Green House Blog

Leaving to Go Back: Al Power and the St. John’s Home Green House Project

When Al Power was in med school and specializing in geriatrics, he would visit his grandmother in a nursing home. During one these visits, he noticed the nameplate on her door; the last name, “Power” had an “s” at the end of it.

“It was a note to me,” he said. “Of how anonymous she was.”

To Al, such anonymity wasn’t an issue unique to that particular nursing home — it was in the corners of every traditional nursing home. It is evident whenever elders are pushed into an institutional setting and away from their families. Away from the libraries. Away from neighbors. Away from the coffee shops. And away from the streets they know.

In other words, away from the community.

Al Power and The Green House Project are bringing elders back to a space where they know the greater community and the community knows them. It is a space that allows for growth, both for the people who serve elders and the elders themselves.

Eventually, Al left geriatric medicine, but he didn’t leave behind his passion for serving elders — not by a long shot. Even before he had left his practice he had already started working with St. John’s Home in Rochester, New York, and had learned about a new movement to revolutionize elder care embodied and supported by The Green House Project.

The Green House vision was the perfect marriage of the physical and operational change along with the philosophical change we really needed to move elder care forward,” explained Al.

“We talk about trying to create independence,” he continued. “But so many of our systems create dependence, make people shut down and feel incapable. I realized how a normalized environment can really liberate those people.”

Now Al Power and the team at St. Johns are focused on normalization. His goal is to maintain the same kind of life for elders in nursing homes as the one they had before they arrived. To do that, St. John’s took the real home concept of the Green House model one step further.

While many Green House adopters had built smaller, person-centric homes to replace the larger institutional-type buildings on their campuses, Al and his team wanted to build their new homes in existing residential neighborhoods. They wanted to bring elders out of isolation, back into multi-generational communities, where they could go to the local gym and the library and walk down the same sidewalk as other people.

Many nursing home executives try to save costs by having a central campus as a base of operations. St. John’s, in effect, wanted the exact opposite; they wanted to decentralize.

Although individual licensing of resident Green House homes proved to be an obstacle with the Centers for Medicare and Medicaid Services, the Green House Project helped resolve conflicts, brought everyone together, and helped St. John’s succeed in desegregating elders from the rest of the community.

In 2012, St. John’s became the first Green House adopter in the nation to locate individual Green House homes in the community. They built two houses, eleven miles away from their campus, in multi-generational, diverse neighborhoods. And it worked.

“When we saw the results,” said Al. “We were even more convinced that it was the way forward.”

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Al Power and everyone on the planning team knew that the St. John’s Home Green House Project would have success stories; they just didn’t know the stories would already be written before the homes even opened.

In preparation for opening day, the St. John’s staff invited family members, elders, and

people from the community to come have lunch. At one table, there was an elder, who Al recognized, sitting with his family. Al also knew that the man needed help from people to lift him up from one chair to another at his traditional nursing home.

Al ended up joining the man for lunch. When they finished their meal, the staff brought over the elder’s wheelchair. But before they could assist him, the man got up and got into the chair — by himself.

When one of the staff asked him how he did it, he said. “I don’t know, I guess over there I’m supposed to be sick.”

Al and the entire team at St. John’s have learned to expect more of the elders they serve. And by raising the bar for long-term services and supports in the community, they are inspiring providers everywhere to expect more of themselves.

A New Definition for Dementia explored at Pioneer Network’s 2012 National Conference

To many, a person with dementia is a complex and misunderstood being, and currently the only way most people treat them is with medication.  Dr. Al Power, M.D., a board certified internist and geriatrician and Clinical Associate Professor of Medicine at the University of Rochester, New York couldn’t disagree more.  In fact, he told conference attendees today that the lessons learned with the culture change movement taking place in skilled nursing facilities could offer insight into dementia care.

Power told the group instead of looking inside the box…we need to get rid of the box!  He offered a new definition for the disease:  “Dementia is a shift in the way a person experiences the world around her/him.”

“Care should be individualized, putting the person before the disease,” explained Power, “We need a paradigm shift, to a person-directed, relationship-based model of care.”   The challenge is on us, the care partner according to Power to find a better way to communicate with those with dementia.  “We put them in places where they can’t succeed.  We need to go where they CAN succeed.”

Part of the approach would include an Experiential Audit, using “Well-being Domains”, i.e. Identity (Is my story known and understood by my care partners?), Autonomy (Do I have opportunities for choice and control throughout the day?), Security (Do I feel safe in my surroundings and do I trust those who provide my care?).

Power believes a physical, operational and personal transformation is needed for facilities and care partners working with those with dementia.  “You feel that when you walk into our Green House homes.”  Power serves as Eden Mentor at St. John’s Home, which opened two Green House homes earlier this year.

