Consumer Voice For Long-Term CareI d i GH & B i /S i A G H HIntroduction, GH101, & Becoming/Staying A Green House HomeMarch 23, 2011

Introductory WebinarIntroductory Webinar

AgendaAgenda

• Recap of the main principles and practices of The Green House model

• Research findings

• Financial viability

i l • National momentum

• Becoming/Staying a THE GREEN HOUSE® Project

We did the best we could with what we knewWe did the best we could with what we knew. And when we knew better, we did better.

Maya Angelou

IntroductionsIntroductions

• Robert Jenkens

• The Green House Project Partnership:Partnership:

– Elders, Providers, & Advocates– Bill Thomas– Robert Wood Jonson Foundation– NCB Capital Impact– State and Federal Policy Makers

• NCB Capital Impact

Green House Redesign Green House Redesign

• Works within current regulatory & • Works within current regulatory & reimbursement systems

• Typically licensed as a nursing home to guarantee ability to age-in placein-place

• Aligns built environment with mission & goals

• All aspects designed to support All aspects designed to support goals & protect against institutional creep

• Improves quality of life for elders and staff and staff

Green House PhilosophyGreen House PhilosophyLiving, Growing, Thriving

• All people are creative, resourceful and whole and p pdeserve meaningful lives in real homes

• Meaningful lives require control, being known, and reciprocal relationships

• Control requires that decisions are placed with the elders and the staff who know them best and fully private space

• People become known in intentional communities

• Organizational and physical structure must foster opportunities for reciprocityoppo tu t es o ec p oc ty

• Green House homes and operations foster control, knowing, and reciprocal relationships

Green House Environment • Warm - small scale & residential finishes and

details

Green House Environment

• Smart - use technology to support high touch services

• Green - support continued growth pp g

• Private bedroom & bath regardless of private pay or Medicaid status

• Hearth - open plan living room dining room • Hearth open plan living room, dining room, and kitchen

• Meet institutional building code standards

All areas of the home open to elders thro gh • All areas of the home open to elders through use of targeted safety features

• Houses independent from each other

Green House TypesGreen House Types

Green House homes are designed to be similar to the housing in the community:

• Single family style in rural and suburban areas

Low rise garden apartment style in • Low-rise, garden apartment style in dense suburban and low-rise urban areas

• High-rise in dense urban areas• High rise in dense urban areas

The Green House ReorganizationThe Green House Reorganization

Reorganization in the house:Reorganization in the house:

• Power and decision making move to the elder and those closest to him/her

• Shahbazim - cross-trained in care, house keeping, laundry, cooking, and enrichment – support elders

• Self-managed Shahbaz team provide flexibility

• Flexibility allows Shahbazim to reorganize cont-inuously to meet elder’s preferences and needs

• Desegregated staffing approach greatly increasesinteraction with elders fostering deep relationshipsinteraction with elders, fostering deep relationships

• Sage, a volunteer from the community, supports self-managed team as an informal coach

The Green House ReorganizationThe Green House Reorganization

Reorganization to support the self-managed team:Reorganization to support the self managed team:

• Shahbazim are coached and held accountable by the Guide

N h d d t bl t• Nurses are coached and accountable to Director of Nursing (DON)

• Clinical team, DON, and MD are partners with and accountable to Guidea d accou tab e to Gu de

• Guide serves as coach to all who interact with elders in the home

All t ff t i l t i d i hil h• All staff are extensively trained in philosophy, principles, practices, and self-management skills

Transition to Coaching SupervisionTransition to Coaching Supervision

• Encourages

– Collaboration– Trust– Effective, participatory

bl l iproblem-solving– Listening– Ethical use of power and

empowerment

• Improves

– Quality of caring thro gh team orkthrough teamwork

– Empowerment of the Shahbazim

– Elder’s self-direction

Research & Outcomes Research & Outcomes Improvements in Elders’ Quality of Life

More privacy autonomy & individuality• More privacy, autonomy & individuality• Greater sense of dignity• More enjoyment of food• Better ability to form relationships

More meaningful activity• More meaningful activity• More emotional well-being

Improvements in Elders’ Quality of Care

Lower incidence of decline in late loss ADLs• Lower incidence of decline in late-loss ADLs• Fewer bedfast elders• Fewer elders with little or no activity• Lower prevalence of depression

Rosalie Kane, et alJournal of the American Geriatric Society, 2007

Research & Outcomes Research & Outcomes

Improvements in Staff Quality of Life

• Felt more empowered to help residents• Greater job satisfaction• More likely to remain• Knew elders better

