Green House Blog

Kris Angevine, Living The Green House Model

Reposted from www.stjohnsliving.org

Kris.pngWhen it comes to long-term care, Kris Angevine strongly believes smaller is better.

“It’s better for relationships with the residents and it’s better for the teams who take such good care of them,” Kris, who serves as the Guide at the Penfied Green House homes, said on a mild March day in 2015. “You get to know the residents so well. And if anything changes, you can respond immediately. This leads to a better quality of life.”

Having worked at St. John’s now for 11 years—first in dining services and for the past three years as a Green House and Eden Alternative guide, educator, and mentor—Kris also believes that residents should have as many choices and as much autonomy as possible. In her multiple roles, Kris helps develop self-managing teams that can care for Green House home elders with a minimum of supervision.

As a member of many teams in the past, Kris said it does not make sense to have a supervisor hovering over staff members who know how to do their jobs. At the Penfield Green House Homes, those staff members are called shahbazim (plural), a Persian word meaning “royal falcon.” At St. John’s, each shahbaz is a versatile, universal worker who sees to all the residents’ needs.

Eden Alternative co-creator Dr. Bill Thomas came up with the idea to apply this term. They are tasked with caring for the 20 elders who live in the two homes, which were built in 2012. Whether submitting work orders, providing care and companionship, building consensus, or providing treatment, the shahbazim, along with the nurses and an on-call doctor, do it all. The main household tasks of shopping, cooking, housekeeping, and laundry are done on a rotating basis so no one person has only one job.

The premise for the Green House model is to create a real home for elders to continue living a meaningful life and create an empowered staff. The staff’s goal is to eliminate the three “plagues of the spirit”: loneliness, helplessness, and boredom. The Penfield Homes are two of more than 170 located in 27 states, and the only community-based homes in the country.

It’s no small task to keep these houses running day after day. But through the considerable dedication and hard work of everyone involved, the Whitman and Moore homes are indeed Eden-like in both form and function. The houses are also well integrated into a quiet, multigenerational community. It takes a great deal of work, planning, and attention to detail to make it all happen, but the best people are on the job to ensure it does.

“I’ve been in the trenches my whole life,” Kris said of the work that prepared her to do this. For her part, Kris is involved in the big picture. Ultimately responsible for the Green House Homes operations, she provides the skills, tools, and resources needed to run the houses. She offers advice on problem solving and maintains relationships with the shahbazim, nurses, elders, and family members. Born in Tucson, Arizona, to a military family, Kris grew up in Titusville, Pennsylvania. Her career in the dining industry led her from North Carolina to Rochester 25 years ago. She and her husband Chris, a mechanical engineer, live in Rochester with their three cats. In addition to music and dancing, Kris has also been working in ceramics for the past year crafting hand-made bowls.

Kris also loves dogs, and assisted the elders to adopt a very friendly one named Lexi last year. After coming to consensus, Lexi came to live at Moore House last June. Together with all the other aesthetic and functional elements, Lexi’s canine companionship truly makes Moore House a home.

“It’s real life here,” Kris says. “We’ve laughed, we’ve cried, we’ve fought. It’s not sterile. It takes a lot of patience, but we work hard to build trust and keep the elders out of harm’s way.”Kris

Power Belongs with The Elder and Those Working Close to Them

New research from The Journal of Applied Gerontology showed that involving Nursing Assistants in decision making has a positive effect on quality of service. From my experience with person-centered care, I can tell you that the research rings true. The Nursing Assistant is the person who works closest with the Elder, day in and day out, and gets to know them best. These staff members know Elders as individuals, rather than just a diagnosis, and when they are empowered to make decisions based on this intimate knowledge, both Elders and staff benefit.

We do a role play exercise during Green House education where we act out a Care Plan meeting. In the first round, the Care Plan meeting is handled as it would be in a traditional setting, with only the clinical staff involved in the conversation. In the second round, we include the Nursing Assistant, Elder, Family Member and Housekeeper. The reaction to this exercise is always astonishment, as participants realize how much important information is missing when all stakeholders are not represented. As the research states, “When nursing staff had the autonomy to make decisions, there was a higher relationship to service quality. The empowerment of nursing assistants had an even greater effect than empowerment of nurses…”

In The Green House model, the power shifts to the Elder and those working closest to them. Power means having the resources and authority to make and execute a decision. This creates a deep-knowing environment where the Elder’s natural rhythm and preferences are honored. Quality is also impacted because of this familiarity. Staff members notice the small things about the Elder’s well-being, that can lead to early detection of illness and acuity changes. When staff members are empowered to meet the needs of the elder, they feel ownership and valued in their job and Elders feel safe and content, because they are known. Ask yourself, “What is best for the Elder?”, when this question is central, it is clear that those who know them well must be involved with decision making.