Nursing home tragedy demands a revolution in care | Opinion
by, Michael Anderson and Kennedy McGowan
Reposted from Sun Sentinal, 9/22/17
BOLD Justice, an interfaith group of 20 congregations, has been hearing tragic stories of abuse and neglect in long-term care facilities for years. We write representing those congregations and the work we are doing to actively fight for a new type of skilled nursing care in Broward County.
The eight tragic deaths at the Hollywood Hills skilled nursing facility, followed by three subsequent deaths, must serve as an urgent wake-up call.
If it hasn’t been obvious to anyone who ever visited a “traditional” nursing care home, we need change. We know there is a criminal investigation into the causes of this tragedy. No matter what that investigation shows, let’s be clear — this was a system-wide failure. It would be naive to believe that this problem and the solution to it are isolated to one nursing home.
BOLD Justice has researched and found a philosophy of person-centered care being practiced around the country. One example is the Green House Model, which features pleasant home-style environments and resident-directed care. Most impressive to us were the scientific studies showing improved health and wellbeing of elders in Green Houses, as well as higher rates of satisfaction among staff and families.
Located in the city of Pompano Beach, Florida’s first GREEN HOUSE® Project served a total of 246 guests (residents/elders) with residents transferring from Assisted Living, along with several Independent Living residents.
Additionally, 31 spouses of residents joined their loved ones along with 24 family members and children who were also together for the storm.
Scott Pfeifer, of RDG Architects comments, “As architects, we are trained in designing environments that focus on the health, safety and welfare of the building occupants as well as the community at large. It is fulfilling for us at RDG Planning & Design to know that we have created a building for the elders and staff at John Knox Village that support The Green House philosophy while keeping everyone safe during Hurricane Irma. The building became a safe haven for the community, and is a testament to the collaborative efforts in planning which involved owners, architects, interior designers, engineers, construction managers,The Green House Project and Florida AHCA“.
Elders in the Woodlands were served by 97 staff/team members which included CNA’s, Shahbazim, Nurses, Housekeepers, Managers, Dining Service Staff and Floor Technicians. The total number of people in the building through the storm was 343. Nobody was turned away.
The JKV team was united in its focus on elders’ safety, so in advance of the storm staff meetings took place based on the JKV Hurricane Manual (2017) following the Emergency Management Plan Manual.
Staff Hurricane Meetings were held twice a day as the storm was approaching. The plan was executed based on:
72 Hour – Hurricane Alert
48 Hour – Hurricane Watch
36 Hour Hurricane Watch
24 Hour – Hurricane Warning
Best Practices Steps Taken Included:
• Double checking hurricane food, water supplies and medications
• Deploying Hurricane Nursing Medical Supplies
• Topping off diesel generators
• Setting up rented cots for Villa Residents and Staff
• Assigning Director or Leadership Team Members as Building Supervisors
• Deploying Two-Way Radios
• Continuing Communications during and post-storm with regular meetings
• Once Power was lost, generators automatically turned on for emergency power
• Once Power was lost in Health Care Settings, temperatures were monitored and hydration rounds were consistently done.
The Green House model has added passion and purpose to my family in many ways. My grandparents, David and Twylah Haun, are Independent Living residents at John Knox Village (JKV) and they were instrumental in bringing The Green House model to their community. We have had many great conversations about the model’s potential over the years, and it has become close to my heart as well. Currently, I am pursuing my doctorate in Occupational Therapy at the University of Southern California (USC). When a professor challenged us to seek out opportunities and learn what it means to be a leader in healthcare, I immediately thought of my grandparents. This led to an exciting externship at The Woodlands at JKV. Before I stepped foot on the grounds at JKV, I was already destined to have valuable experiences simply based on the leadership skills I could learn from my grandparents.
