress when the time comes,” Faye says.

President of Launch Pad Publishing and long time entrepreneur, Faye has been writing and editing for over 30 years and coaching authors for the last seven. She has been a features writer for magazines and newspapers, a contributing author in several books, and has edited magazines, newsletters, and numerous books in a variety of genres, including a Washington Post bestseller.

Faye is co-author of Award-Winning Savory Delights: The Best Restaurants in Greater Fort Lauderdale, author of So You Want to Write a Book? The Best Writing and Publishing Tips, and creator of the upcoming book OMG! My Parents are Getting OLD! scheduled for release Spring of 2013.

Advance purchase the book at a discount and become a supporter of the project at Once the book is released, it will be available at major bookstores, both online and off, as well as on the book’s website and

Surplus Safety: A Symposium To Redefine Risk

Drs. Judah Ronch, Dean of the Erickson School of Aging, and Dr. William Thomas, founder of the Eden Alternative and Green House Project, have coined a new term and developed a new concept called surplus safety. Instead of risk meaning the possibility that only something bad might happen, they teach that the real definition of risk is the possibility of an unanticipated outcome. They further explain that there are two kinds of risk, upside and downside. Downside risk is an outcome that is worse than expected and upside risk is an outcome that is better than expected. They point out that our obsession with downside risk unfortunately leads to the taking away of any chance of upside risk for those living in long term care environments and that we prevent outcomes better than expected (upside risk) because we our obsessed with minimizing the risk of a worse outcome. Dr. Thomas as a physician and Dr. Ronch as a psychologist point out that no other part of the human life cycle allows this removal of upside risk. For instance, we do not restrain toddlers as they try to learn to walk because they might fall. Not too many people talk about our development and growth at an older age but thankfully they do. Each advocate that our human development includes a balance of both upside risk and down side risk.
The current landscape of safety where the current conception of risk includes only downside risk – in which harm may come to elders if they attempt certain activities such as getting out of bed – has resulted in very restrictive policies and practices, such as bed and chair alarms. Many safety measures, such as alarms, are designed with only downside risk management in mind i.e. preventing falls. However, the upside risk of preserving one’s ability to continue walking and to keep their balance and strength are not evaluated. Nor is the other downside risk of losing these abilities talked about. Nor is the quality of life considered according to the person of being immobilized by an alarm or agitated or isolated. Therefore, there is a strong need to look at upside risk management in addition to the traditional focus of managing downside risk.

Thus the first-ever Surplus Safety Symposium was held on September 12 – 13, 2012 in Baltimore, MD. Many thanks to the Hulda B. and Maurice L. Rothschild Foundation for funding and to the Erickson School for hosting this event.
Approximately 50 stakeholders from a diverse group of constituencies discussed the current state of the safety landscape. Experts addressed the areas of: Policy as Written and Interpreted; Risk Assessment Methodologies; Case Law; Management and Workforce Conditions; and Resident Perspective presenting key issues and identifying levers of change. Workgroups then recommended ways to implement a strategy to change how risk is perceived, understood, managed and regulated.

The goals for the two-day symposium were to:
1. Identify strategies to promote a full evaluation of risk vs. potential outcomes in long term care.
2. Reframe the current concept of safety to better balance both upside and downside risk potential.
3. Identify codes and standards which should be addressed in order to better balance upside and downside risk.
4. Identify stakeholder groups to enlist in seeking necessary code and standard changes.

Some ideas collected (not consensus) were the following:

• Consider using probability instead of potential for harm in the CMS scope and severity grid; gather the research to back the use of probability of harm instead of potential which can be anything.
• Consider adding to every regulation “if the resident desires” or “according to the resident;” for example, Tag F363 Menus be followed if the resident desires.
• Discontinue making policies for the 1%, make the policies for the 99%. Broad global policies limit life for the 99%, individualize polices by stating that individual care plans will be adapted for each person in relationship to risk, safety, etc.
• Copy the CMS survey process for homecare where whatever provider has done is recognized and considered into survey findings.
• Incentivize like Colorado P4P bonus reimbursement and Ohio Medicaid Reimbursement where homes must implement a subset of person-directed practices in order to receive full reimbursement.
• Include each person’s goals for themselves and their perspective on risk. This should be individualized based on how much risk they want/can tolerate. Kind of like investing in 401K plans, some of us prefer low risk, others moderate or high risk. Risk needs to be determined by the Elder primarily, and not by surveyors, corporate leaders or other professionals who assign this determination based upon what they think is best for all parties involved.
• Concept of safety is one dimensional regarding the body. Need to add mind/spirit, psychosocial.
• Immediate Jeopardy includes potential for harm which is so very easy to cite, easier to cite IJ than a G. This needs to change because it has the greatest sanction associated with it – possibly move potential for harm somewhere lower down on the grid.
• Equitable attention to all relevant regulations; treat all requirements the same. Preventing accidents is just as important as resident has the right to refuse medical treatment or right to choice.
• Eliminate FOSS/federal surveys as they are over burdensome and do not result in better care for residents; redirect those resources to training of how culture change practices embody intent of OBRA ’87 Nursing Home Reform Law and current regulations.
• Explore legal strategies to promote resident choice and consistent enforcement of all regulations.
• Recognition that accidents happen – differentiate between accident and neglect/systems failure.
• Reconsider the current metrics for success and incentives: do we incentivize surplus safety or highest practicable physical, mental and psychosocial well-being?
• Research the benefits to upside risk.

