Empowering our elders
Jewish Home Family introduces the Green House of communal care
What happens when a senior citizen who at one time managed her own home, raised a family, had a successful career, and oversaw her own healthcare needs finds it necessary, because of cognitive or physical impairment or decreased mobility, decision-making capability, or income, to leave that home and have her care — and life — managed by someone else?
What happens to that person’s sense of home? How can home — the place where she found family, warmth, and comfort — be recreated?
Green House homes are for anyone who needs skilled care. The overwhelming majority of people who live in Green House homes have some cognitive impairment. No matter what they need, it’s provided to them, 24/7.
The Green House Project is a long-term-care model that provides residents with a sense of belonging; staff are supported and empowered, and the living space is designed to feel like a real home.
The Jewish Home Family reconfigured its Memory Lane assisted living unit in the Jewish Home Family in River Vale to the Green House model last spring; it’s about to open Green House homes at the Jewish Home at Rockeigh. (Memory Lane is an assisted living unit for residents with some degree of cognitive impairment.)
“The Green House Project is not just a small-house movement,” said Eric Riguerra, RN, the director of nursing at the Jewish Home at Rockleigh. “Shifting from a traditional medical model of care that is physician- or nursing-directed, our goal in transitioning the Jewish Home Family to the Green House Model of care by providing person-determined care. This gives people the opportunity to control how or when they want their care provided — regardless of their age or stage or level of ability or disability.”
“When the Jewish Home at Rockleigh opened in 2001, we were absolutely state of the art in the care we provided to older adults,” Carol Silver Elliott, the president and CEO of Jewish Home Family, said. “We are still state of the art, but there are things we know about the Green House Model that will improve the lives of elders, enhance their experience, and increase their engagement.
“Providing a Green House Model of care changes the dynamic within the living environment, giving our elders the freedom to experience daily activities in an open setting,” she said. “It means they can decide to get up at 10 a.m. and have breakfast at noon. It means they can choose whatever activity they want to participate in or tell us what else they would like to do. It means that we make every effort to make life normal; to make this their true home.”
Throughout all the communities at Jewish Home Family, from long-term care to assisted living to memory care to short-term rehabilitation, staff use the term “elder” to refer to the older adults they serve.
“By referring to them as elders instead of residents, I believe we are conveying wisdom, dignity, and gravitas,” Ms. Silver Elliott said. “We gauge the satisfaction of our elders based on how they participate, how social they are, how much they sleep. The big change with Green House is that we’re not seeing our elders as a diagnosis, but rather as a person. When the elders’ preferences are honored and their needs are primary, functional and cognitive skills are preserved longer. Families are noticing changes for the better.
“We are committed to three core values — real home, meaningful life, and empowered staff. Our goal is to transition from a medical model, where nursing homes were derived from a hospital-based setting with two beds per room, nurses’ stations, and long hallways, to person-determined care, where the elders in our community dictate how and when they want their care provided.
“Our intention is to transform the long-term-care experience for elders by recognizing and respecting the qualities they hold dear, regardless of their cognitive status.”
“Our goal is for the relationship interface between residents and staff to be more convivial,” Mr. Riguerra said. “This will require retraining and re-orienting with staff. And as we move away from a traditional medical model where care is dictated by the staff, the Green House concept will work for some of our staff, but not for others. Everyone needs to embrace this new model of care for it to work well. We hope staff, from top to bottom and bottom to top, will be open to the transition.”
“What differs from a traditional nursing home setting is that in the Green House model there are no locked doors that sound alarms, no signs on a resident’s room citing personal, clinical details, no medicine carts or medical equipment in view of the elders,” Ms. Silver Elliott said. “The goal is to replicate an elder’s real home, where they can be treated with as much dignity as possible.”
Susan Ryan, RN, is the CEO of the Center for Innovation in Linthicum, Maryland, the Green House Project’s parent organization. She has led the project’s growth to include more than 400 homes in 32 states, Australia, and Canada.
She explained the model’s genesis.
“Dr. Bill Thomas, a Harvard-educated geriatrician, created a totally new approach to long- term care, replacing nursing homes with real homes.” Dr. Thomas “liked the idea of an elder garden — a place where the focus was on growth for people — a place full of light and nutrients and abundance.
“Bill Thomas’s goal was for Green House staff to protect, sustain and nurture the elders in their homes. He’s said that human well-being encompasses more than what is clinically measurable.”
The first Green House home, designed for 10 to 14 residents, was constructed in Tupelo, Mississippi, in 2003. Each household had private bedrooms and bathrooms with open communal space for activities and meals.
