Some people would say, ‘my coffee in the morning!’, some would say, “access to the outdoors’, some would say, ‘I need people to know me’. The Green House Project is a radically new, national model for skilled nursing care that returns control and a sense of well being to elders, their families and direct care staff.

 This 4 minute video takes you into 4 open and operating Green House homes, where you can hear elders and staff talk about their experience.Seeing is Believing, and viewing this video is a good way to gain insight into how The Green House Project transforms the environment, philosophy and organization of traditional Long Term Care, to create a home.

Last month, HHS Secretary Kathleen Sibelius announced the merging of the offices for Aging, Disability, and Developmental Disabilites, to form one new agency. This “Administration for Community Living” is designed, in the Secretary’s words, “to help ensure that the supports people with disabilities and seniors need to live in the community are accessible.” She goes on to say that the term “support” includes not only health care, but also appropriate housing, employment, education, meaningful relationships, and social participation.”

Much of the description is encouraging, and the efforts of organziations like the Eden Alternative to change the culture of aging, both in nursing homes and the community, seem well-aligned. One advantage of the alliance of aging with disability agencies is that it may encourage a broader view of the capabilities of people with dementia or age-related disorders to be included in meaningful ways. The comments about social participation for elders, with or without dementia, are most welcome.

At the same time, I have some misgivings. The concept has many positive features, but it’s tricky terrain to navigate in light of our history of aging in America, and things could easily go the wrong way.

First, the pairing of aging with disability may enhance our tendency to see aging as decline, and further medicalize this stage of life for all elders. Along with that “declinist” view come all the trappings of disempowerment and stigmatization that have led us to where we are today.

Second, full social participation is a great concept, but goes strongly against what our society has done for the past several decades. Is this a feel-good statement, or are we ready to pursue this in an honest manner? Are we ready to bring elders to the tables of our communities–even if they don’t have a job title or position power, even if they live with some forgetfulness–and truly listen to what they have to say?

The third issue is a larger one that I explored during my time away with my friend Emi Kiyota, which I’ll be addressing in future posts as well. That is the idea that aging has become a commodity in our society. Older people are seen primarily as consumers of services that are designed by others, for them. An entire industry has been built around this and in doing so, has marginalized elders and repositioned them as needing care and services, creating excess disability.

A prime example of this is the way in which we have sunk untold millions of dollars into senior living communities, rather than redesigning neighborhoods to be more accessible and inclusive. Are we ready to reverse this trend to create true community integration?

Lastly, Secretary Sibelius’ opening statement said (with my emphasis): “All Americans–including people with disabilities and seniors–should be able to live at home with the supports they need, participating in communities that value their contributions–rather than in nursing homes or other instituions.” Strong words. But does this mean aging in community, or aging in place?

Is there true community participation and reciprocity, where others will “value their contributions”, or is this simply housing that becomes a de facto “separate but equal” situation, due to a lack of accessibility for all? Will there be community gathering places that are truly multi-generational, or will the elders only have a “senior center” nearby for their use? Will the elders be consulted and engaged for their wisdom and experience, or will they simply be served by the other generations? One solution is affordable for society and empowering for elders–the other is neither.

(Parenthetically, I gave two talks last week at local community centers. Both had a “Senior Citizen Room”. That is not inclusion.)

This is the time to raise these issues, and this new agency will hopefully spur much more discussion of these topics. Our aging demographics demand it.

Tell us what you think!

Read more posts like this on the Allen Power blog at Chagingaging.org.

“[Green House Homes offer] an individually tailored environment and experience so someone doesn’t feel as if they’re trapped in a long, pale green hallway of an institution” says Gary Passmore, Vice President and Director of the Congress of California Seniors, which supports a bill being introduced in California by Democratic Senator Elaine Alquist.  The bill, SB 1228, would provide a new licensing category so more person-centered care facilities can operate in the state of California.

