Green House Blog

The Art of Being a CNA Amid COVID-19

We asked CNA Corey Rotella to write about her experience caring for people amid the pandemic. Her response was so compelling that we also created a video of her account. Following is an excerpt of her writing followed by a link to the video.

Memory care has always felt like home to me. The work is more of an art than a science…the art of knowing. In order to give the best care possible, we have to know your people. This is true in every area of caregiving, but especially when working with those living with Alzheimer’s. As we time travel with them through their memories, it is by knowing them that we can best assess their needs. Are they night owls? Do they need more one-on-one time? Are they hot or cold-natured? Do they come from a big family? All information that can help us navigate through their reality and recognize sudden changes in behavior. It takes time, patience, dedication, and a good team that inspires trust between one another and between the staff and those in their care. It is every bit as rewarding as it is challenging. I love what I do. It can be backbreaking and at times heartbreaking but it is never empty.

Working on a memory care unit where consistency is a vital component to the mental and emotional well-being for those in our care has become uniquely challenging. No visitors, no outside activities, eating meals in their rooms in an attempt to maintain some level of social distancing, and taking temps and checking the O2 stats each shift are all new rules being implemented as much as possible in an attempt to keep our residents safe and healthy.

The problem is, as well intended as these rules are, they come at quite a cost, and caregivers in most facilities are not being given the added support needed to fully and adequately implement these policies.

Isolation is not good for people living with Alzheimer’s. My residents are naturally out of sorts. Without daily interaction and mental stimulation, combative behaviors are becoming more commonplace. Sleep schedules are off because when there are no regular activities, many of my folks are sleeping more in the day and staying up through the nights. Fall risks are increasing. I have much less time for one-on-one interaction. The normal troubles in the long-term-care system have suddenly all been exacerbated and none of us have had time to process it. The end result is what we are seeing play out in the news.

COVID It is running through our nation’s facilities in a terrifying way.

It is hard not to feel powerless. It is hard not to feel resentment at our low pay. It is hard not to feel fear because for us there is no way to do our job well with any kind of distance, social or otherwise. It is easy to get lost in all of those dark thoughts and to begin to wonder if you are doing any good at all. So much of it feels like we are sticking fingers in the holes of a dam.

The greatest frustration for CNAs is that we don’t feel heard. We advocate for those in our care. We know when they are off. We know what does and doesn’t work on the halls and too often this knowledge is ignored or brushed aside. In a crisis, there is nothing more important than clear communication and timely action. We need support. We need supplies. We need adequate staffing. We need to know we are not in this alone.

This pandemic cannot be treated as business as usual. Our career will always involve loss. We caregivers know that as difficult as it can be, death is a part of the job. We are there to assist our people in the last stages of their life. We hold their hands, comfort them, try to protect their dignity and improve their quality of life as they walk through their final years.

This disease is a different kind of beast. We live with the knowledge that we could transmit it easily to those in our care. We know we can take it home to our family. We know that the likelihood of us not being touched by COVID-19 in some way is slim to none. The psychological toll that takes is difficult to express.

For me, it hits in the quiet hours when I’m not at work or when I see what is happening in the facilities across the nation. It is incredibly sad and frightening, but it is not surprising. Facilities were not prepared for a situation like this. Caregivers are an untapped resource with a wealth of knowledge that could help management understand the best ways to calm the residents and make this difficult time at least a little easier for all involved.

All it would take is for those in charge to listen.

Here is a link to a full audio version and video of Corey’s response:

Rotella is a writer and certified nursing assistant (CNA) in the memory care unit at Champion’s Assisted Living in Wilmington, N.C.

The Heart of The Home: Elders and Staff

Last year, when Claremont, CA resident Bill Andrus began to need 24-hour care in their home, he and his wife, Georgeann, chose Mt. San Antonio Gardens’ Evergreen Villas for his new home. The Villas are trademarked  GREEN HOUSE homes, which provides a real home for people needing skilled nursing care. In each of the two villas, the residents are supported by a small, self-managed team of care partners, known as shahbazim, and nurses. Mt. San Antonio Gardens pioneered what are California’s first and only small homes licensed for skilled nursing.

