December 2009
A green house movement
Written by Becky Schilling
During the past couple of years, most long-term care communities have undergone a shift in culture to move away from an institutional approach to senior care to a more personal approach. This transformation is known in the senior living industry as culture change. One strong example of this shift in senior living is known as the Green House.
A Green House is a home designed for a small number of residents, called elders. The term Green House was selected to suggest a home where people can continue to grow and thrive. Each elder has his or her own separate living area and bathroom. But the heart of the Green House is the kitchen, hearth and dining area. The Green House employs a universal worker, called Shahbazim, who provide all care for the elders, from nursing and laundry to cooking. The Shahbazim are certified nursing assistants (CNA) who undergo an additional 120 hours of training, during which they learn how to fulfill their foodservice duties. (Shahbazim is an ancient Persian word meaning royal falcon. According to Robert Jenkens, director of the Green House Project, the term was chosen because it has no negative connotations that he says are often associated with CNAs.)
Dr. Bill Thomas developed the Green House model. Thomas worked as a medical director in a nursing home in upstate New York, when “he realized that there was really good care and there were really good people, but the [residents] were really struggling with loneliness, boredom and a sense of helplessness,” Jenkens says.
Thomas developed the Eden Alternative in 1991 as a way to work within the confines of a nursing home to provide better care to help alleviate the residents’ struggles. “A lot of nursing homes adopted the Eden philosophy and then some of those realized that they had a very old physical building and that they were going to need to replace that,” Jenkens says. “Bill really started to think about what it would look like if we totally redesigned nursing homes to fit what we were trying to accomplish. That was the birth of the Green House Project.”
The first four Green Houses opened in May 2004 in Tupelo, Miss., as part of the Mississippi Methodist Senior Services’ Traceway campus. There are now 10 Green Houses at the Traceway Retirement Community. To date, almost 70 Green Houses have opened across the country. Green Houses can be found on any type of senior living campus.
Because there are no traditional foodservice employees in a Green House, meal service is dramatically different. The Shahbazim prepare all meals, and depending on the location the Shahbazim may plan the menus and do ordering as well. In most locations, the Shahbazim coordinate with the community’s foodservice director.
“For Bill, one of the key elements he identified for a Green House was that the kitchen and the hearth have to be key because that’s what makes it a home and not an institution,” Jenkens says. “Cooking in the house came about for two reasons: One was that food is obviously very important to people’s enjoyment of their life, but it is also the key element in a traditional nursing home that drives the schedule. It is one of the reasons why people get up at 6 o’clock in the morning so that they can be made ready to be taken down to a centralized dining room. So cooking food in the house also allows elders and staff to really control their schedules a lot more effectively and be able to be very responsive.”
Adapting the Green House model
Implementing the Green House model isn't feasible for every location. FSD talked with three operators to find out how they employ some Green House concepts in a non-Green House facility.
Cura Hospitality: A couple of months ago, the Orefield, Pa.-based management company developed a culture change guide to help its clients and on-site staff move away from the institutional way of serving seniors to an individualized approach. “It’s a journey,” says Deb Santoro, director of staff development for Cura. “It’s not like you can flip the light switch and change your environments and programs. The roots are very deep and it takes a lot of educating, training and hands-on experience for our communities to transition.” To help with the change, Cura developed a step-by-step guide for culture change. The guide includes a self-assessment tool so a facility can see where it is in the culture change journey. From there, the guide has an action plan for staff to implement, as well as a list of resources for help.
“The manual includes lessons learned and do’s and dont’s,” Santoro says. “The journey is unique in every environment so the experience has taught us a lot of lessons. There is no reason to make the same mistakes twice.” Some of those lessons include learning to work within your client’s vision, allowing for ample time and being flexible to plan changes.
One of Cura’s locations to undergo significant culture change was 450-resident Phoebe Berks in Wernersville, Pa. Three months ago, Village Garden, a 24-bed memory care support unit, opened on the Berks campus. Because of Village Garden’s small size, the staff is able to focus more on the residents, according to Tracy Bozik, director of corporate marketing for Cura. Much like a Green House, the heart of Village Gardens is its open kitchen. The kitchen has food and beverage selections available at all times, but the interaction between staff and residents is another benefit, Bozik says. “There’s a little counter area where the residents can sit and watch their food being prepared and have conversations with the staff and perhaps assist with the preparation of the meal,” she says.
Maria Burdette, district manager for Cura, also sees the benefits of the smaller units in assisting with resident-staff interaction. “Prior to this we delivered meals on food carts from the main kitchen. This is a huge change in really improving the quality of life for the residents because they participate. We have a resident who does not like to get up early in the morning and if he wants bacon and eggs for lunchtime we can do that.”
Burdette says the residents aren’t the only ones undergoing a culture change. “It’s a tremendous shift in the way staff has traditionally thought about their roles,” she says. “We’re seeing this shift in attitude and pride. They take ownership in what they do because they now have a personal relationship with those few residents.”
