GH CV Overview Webinar 3-22-11 · Microsoft PowerPoint - GH CV Overview Webinar 3-22-11...
Transcript of GH CV Overview Webinar 3-22-11 · Microsoft PowerPoint - GH CV Overview Webinar 3-22-11...
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Consumer Voice For Long-Term CareI d i GH & B i /S i A G H HIntroduction, GH101, & Becoming/Staying A Green House HomeMarch 23, 2011
Introductory WebinarIntroductory Webinar
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AgendaAgenda
• Recap of the main principles and practices of The Green House model
• Research findings
• Financial viability
i l • National momentum
• Becoming/Staying a THE GREEN HOUSE® Project
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We did the best we could with what we knewWe did the best we could with what we knew. And when we knew better, we did better.
Maya Angelou
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IntroductionsIntroductions
• Robert Jenkens
• The Green House Project Partnership:Partnership:
– Elders, Providers, & Advocates– Bill Thomas– Robert Wood Jonson Foundation– NCB Capital Impact– State and Federal Policy Makers
• NCB Capital Impact
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Green House Redesign Green House Redesign
• Works within current regulatory & • Works within current regulatory & reimbursement systems
• Typically licensed as a nursing home to guarantee ability to age-in placein-place
• Aligns built environment with mission & goals
• All aspects designed to support All aspects designed to support goals & protect against institutional creep
• Improves quality of life for elders and staff and staff
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Green House PhilosophyGreen House PhilosophyLiving, Growing, Thriving
• All people are creative, resourceful and whole and p pdeserve meaningful lives in real homes
• Meaningful lives require control, being known, and reciprocal relationships
• Control requires that decisions are placed with the elders and the staff who know them best and fully private space
• People become known in intentional communities
• Organizational and physical structure must foster opportunities for reciprocityoppo tu t es o ec p oc ty
• Green House homes and operations foster control, knowing, and reciprocal relationships
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Green House Environment • Warm - small scale & residential finishes and
details
Green House Environment
• Smart - use technology to support high touch services
• Green - support continued growth pp g
• Private bedroom & bath regardless of private pay or Medicaid status
• Hearth - open plan living room dining room • Hearth open plan living room, dining room, and kitchen
• Meet institutional building code standards
All areas of the home open to elders thro gh • All areas of the home open to elders through use of targeted safety features
• Houses independent from each other
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Green House TypesGreen House Types
Green House homes are designed to be similar to the housing in the community:
• Single family style in rural and suburban areas
Low rise garden apartment style in • Low-rise, garden apartment style in dense suburban and low-rise urban areas
• High-rise in dense urban areas• High rise in dense urban areas
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The Green House ReorganizationThe Green House Reorganization
Reorganization in the house:Reorganization in the house:
• Power and decision making move to the elder and those closest to him/her
• Shahbazim - cross-trained in care, house keeping, laundry, cooking, and enrichment – support elders
• Self-managed Shahbaz team provide flexibility
• Flexibility allows Shahbazim to reorganize cont-inuously to meet elder’s preferences and needs
• Desegregated staffing approach greatly increasesinteraction with elders fostering deep relationshipsinteraction with elders, fostering deep relationships
• Sage, a volunteer from the community, supports self-managed team as an informal coach
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The Green House ReorganizationThe Green House Reorganization
Reorganization to support the self-managed team:Reorganization to support the self managed team:
• Shahbazim are coached and held accountable by the Guide
N h d d t bl t• Nurses are coached and accountable to Director of Nursing (DON)
• Clinical team, DON, and MD are partners with and accountable to Guidea d accou tab e to Gu de
• Guide serves as coach to all who interact with elders in the home
All t ff t i l t i d i hil h• All staff are extensively trained in philosophy, principles, practices, and self-management skills
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Transition to Coaching SupervisionTransition to Coaching Supervision
• Encourages
– Collaboration– Trust– Effective, participatory
bl l iproblem-solving– Listening– Ethical use of power and
empowerment
• Improves
– Quality of caring thro gh team orkthrough teamwork
– Empowerment of the Shahbazim
– Elder’s self-direction
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Research & Outcomes Research & Outcomes Improvements in Elders’ Quality of Life
More privacy autonomy & individuality• More privacy, autonomy & individuality• Greater sense of dignity• More enjoyment of food• Better ability to form relationships
More meaningful activity• More meaningful activity• More emotional well-being
Improvements in Elders’ Quality of Care
Lower incidence of decline in late loss ADLs• Lower incidence of decline in late-loss ADLs• Fewer bedfast elders• Fewer elders with little or no activity• Lower prevalence of depression
Rosalie Kane, et alJournal of the American Geriatric Society, 2007