I can still remember back in 2011 when bringing The Green House model to JKV became the main topic of our Thanksgiving meal ; My grandmother was interested and my grandfather was doubtful. Never ones to be easily convinced or to skimp on their research, they decided to take a road trip to eight different Green House homes to see this model in action. After visiting four homes, Grandfather was sold on the idea and came home to put their research into action. In the years since this initial exploratory trip, my grandparents have stayed very involved in The Green House initiative at JKV and also at a national level. They have spoken at the national Green House Meeting, contributed to The Green House blog, and helped with every aspect of creating and opening The Woodlands at JKV (including selecting paintings for the walls and dishes for the dining rooms, pictured right). Grandma has continued her active role in The Green House homes by becoming a Sage, a volunteer role that allows her to mentor and support the self managed work team to become a cohesive team and help create a real home for and with the elders.
In my program, we were discussing different models of care, and my professor brought up The Green House Project. It was something USC knew little about, but were excited to see how it could change the future. I was thrilled to be able to share my grandparents’ experiences with my 150 classmates and professors. I couldn’t wait to see the model in action! The Woodlands at JKV represents the first Green House homes in Florida, and they also offer homes dedicated to short term rehabilitation. Providing meaningful therapy in a natural environment is the ideal for an occupational therapist, and an exciting reality in the Green House homes.
I spent my externship running from meeting to meeting, soaking up as many experiences as possible, and asking questions about everything. From the staff in the homes to the people working across the whole community, I was continually impressed by the way they put the needs of the elder first, and balanced that with the success of the organization.
Some of my most meaningful interactions occurred with the elders, sharing stories of joy, belonging, and feeling safe in The Green House homes. In the end, this is why we do what we do, and it filled my heart with pride to be able to see this vision that my grandparents helped to carry forward, being lived out in such a beautiful way.
My time at JKV was a wonderful learning experience, and one that I will never forget. The Green House model is truly making a difference in the lives of the elders and those who are passionate about working with them. As a leader and therapist, I know that one of the greatest gifts I can give a client is to remind them that they are a unique individual who matters. From talking to the elders and listening to their stories, watching the direct care staff prepare meals in their home, participating in leadership meetings, and delivering mail to the homes with my grandmother, every experience taught me something valuable, and I am incredibly grateful.
BALTIMORE, MD (August 9, 2016)– THE GREEN HOUSE® PROJECT has spent over a decade creating a new vision for the future of elder care. In June, the organization reported an important milestone: more than 200 Green House homes are being operated by leading organizations in 30 states.
Upon reaching this new milestone, Green House Senior Director, Susan Ryan says, “It is beyond exciting to see this initiative gaining momentum. It took us 10 years to reach the first 100 homes, and only five years to add the next 100. As our numbers continue to grow, it means that more people are able to live full and meaningful lives. Both the elders who live in Green House homes and those who work there, benefit from the elements of the model that returns value and autonomy to those who it matters to most.“
John Knox Village, a lifecare community in Pompano Beach, Fl represents the 200th Green House home to open. In May 2016, they opened 12 Green House homes. Says CEO, Gerry Stryker, of the momentous occasion, “Being the 200th Green House home is incredibly emotional and fulfilling for John Knox Village. We recognize that we are a part of a rapidly growing national movement to change the face of care and rehabilitation. Our elders deserve this.”
Cedar Sinai Park, in Portland, OR, opened the first of four Green House homes in July, representing the thirtieth state to include this lifestyle model. Sandra Simon, CEO said, “This is the future of aging services, and we are proud to create the first Green House home in Oregon.”
Research finds that comprehensive adoption of the model has the potential to impact re-hospitalization rates, end of life care, and the quality of decisions made in the homes. A strong evidence base makes this model an appealing option to consumers, policymakers and long-term care providers and increases potential for scaling.
The Green House concept has already spread nationwide, with Green House projects operating or in development in 34 states. The organization’s goal is to increase the pace of growth, and have at least 300 homes open by 2020.
