1. The Green Houses at Mirasol Ushering in a New Era in LTC in Colorado Debby Ahrens VIVAGE

2. An Ageist Society 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

3. Declinist View of Aging Aging is bad! Elderly – a bundle of negative stereotypes about older people Black balloons on your 40 th birthday, coffins on your 50 th. The only GOOD old person is an old person who… 3

4. Acts like a young person! 4

5. 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 5

6. 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 6

7. 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 7

8. 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.

9. Think of it this way... One-word greenhouses grow plants. Two-word Green Houses grow people.

10. 10 Green House Transformation Radical paradigm shift within current nursing home regulatory and reimbursement structures Simultaneous transformation: Philosophy Organizational structure Architecture

11. The Green House Model Core Value:

12. 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!

13. The Green House Model Core Value: 13

14. Warm, Smart and Green Similar to surrounding community Private rooms and baths Residential Finishes Intentional Community Real Home 14

15. The Green House Model Core Value: 15 Empowered Staff

16. Organizational Redesign 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 It’s all about leadership!

17. Transition to Coaching Leadership Encourages – Collaboration – Trust – Listening – Ethical use of power and empowerment Improves – Quality of caring through teamwork – Coaching and empowerment of the Shahbazim

18. Organizational Transformation: The Traditional Power Structure Administrator Director of Nursing ADON RN Supervisors LPN’s C.N.A.’s Dietary Supervisor CooksDiet Techs Dishwasher Environmental Supervisor Housekeeping Supervisor Housekeepers

19. 19 Organizational Redesign

20. The Shahbaz  Protect  Nurture  Sustain

21. Self-Managed Work Team 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

22. Coordinators – Team – Food – Scheduling – Care – Housekeeping

23. Training: Shahbaz 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

24. Nurses in The Green House Homes Think Home Care! Care Role Model Gerontological Expert Care Partner Mentor and Teacher

25. 25 Direct Care Staffing 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

26. The Green House in Action The Green House Video

27. 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 hour more direct 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

28. 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

29. 29 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

30. 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 Project

31. 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

34. Ground Breaking complete Construction begun First house scheduled to be completed in September and final house by first of November.

35. Groundbreaking November 2013

36. Administration Building 5.5.14

37. First House 5.5.14

38. First House 5.16.14

39. Vivage Strategic Team

40. First House 5.21.14

41. Second House 5.21.14

42. Open House October 21, 2014 with Dr. Bill Thomas Reimagining Eldercare

43. Green House Financial Results: What we are Learning Development Costs Operating Costs Financing Green House Homes – Conventional – NMTC – USDA – Weinberg – PRI – RWJF/AARP

44. 44 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)

45. 45 We did the best we could with what we knew. And when we knew better, we did better. -Maya Angelou