Major Culture Change Initiatives:
The Green House Project: This model creates a small intentional community for a group of elders and staff. It is a place that focuses on life, and its heart is found in the relationships that flourish there. A radical departure from traditional skilled nursing homes and assisted living facilities, The Green House model alters facility size, interior design, staffing patterns, and methods of delivering skilled professional services. Its primary purpose is to serve as a place where elders can receive assistance and support with activities of daily living and clinical care, without the assistance and care becoming the focus of their existence. Developed by Dr. William Thomas and rooted in the tradition of the Eden Alternative, a model for cultural change within nursing facilities, The Green House is intended to de-institutionalize long-term care by eliminating large nursing facilities and creating habilitative, social settings.
Eden Alternative: The core concept of The Eden Alternative is that places where elders live must be habitats for human beings, not sterile medical institutions. According to this philosophy, the departmentalized, task-orientation of the current institutional model has created a culture that is characterized by pessimism, cynicism and stinginess. By moving away from the top-down bureaucratic approach to management and moving decision making closer to the Elders, Edenizing organizations are helping to support a meaningful life for their Elders.
Pioneer Network: Culture change in the long-term care world involves many players – residents, administrators, workers, lawmakers, policy analysts – sharing a common vision. The Pioneer Network is comprised of citizens, providers and advocates who are exploring alternatives to traditional nursing facilities. Their goal: facilities that are resident-centered, less institutional and more home-like. This involves trying to piece together financing from Medicaid, Medicare and private funding sources. The Pioneer Network promotes grassroots activities and new ways of de-institutionalizing services and individualizing care.
Wellspring: Wellspring nursing homes utilize educational modules to provide all staff with the information necessary to participate in facility decision making. Leadership provides informal and formal organizational leaders the skills necessary to articulate facility vision and support the line staff in their change process. The clinical modules provide the information needed to critically think through their care delivery processes and evolve beyond department- specific isolated task completion. |
Foundations Providing Major Research and Financial Supports:
The Commonwealth Fund: The Commonwealth Fund, a private foundation, has a major program area called "Quality of Care for Frail Elderly" that has funded significant work on culture change.
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Culture Change in a For-Profit-Nursing Home Chain: An Evaluation (February 2008). Beverly Healthcare—one of the nation's largest nursing home chains—launched a culture change initiative in 2002, called resident-centered care (RCC). This report presents findings from a 12-month evaluation of that initiative. While most prior culture change models had been implemented by nonprofit organizations in a small number of facilities, this project marked a major departure for the culture change movement because it was the first time that a large national for-profit chain implemented culture change.
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Resident Outcomes in Small-House Nursing Homes: A Longitudinal Evaluation of the Initial Green House Program (August 2007). In a study comparing health outcomes and quality of life for Green House residents with residents at two traditional nursing homes, Green House residents were found to experience better quality of life, with the same or better quality of care than those in the comparison homes.
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Radical Redesign of Nursing Homes: Applying the Green House Concept in Tupelo, Miss. (December 2006). The people behind the Green House Project are seeking to "deinstitutionalize" long-term care. They have taken the traditional nursing home and radically transformed it—into a real home, a place where residents receive care, not just treatment. This study, written by a former director of the National Green House Project, presents the goals of the initiative and reports on preliminary evaluation results pointing to positive outcomes for residents, family, and staff.
The Robert Wood Johnson Foundation: One of the largest foundations in the country, the mission of the Robert Wood Johnson Foundation is "to improve the health and health care of all Americans."
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A Place to Call Home: What the future of eldercare should be (December 2007). A 2002 grant from the Robert Wood Johnson Foundation helped demonstrate the Green House model and develop a business plan for how it could be replicated commercially. More recently, a Foundation-funded replication initiative is structured to jump-start development of more than 100 Green Houses nationally.
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Returning Control and Dignity to Elderly Residents (December 2007). "The old [nursing home] setting is based on economies of scale and medical treatment," says Green House administrator Joyce Ebmeier, "and the Green House is based on deep relationships; nurturing, sustaining and protecting each person. It is about creating a home clearly dedicated to supporting who the residents are and what they want to accomplish. Excellent medical treatment is a key component of life in a Green House, but it is delivered discretely and supportively, with respect to the rhythm of each elder's life. In a traditional setting, medical treatment governs nearly everything an elder does; it rules."
The Kaiser Family Foundation: The Kaiser Family Foundation is a non-profit, private operating foundation focusing on the major health care issues facing the U.S., with a growing role in global health.
White House Conference on Aging Greenhouse Project Report
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Additional Consumer Resources:
Almost Home: The Almost Home film takes you inside the revolutionary transformation of a nursing home. This companion Web site pulls back to give you the bigger picture. Understanding Aging addresses general topics, while Changing Long-Term Care offers information about “culture change.”
National Resource Center on Supportive Housing and Home Modification (NRCSHHM).
NCCNHR: The National Consumer Voice for Quality Long Term Care (http://nccnhr.org/default.cfm)
NCCNHR has a variety of information and consumer fact sheets to help people understand their rights in nursing homes and advocate for good, person-directed care.
The Long Term Care Community Coalition (www.ltccc.org)
LTCCC has consumer guides and information related to nursing home resident rights, a dedicated page to Culture Change in New York Sate and information on nursing home performance and how people can advocate for better care and quality of life.
PBS NewsHour Show Report on the Green House Model (http://www.pbs.org/newshour/bb/health/jan-june08/nursing_01-23.html)
Susan Dentzer reports on the "green houses" project, which seeks to reinvent traditional nursing home care and create close-knit communities of patients and caregivers. Some observers, however, question the homes' financial feasibility. |
