Green House Blog

Authenticity, Why it Matters

Anne Ellett is a certified Nurse Practitioner (NP) with more than 20 years of experience in elder living and memory care, and served as Sr. Vice President with Silverado Senior Living, an award-winning Assisted Living company specializing in dementia care.  Currently, Anne is owner/CEO of Memory Care Support, LLC, a consulting agency working with senior housing professionals as they develop state-of-the-art health and wellness and memory care programs.

In Green House homes, authenticity matters – for example, we strive to build real homes, not fake homes, not pretend homes, not places that look like a home but really feel more like an institution.  We want to create that sense of belonging, of warmth and deep knowing that we all crave.  We want the elders to feel connected to the people and the space.

Best Life supports elders living with dementia (ELWD), and here too, we strive for authenticity.  For many ELWD, their experience has been one of loss and lack of choice.  Family, friends, and professionals may respond to their diagnosis rather than to the individual person, focusing on inabilities rather than retained talents and abilities.  The opportunities for real, authentic life experiences may be taken away, justified by saying, “It doesn’t really matter, they won’t know the difference.”

Best Life understands that being authentic does make a difference to elders and those working closest to them.  We know that real friendships, real relationships are meaningful.  One of the Best Life core principles is “Elder-directed, relationship-rich living.”  Offering opportunities for ELWD to sustain old relationships as well as the opportunity to form new ones is part of a normal life, and should be part of living with dementia.

Relationships with pets can also be important for ELWD.  How many of us enjoy the companionship of our pet cat or dog?  The joy that a dog brings when he puts his head in your lap, or a kitten who runs through the house chasing a ball of paper brings a lot of smiles.  An ELWD who can assist with feeding or walking the dog, or enjoys rubbing the neck of their favorite cat knows the significance of rapport with live animal.

As I visit many care locations, I am sometimes shown a community’s “pretend” pet animal program.  There are many varieties available of these fake pets, all of them claiming to bring joy to the elder.

Best Life focuses on real relationships built on retained abilities. If an ELWD is offered a robotic pet, they may respond and stroke it, but there’s no relationship, no purpose, no bond of love that is formed.

What would be the reason for not having a real pet – a loving dog or a real cat who can be the “diva” of the home?  Do we offer a robotic pet because again, we think, “It doesn’t really matter, they won’t know the difference?”  The magic that happens between an ELWD and a real pet cannot be substituted by offering a mechanical toy.

I’m reminded of one woman I knew who had recently moved into a home and was quickly labeled as a “challenge” by the care team.  Joan yelled out frequently, disrupting other elders.  She criticized both staff and elders and refused to participate when invited to meals or engagements.

As an annual event, the home sponsored a pet adoption day by the local animal shelter.  In preparation, the ELWD helped clear the patio where the public would be coming to view the adoptable pets. On the day of event, many volunteers with a variety of dogs and cats showed up at the home and as the volunteers and pets arrived, the elders greeted each one and welcomed them to their home for the pet adoption.

Joan initially resisted becoming involved, but as the dogs arrived, she focused on one small dog who was blind in one eye and was anxiously barking a lot.  As she pet the dog, it seemed to relax and finally laid down and closed its eyes.  Joan said, “It just needed some love,” and continued to sit by its side for the entire afternoon.

At the end of the day, the dog had not been adopted and the care team asked Joan if she would like to adopt it?  The look on Joan’s face said it all.  The significance of the friendship between Joan and her dog Freddy (Joan’s chosen name for it) was evident as the months passed.  It seemed Joan found purpose and peace when she and Freddy would sit together or as she fed it some of her favorite chicken dish that she had saved from her own dinner plate.

Best Life encourages an authentic, real home where an ELWD has opportunities for a life that is purposeful and relationship-rich. learn more>>

 

 

 

 

The Evolution and Impact of The Green House model: Interview with Journalist and Author, Beth Baker

Beth Baker, Journalist

There are 214 Green House homes, however there are 15,600 traditional nursing homes in our country.  As we work to transform long term care, Beth Baker has been a critical voice in journalism, describing innovations in the field.  She has spent the last decade telling the story of culture change to a wide audience and earlier this month, Beth Baker highlighted The Green House model as The Nursing Home of the Future, in Politico Magazine.  

As a journalist and author, Beth Baker, writes about healthcare in outlets like The Washington Post and the AARP Bulletin, describing what is possible in long term care,”What [The Green House Project] does is to demonstrate that people can keep living and enjoying life until their last breath given the right environment and relationships.”  This journey led her to Tupelo, the first Green House homes, and the transformative story of Mildred Adams:

Beth became intrigued by the rich human stories found throughout the culture change world, and eventually decided to write a book, Old Age in A New Age.  Her work has expanded,  in a second book, With A Little Help From Our Friends, that focuses on “the importance of community and social connection as we grow older.”  Beth sees boundless opportunities to write about people who are,”looking at aging in our society and thinking about how to make it a richer and more respected time of life.”

When Politico approached Beth, they asked her to write a visionary piece about the nursing home of the future… when Beth pitched The Green House model, they were delighted to see the potential that exists today to create meaningful lives for those who live and work in long term care.

In her reporting for the Politico article, Beth visited Lebanon Valley Brethren Home in Palmyra, PA.  After a three hour drive on a cold, rainy day she shared how warm and welcoming it was to ring the doorbell and walk into the home, ” there was a fire in the hearth and one of the women was doing a jigsaw puzzle… it felt so familiar and was just a reminder of why [The Green House] is such a wonderful model”.  Through interviews with elders and Lebanon Valley Brethren Home CEO, Jeff Shireman, Beth was able to convey the comprehensive nature of the model, and how the interplay of the environment, organizational redesign and philosophy work together to create positive clinical, financial and satisfaction outcomes, “Having a strong case for the finances and business outcomes of The Green House Project has been really important, ” remarks Baker.

