Green House Blog

Green House Featured on Panel at Ziegler CFO Workshop

Small House Nursing Homes is a trend that providers are recognizing as a solution to the growing workforce crisis, the pursuit of high quality at a lower cost and consumer demand.  Green House Senior Director, Susan Ryan, was invited to the Ziegler/LeadingAge 2018 CFO Workshop join a panel with Otterbein, and discuss, “Keys to Operating Successful Small House Models” .

The data presented during this session stemmed from the recently updated financial survey of Green House partners by Terri Metzker of Chi Partners.  In this survey, she explored the essential elements to achieve viability through comprehensive culture change.

To learn more about how Green House homes are faring in comparison to national trends and the importance of leadership to create sustainable results, please download the full webinar>>

A Person-Centered Approach to Rehab & Recovery

 

Reposted from The Pioneer Network Newsletter

 

 

Lisa Milliken serves as the Director of Education for Select Rehab, where she researches evidence based practices and develops continuing education courses on current hot topics for therapeutic intervention in the post-acute setting. Her goal is to assist this field in the prevention of unnecessary re-hospitalizations and to help therapists deliver the highest level of rehab practices for the most optimal clinical outcomes. 

 

 

“If my therapist asks me to do something that makes sense to help me achieve I want to do, then I would be motivated to do it. It would make sense to me. But how is this bicycle thing going to help me work in my garden or wash my clothes? That doesn’t make sense, so why should I have to do them?”

These are often the thoughts of residents in a community’s rehab department who are there to regain a prior function. I’m reminded of a story shared by a colleague about one man (Tom) who was in short-term rehab following his stroke. His goal was to regain function of his left arm and leg to go home and resume work on his farm. Initially Tom did not like doing the same old exercises, which were assigned to him by the physical therapist to improve his leg strength. And he surely didn’t enjoy the tabletop pegboard and exercise putty his occupational therapist gave him to work on. His comment to all of this was, “This is ridiculous, why I am doing this?” So they stopped and asked “What would you like to be able to do again?” To this he responded, “Well, I want to go home and get on my tractor and get back to work!” So the therapist called Tom’s son and they arranged for the tractor to be brought to Tom’s senior rehab community and parked it in the parking lot. Every therapy task from that point included goals to get on and operate the tractor. This meaningful therapy had a purpose and Tom’s progress then increased dramatically.

Each elder’s rehab goal is different. We should not assume that everyone wants to walk 100 feet and improve standing balance to 15 minutes. There may be no meaning or purpose to such goals. But if we ask them, they will often tell us exactly what they want. It may be that they want to sweep their own floors, go get their mail or walk to the living room to visit with other elders by themselves. Or maybe it’s to independently work in the kitchen because they’re a chef and frequently volunteer at a local shelter to help with meals.

A successful meaningful therapy task includes the following components:
• Person-centered and individualized
o Based on preferences
o Meaningful versus rote
o Graded to abilities
• Volume and content are appropriate to skill level
• Therapy and nursing team members’ attitudes are supportive of the elder’s goals

According to a study by Port and others in 2011, we can effectively solicit an elder’s preferences through a series of steps, including the systematic narrative history of activities enjoyed prior to admission and a direct interview of the elder about activity preferences and available choices. We can then identify health-related or contextual obstacles and develop novel interventions to re-engage each elder in their preferred task. Historically, traditional therapy would focus on impairment-based treatment approaches. And components of such approaches may still be necessary and beneficial at specific points of treatment, such as to collect baseline data for range of motion, strength and activity tolerance.

But functional-based treatment approaches should also be included in the elder’s skilled plan of care. Each elder needs to be challenged and tested in functional skills that will be required of him/her in the following skilled rehab, whether that be within a community setting such as a nursing home or assisted living, , or in their own home. This approach prepares the client for the specific activities and skill sets which they will need to attain their optimal level of functioning in any setting, and where possible, to successfully transition and remain in their home without the potential risks.

The recently updated Rules of Participation for Long-Term Care now cites the resident’s preferences as a requirement in many of the codes of federal regulations. For instance, the Resident’s rights section includes this statement:

“A facility must provide a person-appropriate program of activities that should match the skills, abilities, needs and preferences of each resident with the demands of the activity and the characteristics of the physical, social and cultural environments.”

Furthermore, payer sources such as Medicare and various managed care and insurance companies stress the importance of quality outcomes in a timely manner. So it should be of no surprise that our detailed graphs and charts of outcome data per client shows better and faster improvements as a result of the functional based therapy where we focused on the residents’ personal goals.

Such regulatory and outcome requirements further support our priority to first seek the resident’s input regarding their preference and then help them to achieve their unique goals. Whether we’re working to get Tom back on his tractor, helping Louise to return to her kitchen, or supporting the best quality of life possible as defined by each resident in a community, we can cater each therapy session to their unique goals and the result is a win-win for us all.