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Research & Outcomes Research & Outcomes
Improvements in Staff Quality of Life
• Felt more empowered to help residents• Greater job satisfaction• More likely to remain• Knew elders better
Improvements in Family Quality of Life
• More satisfied with family member’s care• More satisfied in how they were treated
Rosalie Kane, et alJournal of the American Geriatric Society, 2007
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Research & Outcomes Research & Outcomes Workflow
• No more staff time in Green House homes in areasimpacted by reorganization compared to typical NH
• Green House model delivers 1.72 more direct care d i h d i l NH and nursing hours compared to typical NH
• Four times more meaningful engagement between elders and staff in Green House homes
T h l id d f i • Two hours less per resident day of non- nursing departmental support (dietary, housekeeping , laundry,activities) compared to traditional NH
• Green House homes have same acuity, Green House homes have same acuity, organizational, and locational characteristics
Sharkey et al, 2009 (awaiting publication)
j1
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Slide 14
j1 jwon, 4/9/2010
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Research & Outcomes Research & Outcomes Nursing
“…if anything, the nursing care is better [in a Green House home] than in a conventional nursing facility. ‘Things don't get overlooked at a Green House, don t get overlooked at a Green House, as they might be in a nursing home, where caregivers don't work so closely with each other. If an elder stumbles at a Green House, every caregiver , y gknows it and starts watching that person’"
(Barbara Bowers, Associate Dean for Research, (Ba ba a Bowe s, ssoc ate ea fo esea c , School for Nursing, University of Wisconsin, commenting on soon to be published research on Green House homes to The Dallas Morning News, 2/3/09)
all2
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Slide 15
all2 All, 2/14/2010
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Financial ViabilityFinancial ViabilityBuilding on the Workflow Findings
• The Green House model increases direct care and nursing hours
• The Green House project decreases departmental and leadership time
• When increases and decreases are calculated using national salary figures, The Green House model is cost neutral to operate
More direct care time delivered without • More direct care time delivered without higher costs using efficient versatile workforce
• Homes are 650 SF gross per elder or larger – all private rooms increase size over average NHsp g
• Construction costs per square foot equivalent to a little lower for Green House homes vs. typical NH construction
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The Green House Team’s ServicesThe Green House Team s Services
Provides comprehensive consulting and tools for success, including:
• Financial feasibility model • Design toolsDesign tools• Regulatory and policy
review and assistance• Organizational redesign • Project management• Project management• Extensive training• Post-occupancy consulting• On-going education
A t k• A peer network
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MomentumMo e tuOperating
• 84 Green House homes• On 24 campuses• In 15 states (AL, AK, AR, AZ,
GA, KS, MA, MI, MS, MT, NE, PA, TX, WA, NY)
In Development
• 120+ Green House Homes• On 18 campuses• In 11 additional states (CA • In 11 additional states (CA,
CO, FL, IL,MD, NJ, OH, TN, VA, WI, WY)
Totals
• 200+ Green House homes• On 40+ campuses• In 26 states
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Becoming A Green House Project
• Attend one day workshop to learn philosophy,
Becoming A Green House ProjectOverview:
y p p p yprinciples, & practices
• Apply to Green House Project
Work with GHP team on financial feasibility • Work with GHP team on financial feasibility, design, project implementation plan (11 areas),and regulatory review
• Complete leadership Guide nurse educator • Complete leadership, Guide, nurse, educator, and core training components (18+ days)
• Implement all required practices (e.g., person-directed care, consistent staffing, self-managed d ected ca e, co s ste t sta g, sel a aged teams, single rooms and baths, self-sufficient homes, cooking in the homes, etc)
• Open!
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Staying A Green House ProjectStaying A Green House Project
Overview:
• Provide required quality & financial data t GHPto GHP
• Maintain membership in Green House peer network
• Participate in Peer Network assessment for required practices and outcomes (in development)
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Strengths of The Green House Model
Top Five Strengths:
Strengths of The Green House Model
• Better live for elders and staff –research proven increased engagement, satisfaction, QoC
• Green House homes don’t need to be perfect to be good – “rip stop fabric”
• Research shows common improvements across diverse providers
• Operations cost neutral – do more with the same
• Affordable – 50% average Medicaid
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Challenges of The Green House ModelTop Five Challenges:
Challenges of The Green House Model
• Every implementation has areas for improvement
• Green House model not silver bullet till h t b t t id – still have to be competent provider,
strong regulations and advocates equally necessary
• Staff resistance (institutions more • Staff resistance (institutions more convenient for some staff functions)
• Family education (misperceptions & paternalism) paternalism)
• Capital costs no less challenging for green house projects than any culture change modelg