“We wanted Bill to live in a stimulating environment while receiving the care he needs,” says Georgeann. Acknowledging the difficulty of making that decision, the couple feels fortunate that the Villas were an option for them. Georgeann, who served on the Gardens board of directors for six years when The Green House homes were being considered, says, “We are so grateful for Bill to be part of it. It has been particularly heartwarming to see this from the initial concept and then to participate in the reality of seeing it work very well.”

Bill and Georgeann Anrus
Bill and Georgeann Anrus

While Bill was settling in, Georgeann applied to live at the Gardens as an active, healthy independent resident. She moved into an apartment on campus where she takes a quick walk to the Evergreen Villas. Living on the same campus means easy and frequent visits each day. The couple goes together to lectures and performances held at the Gardens or at the nearby Claremont Colleges. “Our neurologist had said to me, ‘Now you can just be a spouse, not the caregiver’, and he was so right!”

“Bill has become physically stronger since his move here,” marvels Georgeann. The special design of the great room has inspired Bill to use his walker, unassisted. The couple also credits the home-like atmosphere and the personalized attention of the shahbazim and nurses to his continued well-being. Because this team works so closely with such a small group of elders, the care partners get to know their personalities and individual needs and preferences intimately. While the shahbazim are also responsible for cooking and maintaining the house, their first priority, Georgeann notes, is always the care of the elders.

“The people are the best thing,” says Bill, who especially enjoys sharing common interests with Registered Nurse (RN) Michael Sansosti. Both are avid readers and love fishing.

Michael and Bill Reading for screen only 100 dpi
Bill and Michael reading

“It’s great,” says Michael. “We trade books and when I have some extra time in my schedule, we’ll spend time talking about them.” The ability to give everyone a little extra attention is very gratifying. Michael, who previously worked in structured hospital environments, enjoys the opportunity he now has to cultivate more personal friendships with the residents he cares for. “Certain people, like Bill, do very well in this kind of setting. It is especially well suited to those who prefer to take the initiative for their daily activities” and who enjoy the interaction and activity that is such an important part of the daily experience in the Evergreen Villas, according to Michael.

Working with the caregivers is also a new experience for Michael. “We work side by side with the shahbazim. While the RNs are in charge of everything clinical, the care partners spend all of their time interacting with the residents, so they can give us feedback on their behavior and needs, enabling us to intervene early.”


Amanda, shahbaz, and Michael, nurse, work together
Amanda, shahbaz, and Michael, nurse, work together

“Communication is a big thing here,” acknowledges shahbaz Amanda Phos, who began her training for her role long before the Evergreen Villas opened. With just 10 elders in each of the two Evergreen Villas, the care partners get to know each person personally, from their life stories to their health needs and abilities, their food preferences, and their hobbies and interests. “If you know the elders well, taking care of them is very easy,” says Amanda. “I think that’s the beauty of this place. We base each day’s activities on what they individually want to do. And every day is different. When we all come together around the dinner table, we like to talk about the day’s activities. It feels like a family.


“It’s hard work, and it takes a team to make it work so well,” says Amanda. “We’re the heart of the home, and that makes it very gratifying to be here.”


Highlighting Shahbaz, Darlene Scott at Porter Hills Green House homes

Empathy, compassion, honor and respect are just a few of the qualities required in those working with elders in THE GREEN HOUSE® homes. These qualities are extremely evident in Darlene Scott, a Shahbaz at the Porter Hills Green House homes in Grand Rapids, Michigan.

2Darlene has worked at Porter Hills since 1998 when she was hired as a certified nursing assistant in the Health and Rehab Center. After a short period of time, she was promoted to Unit Clerk and continued to prove she had the personality and skills needed to build strong and trusting relationships with residents. This ability to connect with those she served opened the door to a position as an activity coordinator.