A Sage’s Testimonial of Short Stay Rehabilitation in a Green House home

For the last few years, I have served as a Sage (volunteer who supports and advises the self managed work team) at The Green House homes of Mirasol.  Recently, my role was reversed, when I moved in to recover after an extremely taxing and debilitating surgery.  These homes are listed as 5 Star by Medicare and Medicaid, a wonderful professional endorsement.  I can tell you, however, that the essence of what I experienced, goes far beyond that checklist, and their stellar outcomes reflect something much deeper and more comprehensive.

The Green House homes were the only attractive option for rehab within 20 minutes from my home.  Because I know how popular The Green House homes are, I was worried that there would not be space for me.  I was delighted to be able recover in a Real Home. I knew that being a volunteer would be very different from being a guest in the community, but I couldn’t have predicted how impressed I would be, or the gratitude I would feel.

The Green House team ensured that the process was smooth and dignified from the very beginning.  They managed all the hospital paperwork, follow-up appointments and coordination, which in my mind already goes leagues above 5 stars!  The driver’s vehicle enabled me to sit comfortably up front, and he even offered me clip-on sunglasses, my choice of music and a warm blanket (an important touch on a freezing Colorado day).  We quickly fell into a comfortable chat and discovered many things that we had in common.

When I arrived, I was greeted warmly, like a long-lost, favorite uncle!  The Shahbazim (direct care staff) offered me the choice of going to my room for a rest, or staying at the table for a meal.  Having already having discovered my dietary preferences, they offered to make something special, just for me.  The whole home smelled scrumptious when I came in the front door! Just being there made me feel better, and I had a renewed appreciation for the airiness of the dining area, the good smells of the kitchen, and the warm, inviting fireplace area.

We went to my room – private room with private bathroom, thank goodness.  As I was oriented, I was reminded that no room is more than six doors from the hearth, and this was confirmed the next morning by the aroma of breakfast wafting into my bedroom.  How refreshing to recover without the long and disorienting corridors lined with carts of stale food or unmentionables waiting to be taken out back.  At no stage
was I “parked” anywhere in the house, as I have seen in other nursing homes, left alone to wait.  To be treated like a person, rather than an object; what this did for my well-being, I can’t begin to measure.

Dinner was a very communal event, and I felt very welcomed by my fellow elders at the table.  Some required help with eating, which the Shahbazim did casually and warmly with considerable skill and NO DEMEANING BIBS.  It immediately felt like the elders were interested in me as a fellow member of the house and its extended family of elders, staff and family members. The feeling of family was beautifully illustrated, as one elder spontaneously went over to another elder, who seemed unhappy, and simply gave him a hug.  It was then that I was brought to tears, so moved by the atmosphere of support and caring. The elders are empowered to care and support each other, creating a community of reciprocity, where everyone has something to offer.

The hearth in the center of the house is a place where elders and Shahbazim could naturally get to know each other more deeply, creating mutually supportive relationships as our stories are shared. What a realization to know that the more deeply we know each other, the more we are valued.  These relationships enable the elders and Shahbazim to go beyond medical needs, and become connected, helping each other to live the best life possible.

The staff appeared to be encouraged to stop over each day and chat for a while just to get to know me better.  I felt understood, and like the things that were important to me, were important to them.  If I had a visitor (like my wife of 51 years) or was engaged elsewhere, my nurse would ask if I would prefer she come back later. She put me in the driver seat of my care, and made me feel like she honored my privacy and dignity. The Shahbazim seemed to anticipate my needs, incorporating what they learned about me from our conversations, and providing personalized care that went well beyond my physical needs.  Team members would stop by at the end of their shift to just chat about their plans for the rest of the day, to ask advice, or to ask me about my life stories.  This genuine caring, was something that I hadn’t experienced in other nursing home/rehab settings, and it was so gratifying and replenishing.  To be known and truly valued, this is better than the best medicine.

What a phenomenal rehabilitation experience, delivered by wonderful people who love their
job, love the people they work with and the elders they serve.  The Green House homes provide opportunities for these open-hearted people to grow and develop their already extraordinary gifts.  I am honored to be able to share my experience as a testimonial to others who are seeking a place where they can recover, not only physically, but holistically.  It is because of this experience that I healed so rapidly, with caring and the preservation of my dignity.

Learn more about The Green House homes at Mirasol>>

 

Happy 50th Anniversary To Medicare…What Will The Next Five Decades Hold?

This year marks some major celebrations when you think of programs for Elders in this country.  80 years for Social Security and the Golden Anniversary for the Older Americans Act as well as Medicare and Medicaid.

Medicare was signed into law on July 30, 1965; however it was a much debated piece of legislation in a variety of forms prior to that historic date!  In many ways it may remind you of the debate that continues today about health care coverage in our country and how it should be provided.

Medicare has grown into the nation’s largest healthcare program, covering 55 million Americans over the age of 65 and includes people with certain disabilities.

As lifestyle changes and advances in medicine have helped increase our life expectancy, it also has created a financial challenge for Medicare.  When the program was first implemented people were living until 70…today you can add another 10 years to that number.