“Dr. Thomas’s model was one of the most radical innovations that hit skilled nursing facilities,” Ms. Ryan said. “He took a traditional nursing home and built four real homes with 10 to 12 residents in Tupelo. Each resident had a private room with an attached bath and shower and shared a central living space with an open kitchen and an area to congregate. He was trying to create a compelling case for the ideas he would eventually pitch to senior living providers, medical directors and architects. He created a trademark with quality standards that could easily be replicated by any long-term setting in the Green House network. All organizations that adopted the trademark were adhering to the same quality parameters.
“What they were learning at Tupelo was showing positive success,” Ms. Ryan continued. “Quality of life and other measures were improving significantly. Consequently, it seemed that the model should be THE model for nursing homes across the United States.”
Ms. Ryan has been working with a team of strategic advisors, educational consultants, neuroscientists, researchers, and other eldercare professionals in the field of aging studies to help organizations launch the Green House Model. “Staff who work in nursing homes, assisted living facilities, and memory-care units need to acquiesce to a different way of doing things,” she said. “The Green House Model offers elders the opportunity to live life with some autonomy, control, and self-determination with a staff that is engaged in building relationships with the elders they serve.”
Ms. Ryan describes Ms. Silver Elliott and Mr. Riguerra as “visionaries who have bought into a concept that they aim to create in their New Jersey locations.”
She said that the Green House model shifts the paradigm from institutional living to real homes with a workforce that’s empowered to support a person-directed approach. “Moving from a staff-directed to an elder-directed approach offers each elder the ability to choose when they sleep, when they wake, when and what they eat, what they wear, and how, if at all, they take part in activities,” she said.
Charlene Vannucci, the director of community outreach at Jewish Home Assisted Living and Memory Lane, is a certified therapeutic recreation director and dementia therapist and director. “In an effort to make meaningful connections with our elders, we ensure that each individual is deeply known by all our staff,” she said. “We want to understand him or her as a whole person with intrinsic worth.”
The Green House Home philosophy of deep knowing, an insight based on active listening, is appreciated and respected by all staff working within the model. Each staff member is trained and equipped with the communication skills necessary to develop relationships that result in purposeful engagement. “We receive education from the Green House national office; learning how to listen to details about our elders’ individual backgrounds,” Ms. Vannucci said. “Often, we gather information from the family who plays an integral part in the relationship network. Who were they in their formative years? What role did they play in their family unit? Who were they as professionals, as leaders, as members of organizations? We want to get to know someone’s preferences, interests and abilities so we can provide the most relevant quality of life in our Jewish Home Family continuum.”
Studies have shown that residents in Green House homes experience improved mobility and social interaction and fewer reports of depression and weight loss, likely due to the positive impact of intuitive and empathic relationships with each other and with the staff.
Ms. Vannucci offered some examples from the experiences of elders at Jewish Home Family’s Memory Lane, the memory-care unit at Jewish Home Family’s RiverVale campus, who already live in a Green House model. “Our staff noticed that one elder regularly folds napkins, sets tables, and helps to feed other elders,” she said. “Back in the day, she was involved with Hadassah, Sisterhood, and Jewish Council, hosting gatherings for members and going to people’s homes for meetings. When asked what she’d like to do, she said she wanted to have a tea party. So we organized a tea party, with a dozen elders and three or four staff members.”
“A male elder moved in and when asked what his interests were, he said, ‘I like baseball and women.’ So we found a copy of ‘A League of Their Own,’ a movie about a women’s baseball league that formed during World War II.” He liked the idea, and he enjoyed the film.
“Another elder insisted on buying M&Ms. Normally, a caregiver or a nurse would have to go out and buy the candy on his or her own time, but in the Green House model, we are responding to the needs of the elders in real time. So one of the guides escorted her out to a local store to buy candy. Ultimately, it was more about getting out to go shopping than eating the M&Ms, but we do what we can to be responsive.”
With a ratio of one caregiver to five elders, there are opportunities for increased engagement and connection. “Our staff eat with the residents,” Ms. Vannucci said. “It’s a real home vs. home-like. Our nursing nook is tucked away in a corner of the wing. No one would know it was there unless they were brought to it. There is less focus on nursing and more focus on living.”
“The majority of our staff has been with us on one of our campuses for at least five years,” Ms. Silver Elliott said. “Everyone, from maintenance to social work to recreation to nursing to our volunteers and guides, is trained on the Green House philosophy.”
For more information on the Green House Project, go to thegreenhouseproject.org/solutions/best-life-memory-care. To learn more about Jewish Home Family’s services, go to www.jewishhomefamily.org.
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