While in this new role, Darlene took advantage of many educational opportunities to develop and hone her skills. This included becoming a Certified Eden Associate1

When Porter Hills decided to build two Green House® homes, Darlene was encouraged to consider working as a Shahbaz. “When I was presented with the opportunity to be a part of Green House® homes I thought, this is it, this is living out everything I have been trained to do. I had retained my CNA license which meant I qualified, so I decided to pursue this role that embodied my passion for elders.”

Darlene has worked as a Shahbaz since September of 2009 and enjoys the person-centered approach and the strong relationships developed. She has seen first-hand the impact that this unique approach to skilled care has on elders in the home.

“We had an elder who moved in with late stage dementia. She was high acuity, didn’t walk or talk, and was total care. Her son brought her here and told us that the doctor had said she had 6 months to a year left to live. The son wanted his mom to have the best care possible and he knew that it would be through the Green House® homes at Porter Hills. His mother had already been receiving care but he wanted her to have the ‘best of the best’. She moved in and initially didn’t talk and needed to be coaxed to eat. One day, I was leading a time of discussion and questions and asked about favorite colors. As we were going around the room hearing each elders’ answer, she raised her head and said, ‘my favorite color is yellow’. After that day she began to feed herself again and communicate. To me that signified living because with a lot of elderly people, eating is the last thing they have control of. Not eating can be their way of saying ‘I’m done’. For her to show that she was going to feed herself and was going to live again was a defining moment for me. I realized in that moment, that the concept of the Green House homes was not just a theory. This works, this is where people want to come to continue living no matter what stage of life they are at.”

3Darlene’s primary role in the home is to protect, sustain, and nurture the elders living there by providing assistance with activities of daily living and meeting other needs as required. “We are given the time and atmosphere to develop relationships with the elders and their families. It’s a wonderful place to work. This is a great community and Porter Hills is a great organization. Having The Green House homes and supporting them as a business, Porter Hills shows that we are here for elders, we are here for the geriatric population, and we are here to provide them with the best services and the best life that they can live.”

The rewards are not only felt by the elders in the community. “When you walk out of the door, despite the ups and downs, you know that you have made a difference. These elders could be living anywhere and not getting the care and relationships that they have here. But, they are HERE and we can give them that. It’s very rewarding.”

A Pre-Conference Intensive for Shahbazim at The 6th Annual Green House Meeting and Celebration: A Day to Explore the Coordinator Roles and Relational Coordination in Green House Homes

On the day a Green House home opens the Shahbazim become the managers of the home as well as partners to the Elders.  It requires a deep understanding of the systems that support the home. The core functions include the Food, Scheduling, Care, Team, and Housekeeping systems and the Coordinator Roles each Shahbaz fills on a rotating basis.  These functions are the guts of the home and to be successfully carried out require strong relationships and excellent communication.  If the systems work, the days go smoothly. Without good systems, respectful relationships and high communication it can be a rocky road!

This preconference day will explore the Coordinator Roles and the core systems around Food, Scheduling and Care.  It will ask participants to identify what makes for good relational coordination; meaning shared vision, shared knowledge and mutual respect.  The best thinking and lessons learned will be the basis for conversations on how to sharpen and improve the core systems and relationships of the homes.  

If you are a Shahbaz at an open or soon to be open Green House home, plan on attending THE GREEN HOUSE®  Annual Meeting and Celebration in Boston on November 18th.   Leave with new ideas, new insights and many new friends.  Register at the Peer Network website.  For more information about the program contact

Please note:  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

3 words, "What makes Green House homes special?"

In May 2006, Tabitha opened Nebraska’s first—and the nation’s second—Green House® Project transforming the way care is delivered by departing from the traditional nursing home model and bringing long-term care into a home setting. We now have four Green House homes on our campus serving 45 Elders. One evening, the Green House family welcomed three newly trained shahbazim to the household during an evening punctuated with music, dancing, eating, champagne popping and a warmth that can only be felt when one is truly at home. This photo and that evening truly showed how Tabitha Green House homes offer love, family and home.