Within 15 years it’s estimated that 76 million additional baby boomers will be eligible for Medicare, however it’s also estimated that there will not be enough people paying into the system to support the current benefits of the program.Generations-summer-2015-cover

It is not a new or surprising issue—we have known that the Baby Boomers would soon be turning 65 in very large numbers—what we did not know was how to begin to find good options that could keep the program in place and honor the true mission of Medicare.  With the 50th anniversary this year, there is more discussion around possible options and some are saying the future for the program is beginning to look brighter.  Click here to read one example of that optimism.

To mark this milestone occasion, The American Society on Aging (ASA) devoted its Summer 2015 quarterly journal to the topic of Medicare.  It explores the past, present and future of this important program.  Click here to read more.

End of Life Counseling: Medicare soon to cover the costs of those discussions with your doctor

elder shahbaz hands 1Plans 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.

atul-beingmortal-cover3d1-319x479It’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:

New York Times  Medicare Plans to Pay Doctors for counseling on End of Life

McKnights  Providers Applaud CMS Proposal to Cover Advance Care Planning

NPR  Medicare Plans to Pay for Voluntary End-Of-Life Counseling

 

 

 

The New York Times Features the Green House Model

Word traveled quickly last week after The New York Times published an article by Jane Brody entitled, “The Green House Effect: Homes for the Elderly to Thrive.” It took only several days after the piece was published to our Facebook page for over 16,000 people to see the article, many of whom liked or shared Brody’s insights with their own social networks.

The author creates a clear and powerful image of the Green House model and its core values with support from interviews with Dr. Bill Thomas and Steve McAlilly, CEO of Mississippi Methodist Senior Services in Tupelo, MS. By showing readers that Green House homes provide Elders with a nurturing and respectful environment where they can continue to thrive, Brody exposes the “medicalization of old age” that many of the 1.5 million Americans living and working in nursing homes experience each day.

Today, nearly 2,000 Elders across the nation are living in Green House homes in partnership with caring Shahbazim, clinical support teams and families. The swell of national recognition that we have received over the past year is a clear indication that the Green House model is well positioned to experience rapid growth and adoption in the new year as Americans embrace the power of meaningful life, real home and empowered staff as they age.

Reducing Readmissions and Healthcare Costs: The Green House Solution

In a recent issue of McKnight’s, I saw this headline – “Reducing readmissions should be No. 1 priority for reducing healthcare costs, quality experts say.”    That was a key conclusion of a recent online poll from 300 members of the American Society for Quality (ASQ) , which describes itself as the “largest network of quality resources and experts in the world” and includes prominent long-term care quality consultants.

It doesn’t take a quality expert to realize that reducing preventable readmissions is a great way to reduce healthcare costs.  By definition, “preventable” means wasted money.  In addition to saving money, reducing readmissions improves the quality of life for Elders, by minimizing the stress and disruption hospital admission causes.

Another article in McKnights from a couple of months ago suggests that pressure ulcer stats are the most reliable indicator of the likely readmission rate from a particular nursing home.  Based on an analysis of data from 4,000 hospitals, HSR: Health Services Research found that pressure ulcer prevalence in particular predicts whether a nursing home will readmit residents.

Can Green House homes help reduce readmissions?  The answer is a resounding “yes!”  In preliminary research (a complete study will be available later this year from the THRIVE research team), traditional nursing homes had readmission rates that were 7 points higher than Green House homes.  A related study found that the incidence of pressure ulcers in Green House homes was “significantly lower” than the incidence in traditional homes.

The bottom line?  The THRIVE research team concluded that the “overall difference in total Medicare and Medicaid costs per resident over 12 months (sum of hospitalization and daily care costs (RUG costs)) ranged from approximately $1,300 to $2,300 less for residents in Green House vs. traditional nursing homes” depending on RUG rates in the state.

Supporting a White House Conference on Aging for 2015

This month, in celebration of the 50th Anniversary of Older Americans Month, THE GREEN HOUSE® Project participated in the Healthy Aging Forum put on by the U.S. Senate Special Committee on Aging.  We were joined by congressional representatives, leaders in the aging field and elder advocates, all of whom demonstrated their passion and dedication to serving older adults by discussing policy frameworks and strategies that result in robust aging services for all.

We must not lose the momentum gained from this event! A national discussion on relevant aging issues, policy strategies and effective care delivery is necessary. Recently, in an article from the National Academy of Social Insurance, Anne Montgomery provides a call to action in order to gain support for a proposed White House Conference on Aging (WHCOA) for 2015. Included in her article is a Letter to the President, signed by 40+ organizations, which explains that now is a critical time for such a conference since, “…By 2015, twelve million baby boomers will have already turned 65 with sixty-six million more to follow.” If the proposal were to be supported, this would be “…the sixth White House Conference in history and the second of the 21st century.”

In order to ensure that core values such as meaningful life, real home, and empowered staff are a non-negotiable part of long-term services and supports, we need to participate in events like the Healthy Aging Forum and the proposed White House Conference on Aging.  

Join us in Unleashing the Power of Age for Older Americans Month by reading the article in support of the 2015 WHCOA and by telling friends and colleagues why we need this national forum.