To read more about the positive impact the SB 1228 bill will make in the state of California and for additional commentary from Gary Passmore, click here.

Tell us what you think about this exciting new development in California Legislature!

Sagecrest Alzheimer's Care Center in San Angelo, Texas

via Texas AARP

“The state supports a culture change” in institutional care that would allow more Green house homes in Texas, says Chris Traylor, commissioner of the Texas Department of Aging and Disability Services.

Elders and family members are extremely pleased with the care offered at the Sagecrest Alzheimer’s Care Center in San Angelo, Texas, a Green House home project.  Many wish there were more homes being built, but money is the issue.  Texas Medicaid reimbursement is among the lowest in the country, and two-thirds of Texas elders in nursing homes get help from Medicaid.  AARP Texas advocacy manager, Amanda Fredriksen, says those rates largely determine “what Texas nursing homes look like.”

Read more about a Medicaid reimbursement rate that would encourage more Green House homes in Texas…and then tell us what YOU think!

She vividly remembers that first visit to the nursing home; she loved the smiles and gratitude from the elders, but didn’t enjoy the institutional feel or smells associated with the home.  While attending the University of Texas Lisa was again in a nursing home setting, but this time as a CNA.  Those experiences helped her realize that the traditional model of skilled nursing care needed to change, and she began her journey to support person-centered care and ultimately to oversee the development, construction and operation of two Green House homes.

Today, as a Project Guide for THE GREEN HOUSE ® Project, Lisa is excited to be part of the team and share her knowledge of the model with potential and current adopters.

• Administrator and Guide—The Village of Redford, two Green House-10 bed homes
• Master’s degree in Business Administration, an undergraduate degree in Business Administration with a concentration in Marketing
• Licensed Nursing Home Administrator – largest facility 556 Skilled Nursing home
• 14 years of experience in a variety of positions in Skilled Nursing and CCRC’s
• Entrepreneur & Business Plan Development expertise

In addition, while Lisa was in Michigan she was an active member of the education task force for LeadingAge Michigan.

Lisa thoroughly enjoys cooking and has quite a collection of pots, pans and utensils for her craft!  She enjoys international travel and watching TV game shows.

The theme this year for Older Americans Month is Never too old to play.  Karl Pillemer, author of the book ’30 Lessons for Living: Tried and True Advice from the Wisest Americans’, shares wisdom he collected about the importance of play.

In the Legacy Project, we’ve spent the past seven years collecting the practical advice for living from the oldest Americans (in their 70s, 80s, 90s, and beyond). They shared their wisdom on a wide range of topics, from marriage, to child-rearing, to career, to how to avoid regrets.

Some of their most useful advice had to do with the question: “What’s the best way to stay happy throughout your life?” And more often than I had expected, the idea of maintaining a lifelong sense of play came up. For example, Maurice gave this recommendation as his advice for marriage: “Think back to the playground when you were a kid. Your spouse should be that kid you would have most liked to play with!”

Sandra, another elder who contributed lessons to the Legacy Project, articulated the importance of play very clearly:

There are certain human needs that are constant. One of them is the concept of “play.” We learn to play without realizing that there may be difficulties that need to be faced in times that lay ahead, but it is going to be all right. As children we can easily write down about ten activities that we love to do, and we can often remember the last time that we did them. We enjoyed being with friends, roller skating, sledding, playing games with family, jumping rope, etc.  It is interesting that when adults are asked, they tend to have difficulty in listing ten things that they love to do, let alone when they last did the fun activity.

Play is an essential. Many times marriages end because couples tend to stop playing. Friendships end because folks get sidetracked with responsibilities and lose touch. Family life becomes mundane when the parents and children omit family chat around the dinner table that leads to listening and laughing. Their time to play as a family can define their love for one another and add to positive memories.

Having fun through play remains with us from birth to death.

So let’s listen to our elders, and keep playing – for all the years that we’re here!

Hello Colleagues!