About The Green House Project
Based in Baltimore, MD, The Green House Project promotes an alternative to the traditional institutional skilled nursing, replacing it with an innovative new model of care that balances quality of life with quality of care. In the Green House model, large nursing facilities are replaced with small, self-contained homes that include private bedrooms and baths, home-cooked meals and access to the outdoors, while meeting all skilled nursing regulatory and reimbursement criteria. Incorporating the core values of meaningful life, real home and empowered staff, the Green House model creates a higher quality of life, improved medical outcomes, and greater caregiver satisfaction. There are currently more than 200 Green House homes in 30 states. The Green House Project is an initiative within the newly formed Center for Innovation. Visit our website at www.thegreenhouseproject.org.
The Woodlands at John Knox Village in Pompano Beach, Florida is the first Green House project to be initiated by the residents themselves. My wife, Twylah and I, live at John Knox Village and were instrumental in bringing this model to our community. When the organization began discussing plans to build a new nursing home, the residents had a simple request; we wanted private rooms with private baths. However, as we researched more, we discovered The Green House model, and realized that privacy was only the beginning.
Twylah immediately got excited about the concept. I was not as convinced. I questioned if the program was financially wise, and if our village could afford it. I had doubts as to the quality and efficiency of preparing meals in each home, and how worthwhile it would be for us to pay outside Green House “experts” who might dictate plans and organizational structures not appropriate for John Knox Village.
In 2011, I suggested that Twylah and I visit some existing Green House homes. I felt it unfair for me to reject the concept in ignorance, so we arranged our summer vacation to include requests to visit Green House homes across the country.
Our trip’s first visit was to Buckner Westminster Place, in Longview, Texas. I remember when we entered the home, thinking, “Wow, this doesn’t look like a nursing facility at all!” Visiting with their leadership and hearing of their success began to alter some of my concerns.
Continuing our trip, we drove to Magnolia, Arkansas, where we were welcomed at The Green House Cottages of Wentworth Place. Twylah’s enthusiasm grew, and after conversations with leadership and administration, I began to consider “why would we want to re-invent the wheel, this seems to be a proven model.”
Both of us were impressed by the testimonials of Shahbazim (versatile workers who serve as care staff) and Guides, who raved about the quality of care they were able to provide in this new model, “I never would want to work in a traditional style again” seemed to be a recurring theme.
All of our research paid off. We could adopt the proven elements and core values of The Green House model and still create homes that would reflect the culture of Florida and John Knox Village. John Knox leadership agreed and decided to become a trademarked Green House organization. In every way, we has benefited from working with The Green House Project on this quest. Their training and guidance is unsurpassed. After much hard work, the organization opened 12 Green House homes of 12 elders each, in a seven story building on May 26th, 2016.
As the first Green House nursing home in Florida, we hope that we are establishing a trend in the state toward person-centered care. How grateful we are to live at John Knox Village, an organization that really listens to its residents, and ensures that, as our needs change, we will receive top notch care in a wonderful home.
As THE GREEN HOUSE® Project celebrates its 10th anniversary, South Florida prepares to open its first skilled nursing Green House homes. The project was highlighted in an article in the Sun Sentinel.
John Knox Village, in Pompano Beach, will start construction on the homes in the fall of next year. While John Knox Village will be Florida’s first skilled nursing Green House homes, “experts predict it won’t be the last. That’s because these new-styled nursing homes, and other places like them, offer the privacy, independence and amenities that aging baby boomers are going to demand when they get to the point they require long-term care.”
John Knox Village is a continuing care retirement community, which will house the 7-story “urban stacked Green House homes.” “There will be two units — each with their own front doors and staff, and functioning as an independent nursing home — on each of the six floors above the building’s ground-level common area. The units will feature 12 private rooms with baths, a large communal living space and an open-area kitchen where all meals are prepared and eaten.”
Jane Lowe, of the Robert Wood Johnson Foundation, which has supported and championed The Green House Project over the last ten years, says that “Just because you are older, frail and need a lot of support doesn’t mean you need to live in a hospital-like setting.” And this philosophy is taking Florida by storm, as more and more long-term care communities are focusing on patient-centered care.
