Green House Blog

New CMS Regulations, a Win for Person-Directed Living

As thought leaders Green House adopters lead the way by supporting, and deeply knowing each individual living in their homes. With the introduction of new CMS regulations comes the opportunity for Green House homes to demonstrate how the model is designed to ensure each elder is able to live on his/her own terms. “Language and being focused on the elder vs. the disease, makes a difference.  At The Green House Cottages of Carmel, we developed our policies and procedures prior to these new regulations, and it felt great to see that what we knew in our hearts to be right, was reflected in government mandates.” said Melody DeCollo, Guide of  The Green House homes of Carmel, in Indiana.

The Green House Project invited, Carmen Bowman, a nationally recognized expert in all things regulatory and culture change to facilitate two webinars exclusively for The Green House Peer Network about the new CMS regulations. In these webinars, Carmen highlighted where, specifically, the new regulations support The Green House Core Values, and how Green House adopters can leverage them to even more fully realize the benefits of the model.  Says Carmen, “There is power in the institution to shut people down, and there is power in the home to bring people back to life.”

There were many areas to highlight, but here are a few of the hot topics:

Language – Words Matter! Where are the opportunities for Green House adopters to utilize language that is more person-centered and less institutional?

  • Community (or home) vs Facility
  • Individual vs Resident/Patient
  • Real Home vs Homelike
  • Meaningful Engagement vs Activities
  • Approaches vs Interventions

Proactive Approach- How can we learn to be ‘preventionists’ and align with an elder’s natural rhythms, patterns and preferences to meet their needs before an issue escalates?

Daily Community Meetings – How does The Green House model support teams to approach issues in real time to emulate the concept of daily community meetings? Where are the opportunities to involve/engage elders in decision making

Care Planning – What are Green House adopters doing to ensure Shahbazim (direct care staff), elder, and family voices are heard in care plan meetings? How can we intentionally gain the rich information that yields deep, knowing relationships?

Highest practicable level of well-being – By intentionally focusing on the physical, social and mental wellness of the person, it expands and elevates the experience. What do individuals need to thrive?

Creating Real Home and Personal Belongings – “We really want to know who you are, so please bring in things that are special to you to decorate our home”.  WHO is doing WHAT to ensure elder’s personal belongings are brought into the home/their room?

Meaningful Engagements – Take a moment and consider, is it real life, or fake life? Break apart the word to understand… What is meaningful? What is engaging?  People want to make a difference, how can we support people to live lives of purpose?

Food and Nutrition – What are Green House homes doing that showcase the power of deep knowing that supports individual preferences?  What can we do to expand ‘choice’ and offer it around the clock.

These new regulations were created in response to person-directed care, that means that our work to change the culture of aging is making a difference! We need to keep telling our stories, and letting the world know that aging and long term care can be different. We want to hear from you! If these new regulations are supporting you to shine—email us at

Chief Experience Officer, New Position Created to Support Person-Directed Care

The Green House model is a radical transformation of traditional long term care.  As a national initiative, Green House adopters are continuously innovating, taking this already proven model to new heights.  The New Jewish Home (formerly, Jewish Home Lifecare), has named veteran eldercare executive Tammy L. Marshall its first Chief Experience Officer, to support a deep and sustained culture change. Ms. Marshall was previously the organization’s Director of Green House Education.

tammy_marshall_headshot2016_preferredIn this newly created position, Ms. Marshall is responsible for leading efforts to create the best possible experience for everyone whom the organization touches.  Ms. Marshall’s chief responsibility will be to ensure that the central tenet of The Green House model—that power resides with the elder and those working closest to them– permeates all facets of the organization.  Building relationships and new kinds of connections between staff members and residents, will be a critical part of Ms. Marshall’s job.

Said Audrey Weiner, President and CEO, The New Jewish Home: “There is no one better qualified to become our first chief experience officer than Tammy Marshall. She brings to the job not only the technical skills and the experience required, but also an unparalleled commitment to the humanity that underlies The Green House model and person-directed care. She is an unrepentant evangelist for the right of elders and those who care for them to live fully realized lives in which their wishes and their contributions are uniquely valued.”

To be called The Living Center of Manhattan, the 20-story structure will be New York City’s first Green House residence and the first to be built in a major urban environment. In keeping with The New Jewish Home’s focus on putting a persons’ wishes first, several of The Living Center’s 22 individual Green House households will be kosher and, in another first for New York City, at least one will be all-LGBTQ, although LGTBQ residents will be welcome in every household.

It has been said that culture change is a journey without a destination, and The New Jewish Home is helping to shape the changing landscape of aging in society.  For more information, visit


Dr. Bill Thomas, Talks to Provider Magazine about Person-Centered Care

In an exclusive interview with Provider, Dr. Thomas casts the vision of living in a world where the ageist slur, “elderly” is no longer a part of polite conversation.  He says, “Think back in memory to the last time an older person referred to themselves as ‘elderly.’ People don’t introduce themselves by saying, ‘Hi, I’m Bob’s elderly mother.’ That’s put onto them. That’s the definition of a slur.”  Dr. Bill Thomas believes that to change long term care, we need to change the larger societal attitudes toward getting old.