We are pleased to announce the Fifth Annual Green House Meeting and Celebration at the Amway Grand Hotel in Grand Rapids, MI.  This gathering celebrates the many Green House projects growing homes across the country. Mark your calendar for this special gathering you won’t want to miss!  This brochure includes program highlights for your review and registration information. 

This year’s theme, “Meaningful Life, Meaningful Engagement” acknowledges the four Green House Projects open and thriving in the great state of Michigan.  From Pinecrest in the Upper Peninsula to Porter Hills, in Grand Rapids, our host city; from the Villages of Redford in Detroit’s outskirts to the western shores of Lake Michigan, we honor all of the homes where elders and persons living with disabilities can live lives of meaning and engagement in homes where they are well known.  We honor the commitments you have made and the hard work you are doing to make this vision a reality in your communities.  We hope this experience provides you with the opportunities for the learning, growth, replenishment and fun that you so richly deserve!

Visits to Porter Hills will be scheduled before, during and after the Conference.  Dr. Bill Thomas, dementia care expert Teepa Snow OT/R, and Karl Pillemer, Ph.D. and creator of the Legacy Project will join with the elders and staff of many Green House homes to network, share successful practices and spend time building relationships and creating intentional community among Green House adopters.

There will be learning, information-sharing and many networking opportunities for everyone, so come join the celebration! 

Below you will find this years brochure, which contains many details about the Annual Meeting and Celebration; including a preliminary program, logistics information and pre-conference and site visit information.  Please print the brochure to keep for your records.  You will also find the direct link to register you and/or your organization for attendance at The Green House Project 5th Annual Meeting and Celebration: Meaningful Life, Meaningful Engagement.                   

The Green House Project Team

CLICK HERE to download the Annual Meeting and Celebration brochure!

Book your travel now!

The Amway Grand Plaza Hotel

187 Monroe Avenue Northwest

GrandRapids, Michigan 49503

Room rate: $104 (Single or Double Occupancy)

Reservations may be made by dialing the following number and providing the group name:

Reservation Line: 800.253.3590

Group Name: Green House Project

*Please note this rate is only valid until August 05, 2012*

Closest airports

9 miles: Gerald R. Ford International Airport- Grand Rapids, MI (GRR / KGRR) 

32 miles: Muskegon County Airport- Muskegon, MI (MKG / KMKG)

Other nearby airports

51 miles: Kalamazoo/Battle Creek International Airport- Kalamazoo, MI (AZO / KAZO)
56 miles: Capital Region International Airport- Lansing, MI (LAN / KLAN)
89 miles: MBS International Airport – Freeland, MI (MBS / KMBS)
93 miles: South Bend Regional Airport- South Bend, IN (SBN / KSBN)
95 miles: Manistee County-Blacker Airport- Manistee, MI (MBL / KMBL)
97 miles: Bishop International Airport – Flint, MI (FNT / KFNT)

156 miles: Detroit Metropolitan Airport - Romulus, MI (DTW / KDTW)

Questions?  Please contact Aja Lawson at 703.647.2311 or alawson@ncbcapitalimpact.org

While many of us would clearly prefer home and community-based care, it’s estimated that 1.2 million Americans currently live in institutional facilities.  This rings especially true for low-income elders and others who lack access to affordable nursing services in their area.

Green House homes offer elders a place where autonomy and choice are honored, direct skilled nursing care is a priority, and they have more satisfying and meaningful lives, work and relationships.  When the home is located within a neighborhood—it also meets that desire for community-based services.

St. John’s Home in Rochester, New York opened the first two community-integrated Green House homes two months ago and will part of an evaluation of the concept over the next three years.

CLICK HERE to read the full story.

Tell us what you think below!

What makes a conversation a difficult conversation?

