This an op-ed Al Power wrote for the Democrat and Chronicle…
A June 13 letter writer (“Offer our elders family-style care) asked why elders cannot have the same “family-style” care that has been provided to those with developmental disabilities in the community. She cited the need for a home that is warm, open and allows elders to direct their own care.
What she describes is the Green House, a new model of care designed by Dr. William Thomas, founder of the Eden Alternative nursing home movement. About 40 Green House homes are operating in 10 states, and more than 30 more organizations have received grants to develop them.
St. John’s Home and the Rochester Presbyterian Home are the only Eden Alternative providers in upstate New York. St. John’s has received a grant to develop Green Houses locally, and we plan to open our first Green House by late 2009. We will be the country’s first organization to place Green Houses throughout the community, rather than on one separate campus. Our main campus will be transformed into a multi-story Green House community as well.
The Eden Alternative process transforms the traditional nursing home in three ways: interpersonal, organizational and physical. The process begins with changing our attitudes about aging and aged care, and developing close, continuous relationships throughout the home. This is followed by a “leveling” of the organizational hierarchy, bringing more decision-making to the elders and those closest to them. The Green House represents the physical aspect of transformation and further evolution of the care environment.
A Green House is a large ranch-style home for eight to 10 people, each with a private bedroom and bath. A central area contains a kitchen, dining area with a communal table for meals, and a living room/hearth area. There is no nursing station; care is taken to remove institutional trappings.
Direct care is provided by a universal worker, charged with helping to bring forth each elder’s abilities. These workers have training in personal care, safe food handling, cooking, activities and light housekeeping. They work collaboratively with a clinical support team of nurses, doctors and social workers who visit the house.
Green Houses also use smart technology, such as paperless record systems, induction cooktops and ceiling-mounted lifts to provide safe and comprehensive care. There is easy access to outdoor space.
Studies of the first Green Houses in Tupelo, Miss., showed that elders who moved there had equal or better outcomes in many health and quality-of-care measurements, with the same reimbursement rate as the comparison nursing homes. They also saw greater family satisfaction, fewer medications and less staff turnover and injuries.
Since that first Green House opened in 2003, similar models of small homes for elders have been developed, both for those in nursing homes and in assisted living communities. Our project team has visited eight Green House communities around the country, as well as other similar models.
It is important to stress, however, that the Green House is more than a building. If such homes are built and operated the way we operate nursing homes, they would simply be small institutions. St. John’s Home has adopted the Eden Alternative because we feel it is the most comprehensive model for transformation. We have learned that the most successful of these homes have followed this pathway to create a truly person-directed habitat, where even the frailest elders can experience growth and full engagement with life.
Power is Eden Alternative mentor, St. John’s Home.