Beth Baker’s credible voice shines light on the potential for aging to be different, and it is so important that we continue, because as Beth shares, we have a lot of work to do, ” … It is going to take a culture change beyond long term care… [we need] a change in how we view aging, to get people to accept that it doesn’t have to be the way that it has always been.”

To read the full Politico Article>> 

 

 

The Green House Pioneers of Alaska

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Seward Mountain Haven

As the only Green House homes in Alaska, we love sharing our story, and our passion for The Green House model’s Core Values of Real Home, Meaningful Life and Empowered Staff. When visitors come to Seward Mountain Haven they are struck not only by the beautiful view, but also by the feeling they have when they step inside our homes. The feeling is immediate and visceral. It’s family. Many people still expect to see the traditional institution and it gives me so much pleasure to be a part of changing that expectation.

I can’t tell you how many times visitors have joked with me, saying, “Sign me up! This is where I want to be!” They are joking but in reality they are saying, “Yes! This is what Long Term Care should be!”

Brittany and her colleagues from Seward Mt. Haven smile with Dr. Bill Thomas at the Green House Annual Meeting

It is easy to focus on the day to day challenges, and sometimes we have to remind each other, our team, to step back and notice the incredible work that we are doing. If we just let that sink in for a few minutes…it is SO powerful.

We are proud to be a pioneer in The Green House movement. The peer network that we are building nationally, enables us to share our successes and lessons learned with developing Green House homes and to gain insights from Green House organizations around the country. There is power in knowing that we are a part of something that is bigger than ourselves, and that we share this calling to better the lives elders every day.

I joined The Green House team at Providence Seward Mountain Haven January 2011 as a social worker. During my education, I never saw myself going into eldercare, and my road to The Green HouDSCN2761se homes was happenstance. I joined the team because I wanted to be a part of something innovative; I wanted to be a part of a group that was making a difference. I never would have imagined how much my decision to work in a Green House home would affect me. I am pushed to grow, learn and continually challenge my thinking… this opportunity is much more than just a job.

One of my most memorable experiences in The Green House homes was when I was pregnant with my son. Because we have such close relationships with the elders, they naturally wanted to stay informed of all the details, and to also share their pregnancy and birth experiences with me. As it got closer to my delivery date their excitement and anticipation grew, and when he finally came, we all celebrated the arrival of THEIR baby! This experience really drove home the fact that we really care about each other here. The elders are just as invested in us as we are in them and that is a feeling you only get in a Green House home. It’s very special.

Empowerment is Foundational to Success: Herzberg and The Green House Model

One of the subjects that have befuddled Long Term Care leaders over the years is worker motivation. One of the foremost researchers in this field is Frederick Herzberg, an industrial psychologist. It is Herzberg’s work on motivation and job enrichment that strikes at the heart of the success of self-direction concepts that are so foundational to The Green House model.

In the 1960’s, Herzberg proposed that a person’s needs break down into two categories: hygiene factors and motivational factors.
Hygiene factors relate to what makes us work and our biological needs, such as providing food, clothing, and shelter. Herzberg says we have a build-in drive to avoid pain relative to these needs, so we do what is necessary, such as work, to provide what we need.

Motivator factors, however, are very different. These factors include those specific items related to what makes us work well such as achievement, and through achievement, the ability to experience psychological growth.
Herzberg used the term job enrichment to describe how the motivator factors can be used to achieve higher levels of satisfaction with a job. The following list was taken from his Harvard Business Review article of 1968 (reprinted in 1987) entitled, One More Time…How Do You Motivate Employees? Take particular note of how closely these factors align with concepts embodied in radical workforce redesign with The Green House model.

Herzberg said that meaningful job enrichment involves the following:
1. Removing controls while retaining accountability.
2. Increasing the accountability of individuals for their work.
3. Giving a person a complete natural unit of work.
4. Granting additional authority to employees in their activity such as job freedom.
5. Making data and reports directly available to the workers themselves rather than just to supervisors.
6. Introducing education programs designed to enrich critical thinking skills.
7. Assigning individuals specific assignments or specialized tasks, enabling them to become experts.

It is surprising to think that Herzberg first discussed these concepts in the 1960’s, but that we are now just beginning to incorporate them through innovative models. In the elder care field, we have a mountain of research that supports the link between frontline caregivers involvement and improved clinical outcomes of care and quality of life. Organizational changes that support self-direction will continue to grow because it makes sense to leaders desperately searching for ways to increase responsibilities of frontline staff as well as the elders’ perception of feeling valued and respected. The Green House model’s systematic approach to workforce redesign and the creation of the Shahbazim, combined with radical environmental redesign, help ensure that the institutional, hierarchical model can’t slip back in.

The empowered Shahbazim that you find within the Green House homes nationwide helps to explain why 83% of Green House projects are ranked as either 4 or 5 Star homes on the CMS Nursing Home Compare website. The Green House model supports the relational coordination among the Shahbaz and the nurses and other staff. The theory of relational coordination states that the effectiveness of care and service is determined by the quality of communication among staff. The quality of staff’s communication depends on their relationships with each other. This theory is highly applicable in healthcare settings where tasks employees perform are closely interrelated. Their interdependence forces the staff to work with one another. But if their relationships and communication are weak, and institutional hierarchies minimize the voice of the elders and their caregivers, then elders’ needs tend to fall through the cracks.

The Green House model develops people’s communication and critical thinking skills so they know what to share and why it’s important. And the redesigned work environment supports good communication creating both a culture of safety and a meaningful life for the elders. Systems and redesigned roles that support relational coordination among staff are the key to the successful outcomes achieved by Green House projects.

Forty-five years ago, Herzberg was spot on. And he still is.