Why I Love My Job…

Shahbaz Sarah Hoffman from The Green House homes at Lebanon Valley Brethren Home shares why she truly loves her position: 

Every Thursday in the Legacy building of our facility, they have bible study. As the elders are filing into the area, we have a pianist playing prelude, often one of our independent living volunteers. For various reasons our regular pianists could not make it yesterday, so activities’ staff asked one of our green house elders if she’d be interested. She agreed, but as it came time to head down, she expressed some reservation about not knowing what to play. I reassured her to just play from her heart.  I assisted her to the piano, adjusting the bench to her liking. For nearly half an hour, without any sheet music she began playing. And then started singing. I watched from the sidelines as her entire face lit up…she was beaming, proudly playing hymns she’d grown up with. The room began singing along with her…it was truly a beautiful moment. A couple of hymns were requested from the audience that she didn’t remember right away. I sang the first line and she picked it up and ran with it!
Sure, there may have been a few missed notes along the way and she may have played a couple hymns twice or thrown in a non hymn here and there…but in that moment, at that piano, she was THRIVING.

And my heart was smiling.

Please share your comments!

Is There a Recipe for Culture Change?

Is there a recipe for culture change? The Green House ‘recipe’ for culture change uses many ingredients. These include specific environmental features, like an open kitchen and private bathrooms, and also re-conceptualized staff (or Shahbazim) roles. Other nursing homes that have embraced culture change have a different recipe. Some, for example, have retrofitted, remodeled households, while others have more traditional environments; some utilize universal workers, but others do not. If culture change can appear unique on so many levels, what is it about the philosophy that really makes a difference? Are there any key ingredients for culture change? To better understand these questions, the THRIVE research team surveyed culture change adopters to learn more about their practices and environments.
What do most adopters report? These adopters most often reported certain relationship-based practices such as the use of staff consistent assignment or family member participation in care conferences. They also reported similar components of work organization and decentralized decision-making such as non-activity staff helping to choose activities and the ability of staff to fulfill requests without prior approval from an administrator. Adopters also reported similar mixtures of ingredients to enhance resident choice including dining in the small house or household to support choice in mealtime.
Are there differences in the culture change components that adopters report? Yes. There were distinct differences in the recipes of small houses, households and more traditional environments.  For example, small house models were more likely to report that direct care staff schedule themselves and choose care assignments, but these were some of the least adopted practices for other adopters. Small houses are also more likely to have CNAs attend care conferences and less likely to use overhead pagers or med carts than other adopters. Meal preparation varied for all three models. For example, small houses were more likely to prepare food in a kitchen in the home while households were more likely to use steam tables with food prepared in a centralized kitchen.
The THRIVE research team is in the process of studying the survey results to better describe the recipes of culture change adopters. As pay-for-performance and policy programs are developed to incentivize culture change, understanding the core ingredients in implementation can promote a recipe for change that is attainable for a broad range of providers.
The Green House Project has partnered with the Robert Wood Johnson Foundation’s
THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care. Supported by the Robert Wood
Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes.  Each month, a member of the THRIVE team will contribute a blog post to the Green House Project website.

Questions about THRIVE can be directed to Lauren Cohen ( or 919-843-8874).

Porter Hills Green House homes awarded 2012 Goodwill Industries Power of Work Innovator of the Year

Porter Hills Green House® Homes is honored to be awarded the 2012 Goodwill Industries Power of Work Innovator of the Year Award. Porter Hills has partnered with Goodwill Industries for 15 years to provide individuals with Certified Nursing Assistant (CNA) training. When the Green House® Homes opened three years ago, Sue Kinney the CNA Program Manager and Instructor approached Cheryl VanBemden, Guide, about offering clinical training opportunities in the GHH. Sue believed exposing students to the traditional nursing home model and the Green House® Homes would provide greater opportunities for success to both students of Goodwill and Porter Hills. Porter Hills has hired 12 Goodwill graduates and continues to employ 11 of the individuals. Greg Booth is one of the graduates of Goodwill Industries. Greg exemplifies the character of individuals we desire to employ. He made a decision to change his career path and utilize the training program through Goodwill because of the support provided. Greg has been employed at Porter Hills for just over a year, and it has truly been a rewarding relationship for everyone involved. We are thankful to have partners like Goodwill to assist in giving back to our community and helping others succeed.