Improvements in Family Quality of Life

• More satisfied with family member’s care• More satisfied in how they were treated

Rosalie Kane, et alJournal of the American Geriatric Society, 2007

Research & Outcomes Research & Outcomes Workflow

• No more staff time in Green House homes in areasimpacted by reorganization compared to typical NH

• Green House model delivers 1.72 more direct care d i h d i l NH and nursing hours compared to typical NH

• Four times more meaningful engagement between elders and staff in Green House homes

T h l id d f i • Two hours less per resident day of non- nursing departmental support (dietary, housekeeping , laundry,activities) compared to traditional NH

• Green House homes have same acuity, Green House homes have same acuity, organizational, and locational characteristics

Sharkey et al, 2009 (awaiting publication)

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Slide 14

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Research & Outcomes Research & Outcomes Nursing

“…if anything, the nursing care is better [in a Green House home] than in a conventional nursing facility. ‘Things don't get overlooked at a Green House, don t get overlooked at a Green House, as they might be in a nursing home, where caregivers don't work so closely with each other. If an elder stumbles at a Green House, every caregiver , y gknows it and starts watching that person’"

(Barbara Bowers, Associate Dean for Research, (Ba ba a Bowe s, ssoc ate ea fo esea c , School for Nursing, University of Wisconsin, commenting on soon to be published research on Green House homes to The Dallas Morning News, 2/3/09)

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Slide 15

all2 All, 2/14/2010

Financial ViabilityFinancial ViabilityBuilding on the Workflow Findings

• The Green House model increases direct care and nursing hours

• The Green House project decreases departmental and leadership time

• When increases and decreases are calculated using national salary figures, The Green House model is cost neutral to operate

More direct care time delivered without • More direct care time delivered without higher costs using efficient versatile workforce

• Homes are 650 SF gross per elder or larger – all private rooms increase size over average NHsp g

• Construction costs per square foot equivalent to a little lower for Green House homes vs. typical NH construction

The Green House Team’s ServicesThe Green House Team s Services

Provides comprehensive consulting and tools for success, including:

• Financial feasibility model • Design toolsDesign tools• Regulatory and policy

review and assistance• Organizational redesign • Project management• Project management• Extensive training• Post-occupancy consulting• On-going education

A t k• A peer network

MomentumMo e tuOperating

• 84 Green House homes• On 24 campuses• In 15 states (AL, AK, AR, AZ,

GA, KS, MA, MI, MS, MT, NE, PA, TX, WA, NY)

In Development

• 120+ Green House Homes• On 18 campuses• In 11 additional states (CA • In 11 additional states (CA,

CO, FL, IL,MD, NJ, OH, TN, VA, WI, WY)

Totals

• 200+ Green House homes• On 40+ campuses• In 26 states

Becoming A Green House Project

• Attend one day workshop to learn philosophy,

Becoming A Green House ProjectOverview:

y p p p yprinciples, & practices

• Apply to Green House Project

Work with GHP team on financial feasibility • Work with GHP team on financial feasibility, design, project implementation plan (11 areas),and regulatory review

• Complete leadership Guide nurse educator • Complete leadership, Guide, nurse, educator, and core training components (18+ days)

• Implement all required practices (e.g., person-directed care, consistent staffing, self-managed d ected ca e, co s ste t sta g, sel a aged teams, single rooms and baths, self-sufficient homes, cooking in the homes, etc)

• Open!

Staying A Green House ProjectStaying A Green House Project

Overview:

• Provide required quality & financial data t GHPto GHP

• Maintain membership in Green House peer network

• Participate in Peer Network assessment for required practices and outcomes (in development)

Strengths of The Green House Model

Top Five Strengths:

Strengths of The Green House Model

• Better live for elders and staff –research proven increased engagement, satisfaction, QoC

• Green House homes don’t need to be perfect to be good – “rip stop fabric”

• Research shows common improvements across diverse providers

• Operations cost neutral – do more with the same

• Affordable – 50% average Medicaid

Challenges of The Green House ModelTop Five Challenges:

Challenges of The Green House Model

• Every implementation has areas for improvement

• Green House model not silver bullet till h t b t t id – still have to be competent provider,

strong regulations and advocates equally necessary

• Staff resistance (institutions more • Staff resistance (institutions more convenient for some staff functions)

• Family education (misperceptions & paternalism) paternalism)

• Capital costs no less challenging for green house projects than any culture change modelg