A difficult conversation is anything you find hard to talk about.  There are many reasons why a conversation may be difficult for you, including:

-You care deeply about the issue

-The topic is controversial (i.e. religion or politics)

-The outcome is uncertain

-You feel vulnerable or your self esteem is implicated

-You care deeply about the people with whom you are discussing the issue

When a difficult conversation occurs, spend a little time considering what really happened.  There are generally three levels of conversation:

The “What Happened?” Conversation:  Often there is a basic disagreement about the facts of the situation. Who said and did what, what it meant and who is wrong or right.  This creates an immediate disconnect between the people in the conversation.

The Feelings Conversation:  Every difficult conversation involves feelings.  Am I right or wrong; are my feelings appropriate and valid? How about the feelings of the other person?  Do feelings belong in the conversation or should I ignore them?  Unfortunately feelings are part of the equation. 

 The Identity Conversation:  We figure out what the conversation means to ourselves.  In this conversation many judgments happen: are we right or wrong, a good or bad person, competent or incompetent?  These judgments affect our self-esteem and self-worth.  

Here are some ways to reframe the situation for greater understanding and alignment:

1. Pull back from arguing about who is right.  Be open to exploring the other person’s story.  The pull back will help to reframe the conversation, and look with real curiosity into what the person understands and believes about the “what happened”.
2. Don’t assume they meant it!  Intentions strongly shape our views and judgments about the impact of the situation.  By putting aside blame and judgment, we open up the possibility of a very different outcome of the conversation.
3. Choose to not focus on blame.  Sometimes one person is clearly the cause of something that has gone wrong.  Focusing on blame is not helpful because it inhibits our ability to learn what’s really causing the problem and find insights and answers to correct it.  The impulse to blame often comes from our own concern of being blamed.

This is only the beginning of an exploration of difficult conversations.  The book Difficult Conversations: How To Discuss What Matters Most is a terrific resource to strengthen communication and to build trust and respect among team members.

Stone, D.,  Patton, B., Heen, S.  Difficult Conversations: How To Discuss What Matters Most. Penguin Books, New York, NY. 2000.

.

“It puts the ‘home’ back into nursing home.”  That’s how California Senator Elaine Alquist (D-San Jose) described SB 1228 when addressing the Senate Committee on Health this week.

The bill would create a new health facility licensing category for a small house skilled nursing facility that is either a standalone home or consists of more than one home providing skilled nursing care in a noninstitutional setting.

David Pierce of Mt. San Antonio Gardens, a continuing care center in Pomona, explained that his organization has been pursing approval to build a Green House home for years.

Find out what needs to happen next for full approval in California and let us know what you think!

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 compose 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.

Let’s be honest—when someone comes along and says, “Wouldn’t it be great to do a research study to learn about how well Green House Homes function and the impact that they have on residents?” It won’t sound like a good idea to everyone, especially those who are asked to spend time and effort on the study.  The time needed for site visits and data collection will lead some people to ask, “Is it really worth the time and energy?”

We think it is — and let us tell you why.

Many groups of people benefit from studies of the Green House model. The first group is–naturally–the residents of the homes.  Sharing best practices across homes is sure to help care and resident well-being. When researchers look at best practices they don’t just look at one home with a good idea, they look across a number of homes to see if the practice works in various settings or could work in various settings, or instead whether it’s a one home phenomenon.

The second group to benefit is the homes that want to move to the Green House model, or to adopt some of its best ideas. They need evidence that this model will be worth the effort it takes to make change. Within the homes, the staff who make the changes need evidence, and so do their bosses.

The third group is the agencies who foot the bill. Whether it’s a government program or a foundation, “payers” want to know the facts. Stories of success are important, but only information collected in a standardized manner across a number of homes will provide them with the evidence they need.

Participating in research does take some time, but what can be learned by thoughtful, experienced researchers is useful not just to those they study but to the field overall. Participating in research is an act of giving to your residents, their families, and caring staff all over the country. Thank you for all that you do.

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

The THRIVE research studies are funded by the Robert Wood Johnson Foundation.

