Green House Presentation

March 24, 2006

Pinecrest Medical Care Facility

Darlene Smith, RN, DON

Planting the Seeds of Change

The Green House at Pinecrest

Green House Organization

• The Elder• The Shabazim (Elder Assistants)• The Sage• The Clinical Support Team• The Guide• Clinical Support Team Nurses• DON, Activities Director, Therapy, Dietician,

Social Worker

The Elder

The Elder• At the center of the organizational structure

• Decision making is kept as close to the elder as possible

• If unable, the individual closest to the elder who has the training and expertise to make the decision, does so with within the framework of the known wishes of elder & family

The Shabaz

The Shabaz

• The role of a “Shabaz” is to provide care to the elder

– Activities of daily living such as meal preparation, dining, laundry, housekeeping, dressing, bathing, grooming, recreation and socialization

The Sage

The Sage

• A member of the community who participates as a volunteer

• Provide advice and guidance to the Shabazim

• Visit Green House regularly and participate in house meetings

• Has no authority to direct activity

The Sage

• Held to confidentiality regarding any communication with the Shabaz except if the information involves elder abuse, neglect or potentially dangerous circumstances

• Any of the above would be reported immediately to the Guide

The Shabazim

The Shabazim

• Shabazim function as a self-managed work team

• They monitor and report the outcomes of their work to the Guide

The Clinical Support Team

The Clinical Support Team

• This interdisciplinary team consists of:– Physical, Occupational & Speech Therapists– Social Worker– Dietician– Recreation Therapy– Nurses

The Clinical Support Team

• The Clinical Support Team members work under the direction of the Physician and the outcomes of their work are monitored by the Guide, Director of Nursing and the Medical Director

• Nurses report to the DON

The Clinical Support Team

• Determines clinical needs of the elders and decides how those needs will be met

• Visits to provide clinical services

• Collaborate with the Shabaz regarding the elders’ clinical status, delegate clinical treatment, review effectiveness and modify treatment if necessary

Care Planning Meetings

• Held at the Green House with the elder, the Shabaz and members of the Clinical Support Team

• Family is notified and invited if the elder wishes them to attend

• The meeting is coordinated by the Clinical Support Team in collaboration with Shabaz

The Guide

The Guide

• A licensed nursing home administrator who guides, directs and monitors the quality of care and the quality of life of the elders in the Green House

The Guide

• Responsible for evaluating the outcomes of the work of the self managed work team of the Shabazim

• All Shahbazim are supervised and directed by the Guide

Clinical Support Team Nurses

Clinical Support Team Nurses

• Responsible for monitoring the clinical status of the elders

• Responsible for visiting each elder on each shift, performing daily general assessment of clinical status

• Results discussed with Shabazim and documented in elder’s medical record

Green House

Education

The education of all who contribute to the

Green House is of fundamental importance.

Green House Education

• The best designed structure, the most cutting edge technology, and the best business plan are wasted resources if all of the participants in the Green House are not educated.

Green House Education

• If the Green House is to be a place which is not a mini-nursing home or a new version of assisted living, it must embody a cultural change.

Green House Education

• A Green House is a vessel for the enactment of a humanistic, interactional philosophy of growing old.

Green House Education

• The philosophy of the Green Houses hold that it is a space where frail elders and those who support them come together to maximize the wellness of the aging individual.

Green House Education

• The quality of life an elder achieves is the result of interactions between the elder, other people, and the environment.

Green House Education

• Rather than simply “train staff,” it is necessary to re-educate all who participate in the Green House.

• Elders, their families, volunteers, clinicians, visitors and the community all need to understand the Green House philosophy.

The Green House & Participants attempt to…

• Provide Privacy

• Recognize and value individuality

• Honor autonomy and choice

• Foster spiritual well being

• Create a sense of safety, security and order

• Facilitate physical comfort

The Green House & Participants attempt to…

• Foster enjoyment• Provide opportunities for meaningful

activities• Offer opportunities for reciprocal

relationships• Promote functional competence• Convey the importance of an individual’s

dignity