For more on the John Knox Village Green House project, or to read the whole article, click here.
John B. Thompson, a resident of John Knox Village, and Harvard Graduate class of ’59, wrote an essay for his 55th reunion about his experience at John Knox Village. Click here to read what he has to say to his classmates about the Green House® model.
The opening of the two 12-Elder assisted living homes was kicked off with a “Celebrate Aging” event. The founder of THE GREEN HOUSE® Project, Dr. Bill Thomas was the keynote speaker. He is pictured below with Shahbaz Tracey Crawford.
Click here to learn more about the homes and the celebration in a story from The Florida Times Union. Then tell us what you think!
Operating: 0; In development: 2; Square Feet per Home: 8000
Brooks Rehabilitation, a non-profit health system serving the North East Florida region for over 35 years, is proud to announce the development of two 12-person Green House homes to add to its existing continuum of healthcare services. Brooks Rehabilitation currently consists of the nation’s busiest freestanding Inpatient Rehabilitation Facility (IRF), 26 outpatient clinics, one of the region’s largest Home Healthcare Agencies, a 68-bed five-star rated Skilled Nursing Facility, a 100-bed Skilled Nursing Facility (under development), a 61-unit Assisted Living Facility (under development) and a Clinical Research center.
The Green House ® Residences at Brooks Rehabilitation will provide specialized care to individuals with Alzheimer’s or other Dementia-Related Disorders. The homes will be licensed with the Extended Congregate Care – Assisted Living Facility license which will allow Brooks to provide a high level of personalized care to each of the elders. Each home will be centered on creating a community that supports the most positive elderhood and work life possible, and will embody the Brooks core values of teamwork, integrity, service, accountability, innovation and excellence at every level.
To learn more about The Green House® Residences visit:
In a first for THE GREEN HOUSE ® Project (at least that we know of), resident research contributes to the adoption of The Green House model:
[Excerpts from The Thursday Flyer, a weekly newsletter of the residents of John Knox Village of Florida as published September 22, 2011] “In a landmark move to cement the position of John Knox Village as the premier state-of-the-art nursing home provider in the State of Florida, the JKV Board of Directors…voted to apply for membership in The Green House Project. That motion, from an Ad-Hoc New Health Center Building Committee including ten members who are JKV residents, came before the Board with the unanimous approval of the Board’s Building Committee and Finance & Audit Committee, and passed the Board by near unanimity.
Board Chair Bill Knibloe pointed out that The Green House Project, with more than 100 homes open and functioning, has gained extensive experience operating in 27 states over the past seven years. They are the only organization, Knibloe said, to have developed a comprehensive, time-tested model embodying the philosophy of person-directed care, a supportive building plan and a corresponding cost-effective staff reorganization model. Rather than trying to “reinvent the wheel,” JKV will be better served by adopting the proven Green House model.
Board Member and prominent geriatric neurologist Dr. Murray Todd, who visited an operating Green House home in Birmingham, Alabama, earlier this year with Health Center Administrator Mark Rayner, Director of Nursing Christina Desposito and JKV resident Nancy Matthews, said all four had been impressed with what they saw and that he personally was convinced the Green House model was the way to go. It is more like a real home than an institution.
Addressing the question of cost, Resident Board Member Norm Rasmussen cited extensive independent scholarly research showing that the costs of Green House construction and operation are on a par with those of other first-class skilled nursing facilities featuring all private rooms, as does the Green House model. Resident Board Member John Thompson had spoken with the Health Center Administrator and CFO at a 5-star California CCRC operating, as does John Knox Village, with “Type-A” insurance-policy contracts and set to start construction of the first Green House homes in California in a few months. Both were enthusiastic about their project. The Administrator praised in particular the skill of The Green House Project in negotiating their project’s approval through three demanding California state agencies. The CFO said they would not raise monthly maintenance fees at all due to expected operating costs of Green House homes.”
The Green House Project is thrilled to be working with such a strong partnership of staff and residents.