The Grand Opening of Stadium Place, built on the site of Memorial Stadium, had all the festivities of opening day at the ballpark, complete with hot dogs, and a ceremonial first pitch thrown out by Dr. Bill Thomas and elder, Shirley Dickens. It was a wonderful culmination to a long and winding journey with strong partners. The Green House Project is built on relationships, and this project, the first in Maryland, highlighted that core value. GEDCO’s steadfast vision partnered with NCBCI and RWJF’s creative and innovative financing to create a home where Catholic Charities, with a long history of compassionate care, could create real home, in the community, for the community!

In addition to the Oriole Bird, the media were present to document this moment that propels Baltimore to the forefront of providing cutting edge services for low income elders. The Baltimore Sun covered the Stadium Place grand opening with a great story about the elders and background on the project. A couple TV stations attended the festivities and WBAL Channel 11 broadcast this excellent story featuring Stadium Place’s administrator Nate Sweeney GEDCO Executive Director, Mitch Posner and others. A blogger from Kaiser Health News also attended the gala and wrote a post touting the research proving The Green House Project model. WYPR 88.1 FM’s Maryland Morning with Sheilah Kast interviewd Dr. Bill Thomas about the urgent need to provide long term care to underserved populations he was joined by Brown University assistant professor Zhanlian Feng, who has led ground-breaking research about the changing ethnic and racial make-up of nursing home residents.

This event was one of those beautiful days, where everyone in attendance is filled with hope, and happiness.

“Regardless of income, everyone should have the opportunity to age with dignity and receive the highest quality of care,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation.

“By thoroughly redefining what a nursing home should be and placing elders at the center of all they do, Green House homes help residents live happier, healthier lives,” continued Lavizzo-Mourey. “Stadium Place is a milestone for Baltimore and a model for what every city should be doing.”

The Stadium Place project will be operated by Associated Catholic Charities. It will include four small homes that will serve up to a dozen seniors per home, and at least sixty percent of the rooms in the Green House homes will be reserved for older adults who are eligible for Medicaid. Stadium Place has also been built to obtain LEED Silver certification.

“Stadium Place is helping to change the face of long-term care,” said Terry Simonette, president and CEO of NCB Capital Impact. “It demonstrates that it is possible to provide the best care to the people who need it most, at the same cost as a traditional nursing home.”

The Green House Residences are an integral part of the holistic continuum of care GEDCO is developing at Stadium Place. They are integrated into a larger mixed-income urban retirement community that currently includes four apartment buildings for low and moderate-income seniors, a YMCA facility, Memorial Field at the Y, ThanksGiving Place and a community-built playground.

Click here to view the full press release

CONTACT:
Eric Antebi, 415-279-0748, eantebi@fenton.com
Kelly Osmundson, 415-901-0111, kosmundson@fenton.com

BALTIMORE ANSWERS SKILLED-NURSING CARE SHORTAGE WITH GROUNDBREAKING GREEN HOUSE PROJECT AT STADIUM PLACE

Opening marks first Green House project in Maryland

Baltimore, Maryland — With a looming shortage in long-term care options in poor neighborhoods around the U.S., Baltimore is leading the way today with the opening of The Green House® Residences at Stadium Place, which will provide the area’s low-income seniors with a radically different, skilled-nursing home on the site of the former Memorial Stadium.

Stadium Place, developed by Govans Ecumenical Development Corporation (GEDCO), is the first certified Green House project in the state of Maryland. It is also the first in the nation to take advantage of special financing for Green House projects aimed at low-income elders under a joint initiative of the Robert Wood Johnson Foundation and NCB Capital Impact. This project received significant additional support from The Harry and Janette Weinberg Foundation, the state, the City of Baltimore, and private donors.

“Regardless of income, everyone should have the opportunity to age with dignity and receive the highest quality of care,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation.

“By thoroughly redefining what a nursing home should be and placing elders at the center of all they do, Green House homes help residents live happier, healthier lives,” continued Lavizzo-Mourey. “Stadium Place is a milestone for Baltimore and a model for what every city should be doing.”

