Plans to reimburse doctors for conversations with Elders about what to do about end-of-life care has been talked about for years–and at times a very controversial topic–but it appears Medicare is ready to implement that change. Currently they are gathering public comments and if approved, would take effect in January.
It’s a proposal applauded by many because they believe people should have a greater say about how many medical options they want used to stay alive such as a ventilator or feeding tube.
It’s a topic close to the heart for Dr. Atul Gawande, author of the book, “Being Mortal: Medicine and What Matters in the End“. He challenges people to think carefully about the decisions they make for themselves and their loved ones at the end of life. In his book, he examines the loneliness, helplessness and boredom so often experienced by those living out the end of their lives in long-term care institutions and he argues that this should not be the norm in our country. He writes that Green House homes are “…designed to pursue that idea that a life worth living can be created…by focusing on food, homemaking, and befriending others.”
A final decision on the proposal is expected by early November. It would allow qualified medical professionals to be reimbursed for face-to-face meetings with patients. Read more about the plan using the following links:
The Green House Project was highlighted as an innovator and thought leader during the 2015 Pioneer Network Conference. The Pioneer Network is a convener of organizations who are moving away from institutional models of long term care to more consumer-driven models that embrace flexibility, self-determination and a belief that elders are meant to thrive. During the stimulating days of educational sessions, representatives from the national Green House initiative, and Green House organizations from around the country spoke on various topics to help move the field forward.
Debbie Wiegand, Rhonda Wolpert and Rob Simonetti shared design lessons learned in their session, “Build This, Not That, Lessons Learned from a Decade of Green House Experience.” Since the first home opened in 2003, there have been variations in layout and design. Through a formal Design Survey, The Green House Project asked every Green House adopter what works and what doesn’t for building design and regulatory challenges, and what strategies worked to overcome perceived regulatory code barriers. Also, insights from newly completed THRIVE research help us understand how the design contributes to sustainability, from operating cost and quality of care perspectives. Listen to this webinar that Debbie and Rob did to help those interested in changing the paradigm of long term care, build environments that support a new way of life.
Susan Frazier, Marla DeVries and Cheryl Van Bemden took audience members “Into The Black Box of Green House homes”. Here they talked about the impact of decision making to reinforce or erode culture change. Utilizing new insights from The Research Initiative Valuing Eldercare (THRIVE), a collaborative of top researchers created to learn more about what contributes to higher quality in nursing homes, this session explored the factors impacting problem-solving in long-term care organizations that lead to reinforcement or erosion of an empowered workforce, and person-centered models. Participants explored the four factors that the research determined to most greatly impact sustainability, while discovering organizational strengths and growth opportunities to create a slip-resistant change.
Tammy Marshall, Lori Grossman and Miriam Levi shared their experience of implementing person-centered care principles across Jewish Home Lifecare, a large organization with multiple sites. Tammy Marshall facilitated a second session with Sonya Barsness. They spoke about the importance of research to support “culture change” and “person-centered care.” They shared research that is being done at Jewish Home Lifecare, and how others can access research, translate it to those who need it most, and identify opportunities for additional research.
Finally, the team from Lutheran Homes of Oshkosh shared a special session called, “Honoring the Spirit Within Through Namaste Care: An End-of-Life Program for Persons with Dementia”. Namaste Care takes its name from the Hindu word meaning “to honor the spirit within.” The program was developed for elders with advanced dementia and strives to maintain their highest quality of life. It includes simple and practical ways for care partners to create opportunities for connection, meaning, and joy.
This conference is always an energy boost, knowing that the movement to transform long term care, and what it means to age, is growing, evolving and gaining momentum. The Green House Project is honored to be a leader of culture change and will continue to pursue evidence based excellence, that is based in deep knowing relationships, meaningful life and empowerment for all.
Providing pain and symptom management along with religious, spiritual and emotional support can create the conditions for a good death. In order to do this, a deep knowing of the individual is paramount. But too often in skilled nursing settings, this is not the case.
In fact, a recent survey by Centers for Medicare and Medicaid (CMS) has found that traditional nursing homes were lowest ranked for end of life care experience when compared with home care and hospital settings. The survey is a pilot right now but it will be officially launched by CMS in 2015 in an effort to provide better information to elders and their family members about hospice programs in their area.
The Green House model creates environments that support a meaningful end of life experience. The Green House “home for life” philosophy, combined with the small number of elders in a home, and consistent staffing, leads to deep relationships. In this setting, as an elder nears the end of their life, their desires and preferences are clear and respected. End of life care is a time of honor and reverence in The Green House model. Read this granddaughter’s experience at Tabitha Health Care in Lincoln, NE. The Green House Project has placed an emphasis on end of life care, and has worked with adopters of the model to develop resources and guidance for the end of life that respect the needs of the individual, other elders in the home, support staff and families.