In pursuit of this reality, Dr. Thomas is hitting the road for the Age of Disruption Tour, “I’m going on tour again, starting in April,” [Dr. Bill Thomas] tells Provider. “I feel a responsibility to have an impact on not just long term care, but how our country views aging and how our country thinks about older people. I think that many of the issues we deal with in long term care are driven by deep, cultural misunderstandings about aging.”  Part of the tour will be an old-fashioned rap session, with Thomas sitting down with leaders, that “explores new ideas, practices, and models to transform the experience of care and caregiving,” the tour’s ad copy says.

While there have been great strides to create opportunities for elders to live a life worth living, we have a long way to go… and there is always the danger of a good idea being turned into a marketing gimic, rather than the real deal.  Take “person-centered care” for an example, “The problem with person-centered care,” Thomas says, “is that it’s possible for people to become satisfied with the name and to actually lose interest in the hard work that’s required to turn the name into a lived experience. The words are everywhere, but the meaning of the words is changing… What we really mean by person-centered care is relationship-rich care.”

In The Green House model, relationships are the cornerstone of success.  The deep knowing relationships between elders and the direct care staff facilitates a familiarity that leads to positive outcomes, including increased workflow, cost savings, and health outcomes.

Dr. Thomas has truly made an impact on the field of aging, as the reporter says, “he is a founding father of a revolution. (How many other Birkenstock-wearing gerontologists are getting shout-outs from the Senate floor?)”  As he embarks on this latest adventure, there will be new ideas shared, fires stoked, and people moved to action… bringing us ever closer to the ideal of meaningful lives for all.

To read the full article >>

Generations Journal focuses on Person-Centered Care for People Living with Dementia

“More than 5 million people in America currently have some form of dementia, a number expected to rise to 13.8 million by 2050.”   As Kathy Greenlee, Assistant Secretary for Aging, US Department of Health and Human Services, says, “The numbers capture our attention.  But it’s the number one that captures our hearts.  To most of us, dementia is about a loved one.”   While a large part of the work to date on dementia has been to find a cure, however there is a larger story to explore– one of improving the lives of those who have dementia and the people caring for them.  Generations, the quarterly journal of the American Society on Aging, devoted their Fall 2013 issue is devoted entirely to Person-Centered Care for people with dementia.

By focusing this publication on Person-Centered Care, the importance of a holistic approach to dementia is highlighted.  Sam Fazio, director of Special Projects, for the Alzheimer’s Association in Chicago, and guest editor of the Generations issue, discusses the power of words in how they influence our perceptions of people, “very simply, words affect thoughts and, ultimately actions…The loss of memory is not equal to the loss of self.  If someone thinks of a person with dementia as someone without a self– they think of him or her as not being a person.”

Green House Project team members contributed an article called, ” Seeing the Person First: Living with Moderate-Stage Dementia” .  Drawing from experts in the field, this article emphasizes, “To keep seeing the person as creative, resourceful and whole requires a major reframing of our thought processes.”   By seeing the person, not just as a stage in a disease, but rather as an individual through the framework of their physical and emotional health, environment and care partner relationship, there is potential to create well-being.

The Green House Project is an evidence based model that returns control, dignity and a sense of well-being to elders living with dementia.  By transforming the environment, organizational structure and philosophy of long term care, the elder is placed at the center of the model where they can grow and thrive.  To learn more, visit:



Purchase the complete Fall 2013 isues of Generations >>

View Select Articles on the American Society on Aging Blog >>

New Toolkit to Help Communities Personalize Care in Nursing Homes

In November we will be celebrating the 6th Annual Green House Meeting and Celebration in Boston, MA.  THE GREEN HOUSE® Annual Meeting & Celebration is an event exclusively available to Green House adopters for sharing, learning, and celebrating the growth of The Green House model!  The Annual Meeting honors organizations for their commitment to create real home, empowered staff, and meaningful lives for elders. Sessions provide peers with an opportunity to reflect on lessons learned, revisit skills for coaching leaders, and build relationships to support sustainable change. One of the thought leaders presenting at the meeting this year is Dr. Kimberly Van Haitsma and we are pleased to share the below information on her latest project.

Kimberly Van Haitsma, Ph.D. is Vice President of Research at the Madlyn and Leonard Abramson Center for Jewish Life, North Wales, PA. After working as a nursing assistant in a nursing home, Dr. Van Haitsma decided to focus her career as a clinical psychologist on developing ways to improve quality of life for older people. For the past 20 years, she has directed research on understanding the needs and preferences of older adults living in their own homes and in long-term care communities. Most recently, she collaborated with the Advancing Excellence in America’s Nursing Homes campaign to design and test the new Person-Centered Care Toolkit described here.

 The New Toolkit

In May 2013, Advancing Excellence in America’s Nursing Homes, a national long-term care collaborative aiming to improve quality of care, launched a toolkit to help communities provide more personalized care for their residents (  The toolkit makes it easier for staff to learn about resident preferences, see how well care aligns with resident wishes, and problem solve when there are gaps.