The Green House Model
Green House homes provide an environment in which residents receive nursing support and clinical care without the care becoming the focus of their daily lives. By altering the facility size, interior design, staffing patterns and methods of delivering skilled services to residents, the Green House model provides residents greater health and lifestyle benefits compared to residents of traditional nursing facilities.

Early results show that Green House residents report higher satisfaction levels, less physical decline and less depression — at a cost that is comparable to traditional nursing facilities. Last year, AARP called the Green House homes “a model for aging that promotes growth.” Long-Term Living magazine also recently named it one of the decade’s Top 10 Senior Design Innovations, and Provider Magazine has called the Green House model “the pinnacle” of culture change in long-term care.

The Stadium Place project will be operated by Associated Catholic Charities. It will include four small homes that will serve up to a dozen seniors per home, and at least sixty percent of the rooms in the Green House homes will be reserved for older adults who are eligible for Medicaid. Stadium Place has also been built to obtain LEED Silver certification.

“Stadium Place is helping to change the face of long-term care,” said Terry Simonette, president and CEO of NCB Capital Impact. “It demonstrates that it is possible to provide the best care to the people who need it most, at the same cost as a traditional nursing home.”

The Green House Residences are an integral part of the holistic continuum of care GEDCO is developing at Stadium Place. They are integrated into a larger mixed-income urban retirement community that currently includes four apartment buildings for low and moderate-income seniors, a YMCA facility, Memorial Field at the Y, ThanksGiving Place and a community-built playground.

The Growing Crisis of Long-term Care
In 2011, the first baby boomers turned 65. By 2030, one in five will be at least 65 — nearly doubling today’s numbers. Over that same period, the number of 85-year-olds will increase by 50 percent.

Despite the growing number of seniors in need of long-term care, the number of beds in skilled-nursing facilities has been dropping significantly over the last decade. Traditional nursing homes that were built several decades ago have been closing due to their age, but also due to shifting consumer preferences. Meanwhile, the financial crisis of the last few years has made building new facilities even more difficult.

While these trends are likely to affect older Americans across the board, low-income seniors are faring the worst. A study published last year in the Archives of Internal Medicine concluded that shortages of skilled-nursing facilities were most likely to occur in minority and poor communities.

”This project will provide the highest quality housing and care for older adults regardless of their financial situation,” said Mitchell Posner, Executive Director of GEDCO. “People who are eligible for Medicaid will be living side by side with other elders who have greater resources because in our eyes, they all deserve the best.”

About the Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable and timely change. For nearly 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.

About NCB Capital Impact
NCB Capital Impact helps people and communities reach their highest potential at every stage of life. As a national, non-profit community development finance institution, Capital Impact provides financial services and technical assistance to help make high-quality health care, healthy foods, housing, and education more accessible and attainable, and eldercare more dignified and respectful. Capital Impact has used its depth of experience, cooperative approach, and diverse network of alliances to generate over $1.6 billion in critical investments that create a high quality of life for low income people and communities. www.ncbcapitalimpact.org

###

In the houses, elders, many of whom have dementia, have private rooms; they can bring a recliner and dresser from home. There’s lots of natural light around the airy “common” areas: a hearth area, with conversational seating around a fireplace; a dining room adjacent to an open kitchen, with one large table around which residents and staff eat meals together; and a sitting room with a television and games.

Roger Mynatt, administrator, reflects back on his decision to pursue Green House homes, “it looked like home. It was just such a difference from the traditional institution. The board saw that the elders had better quality of life, and that it was a good situation for the staff, and they wanted it. They thought, ‘That’s what we need.’ ”

Jefferson County Nursing Home is one of two Green House Projects in Tennessee. Ave Maria Home is a Green House Project located outside of Memphis.

Click here to read the full article about how Jefferson County is achieving great results for the elders of their community, and those who love them!