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The Green Houses at Mirasol Ushering in a New Era in LTC in Colorado Debby Ahrens VIVAGE. Daily, in America we are witness to, or even unwitting participants in, cruel imagery, jokes, language, and attitudes directed at older people Even old people are ageist. An Ageist Society.
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The Green Houses at MirasolUshering in a New Era in LTC in ColoradoDebby AhrensVIVAGE
Daily, in America we are witness to, or even unwitting participants in, cruel imagery, jokes, language, and attitudes directed at older people Even old people are ageist An Ageist Society
Declinist View of Aging • Aging is bad! • Elderly – a bundle of negative stereotypes about older people • Black balloons on your 40th birthday, coffins on your 50th. • The only GOOD old person is an old person who…
The Declinist’s View • Has led us to create and inhabit a constellation of programs, services, and facilities that attempt to mitigate aging by dealing with decline. • “Long-Term Care” - dreadful hopelessness
A New View • Developmental Aging • Aging is a continued stage of growth and development • Elders are not less or more than adults • They are different • Just as adults are different from children
Elderhood • Human Elders have their own station and noble purpose • Many other countries and some cultures within the US hold Elderhood as a place of honor and respect. • “When an Elder dies, a library is lost.” – African Proverb
The Green House Model • Based on the belief that we continue to grow and develop throughout our lives despite any mental or physical incapacities. • Based on the Principles of The Eden Alternative • Principle #2 – The places where people live should be nurturing places where they can grow. • Principle # 9 – Human Growth can never be separated from human life.
Think of it this way... One-word greenhouses grow plants. Two-word Green Houses grow people.
Green House Transformation • Radical paradigm shift within current nursing home regulatory and reimbursement structures • Simultaneous transformation: • Philosophy • Organizational structure • Architecture
The Green House Model Core Value: Meaningful Life
Living, Growing, Thriving • Place decisions with elders or as close to them as possible • Facilitate deep knowing and reciprocity • Support a life worth living: engagement, enjoyment, purpose, continued growth It’s all about relationships!
The Green House Model Core Value: Real Home
Real Home • Warm, Smart and Green • Similar to surrounding community • Private rooms and baths • Residential Finishes • Intentional Community
The Green House Model Core Value: Empowered Staff
Places the elder at the heart of the organizational chart Radical change in leadership style Redefines the role and responsibilities of the direct care worker, nurses and the clinical support team Organizational Redesign It’s all about leadership!
Encourages Collaboration Trust Listening Ethical use of power and empowerment Improves Quality of caring through teamwork Coaching and empowerment of the Shahbazim Transition to Coaching Leadership
Organizational Transformation: The Traditional Power Structure
The Shahbaz • Protect • Nurture • Sustain
Group of Shahbazim who are empowered, responsible and trusted to manage the Green House home Work collaboratively with leaders and members of the clinical support team Self-Managed Work Team
Coordinators • Team • Food • Scheduling • Care • Housekeeping
CNA – required as a foundation 128 Hours additional training: Safe food handling CPR / First Aid Culinary skills Home maintenance/ management skills 48 hours Green House Training: Dementia care Critical Thinking for Clinical Excellence Communication Teamwork skills Policies & Procedures Training: Shahbaz
Nurses in The Green House Homes Think Home Care! Care Role Model Gerontological Expert Care Partner Mentor and Teacher
Total hours per elder per day = 5 - 5.2 (10-elder home) Nurses: One Nurse per two houses days One Nurse per two - three houses evenings and nights Total: 1 - 1.2 hrs per elder per day Shahbazim: Two Shahbazim days & evenings One Shahbaz overnight Total: 40 hrs total per day, 4 hrs per elder per day Direct Care Staffing
The Green House in Action The Green House Video
Satisfaction & Clinical Research • Kane: JAGS 2007 – Satisfaction and Clinical • Compared 4 pilot GH homes to traditional NHs • Significant improvements in elder, family, and staff satisfaction • Better clinical outcomes • Sharkey: JAGS 2011 – Staff Time and Clinical • Compared 14 GH homes to traditional nursing homes • Acuity the same between settings • Fewer total direct care, nursing, or departmental hours in GH homes • Same or better clinical outcomes • ½ hourmoredirect care time • 4 times more engagement between staff and elders • Bowers: Working Paper – Nursing Care Quality • Qualitative research at GH homes • Seamless communications and deep relationships • Nursing care as good or better than traditional
Consumer Research • Edge Research 2012 – Caregivers • 97% say GH model addresses their greatest concerns about NHs • 90% think it is important or very important for providers to build more GHHs in their community • 68% of caregivers believed GH better for relative than being cared for at home • 61% better than adult day • 73% would drive 15-60+ miles to receive Green House services • 60% would pay 5% - 25%+ more
System Costs Recent Additional Analysis: • Pressure Ulcers: In-house acquired pressure ulcers - GH homes 0%, traditional units 4.2% • Hospitalizations: 30% to 75% fewer hospitalizations than national average • Potential savings: $1K per elder per year
Loveland Project • Mirasol Senior Living Campus • Owned and Operated by The Housing Authority of the City of Loveland (HACOL) • Currently 2 apartment buildings, patio and single family homes • Both rental and purchase • Mixed income campus • Mirasol Event Center
Loveland GHP • 6 individual houses and an administration building • Each house will have 10 private rooms with private baths • Each house will have a kitchen, living, den and dining area, a spa, and outdoor spaces. • All 6 houses will be licensed as one skilled nursing facility. • The facility will be licensed for Medicaid and Medicare.
Loveland GHP • Ground Breaking complete • Construction begun • First house scheduled to be completed in September and final house by first of November.
Reimagining Eldercare Open House October 21, 2014 with Dr. Bill Thomas
Green House Financial Results: What we are Learning • Development Costs • Operating Costs • Financing Green House Homes • Conventional • NMTC • USDA • Weinberg • PRI – RWJF/AARP
Join the Revolution! • Operating • 148 homes • On 34 campuses • In 24 states (AK, AL, • AR, AZ, CA, GA, IL, KS, • MA, MD, MI, MS, MT, • NE, NJ, NY, OH, PA, TN, • TX, VA, WA, WI, WY) • In Development • 150 homes • On 26 campuses • In 7 additional states • (CO,DC, FL, KY, MN, NC, NM)
We did the best we could with what we knew. And when we knew better, we did better. -Maya Angelou