The toolkit has two major parts. The first is an interview protocol that staff, including direct care workers, can use to ask residents about their preferences for personal care and recreational activities, as well as to gauge how satisfied residents are with the way their important preferences are addressed. The interview builds on information already collected as part of MDS 3.0 – Section F (Preferences for Customary Routine and Activities), by adding new questions that ask residents how satisfied they are with fulfillment of “very” or “somewhat” important preferences.

In the second part, staff record this information in a user-friendly, pre-programmed Excel workbook. This tool produces color-coded graphic displays showing when a resident’s preferences are being fully met (in green) and when preferences require further follow up (in yellow or red). Staff can use the results as the basis for discussion and problem solving during individual care planning conferences.

Also, the Excel workbook can show preference gaps affecting many persons residing together in a household. The tool allows staff to see “at a glance” particular preferences that are not being met for several individuals who live in a common location. Staff then can collaborate on strategies for improvement.

A final feature of the workbook is that it automatically calculates four person-centered care quality indicators. One measure shows the percentage of “preference congruence” (the extent to which a resident is satisfied with the way important preferences are met) for an individual, household or facility during a given month. Three other measures show the percentage of care conferences attended by residents, family or friends, and direct care workers in a one-month period.

The Advancing Excellence Person-Centered Care toolkit is available for free download at

Pilot Testing the Toolkit

Before Advancing Excellence rolled out the new toolkit nationally, Dr. Van Haitsma and her team led a pilot study in which 12 nursing homes tested the interview protocol and software and reported on their experience. The study offered a first look into rates of preference congruence, which averaged 67% for short-stay and 75% for long-stay residents across the nursing homes. 

What Do Providers Say About the New Toolkit?

Overall, pilot sites gave the toolkit strong positive ratings. In a follow up survey and interview, site coordinators said that the components were easy to use, and they would recommend the toolkit to others. Providers found many benefits:

Acceptability for residents, family and staff 

  • Nursing home residents valued the opportunity to give input about their preferences and satisfaction levels.
  • Families were impressed with communities’ commitment to quality of care, as demonstrated by taking the time to ask about a loved one’s preferences.
  • Social workers, recreation staff and direct care workers all found the tool easy to use.
  • CNAs enjoyed the experience of interviewing residents, and learning about their preferences before providing care.

 Enhances individual care planning and delivery

  • The toolkit increased understanding of person-centered care – interview protocols and data displays make this abstract concept more concrete.
  • The interview provided a conversation starter and a systematic way to get to know more about what is important to each resident. Ultimately, this can enhance relationships between residents and staff.
  • The software made it easier to share resident preferences with the whole care team, and the colors and graphics showed clearly what needed to be done for individual residents.
  • Quarterly interviews help providers stay up to date with changes in resident preferences or satisfaction levels.

Assessing care at the individual and household level

  • The toolkit’s graphic displays provided a useful visual resource to help communities know “what we are doing well and what we need to keep working on”. 
  • With new information in hand, staff identified previously unknown areas of preference incongruence at the resident level (e.g., desire for a bath versus shower) and household level (e.g., in one household, residents were dissatisfied with their access to the outdoors in good weather).

Already over 500 long-term care communities have downloaded the new tool. Dr. Van Haitsma and the Advancing Excellence team will study user experiences, and promote sharing of best practices across communities to strengthen person-centered care for residents nationwide.

For more information, contact Dr. Kimberly Van Haitsma,,  or visit the Advancing Excellence website at

"Look Who's Aging", a Conference to Discuss the Future

Last week, The Green House Project participated in a conference presented by The Erickson School’s Institute for Leadership. The School’s mission is to convene leaders in the field of aging services, through summit educational programs and research, to discuss and develop solutions to the common challenges that await in the future. The plethora of creative presentations and conversations worked to create links between person centered services and the creation of competitive advantage and a dominant market position, now and in the future. Some of the major take a ways from the conference:

  • Scott Townsley, Clifton Larson Allen, dissected the DNA of an innovator, and described, The 5 discovery skills of an innovator: Associating, Questioning, Observing, Experimenting, and Networking
  • When a field becomes homogenized, we compete based on price– Differentiate!
  • Robyn Stone of Leading Age described the need for seamless links between acute and primary care, and use of technology to improve home care.
  • Focus on prevention and infusing the community with a range of services to support an aging population
  • Bob Kramer of National Investment Council, says that this not an evolution, but a revolution and the future will represent a wide diversity of options for elders
  • Will we see the aging of boomers as unwilling and unwanted? or willing and wanted?  Unprecendented epedemic of lonliness or unprecedented infusion of workers, volunteers and energy?
  • Don’t underestimate the pace of change once expectations change
  • Carmen Bowman, “Why do we say Independent LIVING, Assisted LIVING, but Skilled Nursing CARE– let’s shift perception to believe that life continues at every stage”
  • Rob Mayer of the Rothchild Foundation talked about creating a culture of philanthropy in aging- there is 298 billion philanthropic dollars out there and currently the Aging field gets less than 1% of that $$!!

It was a very stimulating and thought provoking few days!!