For more information about dementia and Dr. Al Power, you can contact him at:  apower@st.johnsliving.org or at his website http://www.alpower.net/

A New Definition for Dementia explored at Pioneer Network's 2012 National Conference

To many, a person with dementia is a complex and misunderstood being, and currently the only way most people treat them is with medication.  Dr. Al Power, M.D., a board certified internist and geriatrician and Clinical Associate Professor of Medicine at the University of Rochester, New York couldn’t disagree more.  In fact, he told conference attendees today that the lessons learned with the culture change movement taking place in skilled nursing facilities could offer insight into dementia care.

Power told the group instead of looking inside the box…we need to get rid of the box!  He offered a new definition for the disease:  “Dementia is a shift in the way a person experiences the world around her/him.”

“Care should be individualized, putting the person before the disease,” explained Power, “We need a paradigm shift, to a person-directed, relationship-based model of care.”   The challenge is on us, the care partner according to Power to find a better way to communicate with those with dementia.  “We put them in places where they can’t succeed.  We need to go where they CAN succeed.”

Part of the approach would include an Experiential Audit, using “Well-being Domains”, i.e. Identity (Is my story known and understood by my care partners?), Autonomy (Do I have opportunities for choice and control throughout the day?), Security (Do I feel safe in my surroundings and do I trust those who provide my care?).

Power believes a physical, operational and personal transformation is needed for facilities and care partners working with those with dementia.  “You feel that when you walk into our Green House homes.”  Power serves as Eden Mentor at St. John’s Home, which opened two Green House homes earlier this year.

For more information about dementia and Dr. Al Power, you can contact him at:  apower@st.johnsliving.org or at his website http://www.alpower.net/

Elders rule in Green House homes; setting a trend for traditional nursing homes

Via DemocratandChronicle.com

“The medical model is not good for the human condition.  We need quality of life to thrive.”

That’s how Rose Marie Fagan, co-founder of the National Pioneer Network describes how Elders should be at the center of their care and well-being.  Green House homes provide that quality of life for Elders to thrive. 

77-year-old Sal Speranza, who helped plan the St. John’s Green House homes, couldn’t agree more:

“This is getting away from the institution thing,” said the 77-year-old, this is the thing of the future.”

Let us know what you think!

St. John’s Green House Project Brings Elders Back To Their Communities

On the heels of opening the 100th Green House Project home in the nation, we’re getting ready to celebrate another landmark — St. John’s Home Green House Project in New York will be the first in the nation to bring elders back to their hometowns to live in homes throughout the greater Rochester community.

St. John’s will open it’s first two Green House Project homes this fall in the community of Penfield followed by additional homes throughout the community. Elders from Penfield currently living in St. John’s Home will have the opportunity to move back to their hometown to be near family, friends, their church congregation and take advantage of other community resources.

The Penfield Green House homes are located about 10 miles from St. John’s Home main campus in Rochester. They will be the first decentralized Green House homes to open. Other notable community-based Green House Projects are in development in Sheridan, Wyo. , and Baltimore (see also Wyoming Launches First Community-Driven Green House Project Eldercare Homes and Get Excited For Maryland’s First Green House Project).

“Anyone who needs nursing home services will have the opportunity to live in a home environment,” Green House Project Guide Rebecca Priest told Rochester’s Channel 13 ABC News. “Whether you have dementia or any type of need as you age you should have the opportunity to stay in your community and this is the first time in the U.S. we’re making it possible to do so.”

Channel 13 aired a three-part series on St. John’s Green House homes this week. Click here to learn more about St. John’s Green House homes.



St. John's Green House Project Brings Elders Back To Their Communities

On the heels of opening the 100th Green House Project home in the nation, we’re getting ready to celebrate another landmark — St. John’s Home Green House Project in New York will be the first in the nation to bring elders back to their hometowns to live in homes throughout the greater Rochester community.

St. John’s will open it’s first two Green House Project homes this fall in the community of Penfield followed by additional homes throughout the community. Elders from Penfield currently living in St. John’s Home will have the opportunity to move back to their hometown to be near family, friends, their church congregation and take advantage of other community resources.

The Penfield Green House homes are located about 10 miles from St. John’s Home main campus in Rochester. They will be the first decentralized Green House homes to open. Other notable community-based Green House Projects are in development in Sheridan, Wyo. , and Baltimore (see also Wyoming Launches First Community-Driven Green House Project Eldercare Homes and Get Excited For Maryland’s First Green House Project).

“Anyone who needs nursing home services will have the opportunity to live in a home environment,” Green House Project Guide Rebecca Priest told Rochester’s Channel 13 ABC News. “Whether you have dementia or any type of need as you age you should have the opportunity to stay in your community and this is the first time in the U.S. we’re making it possible to do so.”

Channel 13 aired a three-part series on St. John’s Green House homes this week. Click here to learn more about St. John’s Green House homes.