As you can see, many good ideas on how to eliminate surplus safety were collected. According to Rob Mayer of the Hulda B. and Maurice L. Rothschild Foundation, this is just the start. Be on the alert for more to come. In the meanwhile, do whatever you can to promote the balance in every person’s life of both upside and downside risk. Better yet, do all you can to promote that the person continues to be the boss of their life. Promote this daily with persons you serve. Call for meetings with your survey agency that is to serve the persons living in nursing homes and assisted livings in your state. Lean on your state culture change coalition to bring up these issues in already-established stakeholder meetings. Don’t wait for someone else to do something. See what you can make happen. Go get famous. Eden has a great motto: “It’s Time.” Actually, it’s past time. We all want better.

Carmen Bowman, Regulator turned Educator, owner Edu-Catering: Catering Education for Compliance and Culture Change and Facilitator of the 2012 Surplus Safety Symposium

Green House model creator, Dr. Bill Thomas, to be honored by The Long Term Care Community Coalition

Green House model creator, Dr. Bill Thomas,”an international authority on geriatric medicine and eldercare”, will be honored by The Long Term Care Coalition in a fundraiser to benefit the coalition. The theme of this year’s fundraiser, “improving the lives of nursing home residents and changing the way we think about the elderly”, is a perfect backdrop to Dr. Thomas’ message that it can be different!

The Long Term Care Community Coalition (LTCCC) is a group devoted to improving care for the elderly and disabled. Their work centers around work to ensure that long term care consumers, who are often very vulnerable, are cared for safely and treated with dignity.

The Green House model, created to be a place where Dr. Thomas’ Eden Alternative Principles can thrive, is a living testement to the goals of the coalition. By simultaneously transforming the philosophy, environment and organizational structures of traditional long term care, real power is shifted to the elder and those working closest to them.

To learn more about the coalition and the fundraiser, click here.

Teepa Snow, Dementia Expert, Featured as a Keynote of The Green House Annual Meeting and Celebration

THE GREEN HOUSE ® Project is excited to welcome Teepa Snow, MS, OTR/L, FAOTA as a keynote speaker at the 5th Green House Annual Meeting and Celebration. Teepa Snow is a dementia expert and a certified Occupational Therapist, who brings a unique, person-centered perspective to engaging with people living with dementia. Teepa’s techniques, highlighting in the video, Accepting The Challenge, are utilized during Core Team Education, an important part of The Green House Project’s comprehensive education plan. This six-day training prepares staff to work in The Green House homes and includes an exploration of Green House philosophy, coaching communication, and developing skills to interact effectively with people who have dementia. The Green House Annual Meeting is an exclusive event for organizations who are trademarked Green House homes. This will be a great opportunity for the attendees to refresh their knowledge of Teepa’s philosophy, and to express their gratitude for how these techniques have impacted the elders living with dementia in their Green House homes.

Accepting the Challenge! Being with and Learning from Persons Living with Dementia, Teepa Snow’s keynote speech, will be livestreamed for free on The Green House Blog from 8:30-10:00a ET on September 7, for all of those people who are unable to attend The Green House annual meeting and celebration. Teepa will also facilitate a smaller breakout session that will be interactive and utilize many techniques for communicating and interacting effectively with people who are living with dementia.

The Green House Annual Meeting and Celebration, in Grand Rapids, MI from September 5-7, will be an event of learning, information-sharing and many networking opportunities, so if you are a trademarked Green House organizations come join the celebration! Register today for The Green House Annual Meeting and if you have questions, please call (703) 647-2311

Reciprocity: A Bake Sale at Lebanon Valley Brethren Home

In What Are Old People For?, Dr. Thomas describes “Reciprocity” in this way, “Protection can, in fact, be given and received among equals. This approach is founded on the principle of reciprocity rather than on the helplessness of the frail in the face of adult vigor.” (pg. 261)

Sarah Hoffman, illustrates this principle through her story of a bake sale at Lebanon Valley Brethren Home. After a devestating flood, the elders got together to help their community. Click on the below video to hear Sarah recount the event:

Sarah– Bake Sale– Reciprocity from The Green House Project on Vimeo.

Veteran’s Day Interview Project

    Veteran’s Day Interview

In honor of Veteran’s Day, The Green House Project would like to honor those who have served to protect our country and our freedom by collecting meaningful stories to honor their lives and contributions:

To participate in this project:
• Collect important information about who that veteran is (where they served, important life highlights)
• Conduct short interview with a veteran in your community or one who knows them well
• Share a photo/video with the veteran’s interview with The Green House Project (email Rachel,
• Present the story to your local media outlets Continue reading “Veteran’s Day Interview Project”

Veteran's Day Interview Project

    Veteran’s Day Interview

In honor of Veteran’s Day, The Green House Project would like to honor those who have served to protect our country and our freedom by collecting meaningful stories to honor their lives and contributions:

To participate in this project:
• Collect important information about who that veteran is (where they served, important life highlights)
• Conduct short interview with a veteran in your community or one who knows them well
• Share a photo/video with the veteran’s interview with The Green House Project (email Rachel,
• Present the story to your local media outlets Continue reading “Veteran's Day Interview Project”