Green House Living in Wyoming Prepares To Welcome Elders

Green House Living for Sheridan

The nation’s first grassroots-organized Green House Project homes will open their doors to welcome elders on January 31st in Sheridan, Wyoming.

Nearly five years in the making, Green House Living in Sheridan has completed construction on two of four planned Green House cottages at the newly created Village at Cloud Peak Ranch. Two more cottages will be completed by mid-February, serving a total of 48 elders, and a grand opening celebration is scheduled for March.

Green House Living in Sheridan President Doug Osborn shared the news Dec. 30 and said the community-based initiative would not have been possible without support from volunteers and contributors from every level of local government and walk of life.

“The Scott Cottage, the Watt Cottage, the Whitney Cottage, the Founders Cottage… will introduce this change in nursing home care to the state of Wyoming and help other communities as they consider providing the kind of care and fulfilling lives our elders deserve,” Osborn said.

Green House Living in Sheridan will provide 24/7 skilled nursing care but it is not a nursing home or assisted living facility. Elders have their own private room with bathroom and shower, and each cottage has a spa room near the kitchen. Up to 12 elders share a cottage and a central living and dining area. Each cottage has a household team of Shahbazim who care for, cook for and eat with the elders.

“We have a table where everyone sits together and experiences what we call convivium, which is the experience of eating together, just like in a real home,” said Green House Living administrator Chris Szymanski in an interview with Sheridan Media posted online here.

What really sets the model apart is the philosophy and organizational structure. The Shahbazim and all medical and support staff are trained in a circular organizational structure centered around the elders, creating an environment for them to grow and thrive, like in a “green house.”

The model is designed to transform the experience for both the elders and the staff. Sheridan just completed the first round of training Shahbazim for the Scott and Watt cottages and will begin training the second round later this month.

“Especially gratifying is watching our new employees in training, wrapping their minds and souls around the concepts and methods which define the Green House model,” Osborn said.

Visit for more information, photos and updates on Wyoming’s first Green House Project.



Revolutionizing Environment and Transforming Mindset of Long Term Care

    Sarah Hoffman, Shahbaz, Lebanon Valley Brethran Home, Palmyra, PA

Having worked in long term care for the past 12 years, I’ve seen my share of the good, the bad and the ugly. I’ve also had the privilege of working in the Green Houses in Palmyra, PA for the past four years, and truly feel this is how long term care should have been modeled all along. While the environment is a vast improvement to traditional nursing homes and fosters more opportunities for elders to be more active and independent than they could in a traditional setting, that is only one side of the coin. I think what sets the Green House model apart is the deep rooted mission and passion that all staff share to let elders rule. Life doesn’t stop simply because one requires skilled nursing services, and all staff in Green Houses, from the shahbaz (caregiver), to the nurse, to the administration/support team undergo training to recognize this and empower the elders entrusted to our care to thrive and live life to the fullest despite whatever medical needs they have. Instead of having to conform to a schedule built around staff efficiency and convenience, elders in Green Houses truly get to live life on their terms and set their personal routines for each day based on their preferences and needs. As staff, we get to know our elders far better than we ever could in a traditional setting…we truly are family. Because we have more time to spend with the elders, we are able to deeply learn about the entire person and the rich lives they’ve led through the stories they and their families share. This allows us to help our elders create meaningful daily routines and engagement opportunities with not only staff, their families and each other, but their community as well. The Green House model isn’t only revolutionizing environment, it is transforming the mindset of long term care by putting the focus back on the elder, not the diagnosis (regardless of how severe or advanced it may be). There is a better way, and I’m honored to witness elders living it daily.