1. "A great many people think they are thinking when they are merely rearranging their prejudices.“ William James RETHINKING THE NURSING HOME

2. Tupelo Mississippi 2001

3. Current State Small House /Green House® 67 Houses operating 220 Planning/construction

4. SMALL HOUSE De-institutionalization The redesign of an institutional nursing home environment that results in the creation of a home for the resident.

5. Client Needs long term care Chronic disease management housing assistance with ADLs

6. The Effects of the Institution

7. Components

8. Housing Patterns of Home Living room, dining room, kitchen Private rooms and baths

9. Housing access to all areas of the house

10. Housing Friendly Furniture and Good Lighting

11. Housing privacy and opportunities for personalization

12. Housing Short walking distances Wheelchairs are evil

13. Housing Person environment fit

14. Easy Access to Outdoor Space Housing

15. ADL Support RELATIONSHIP BASED CARE  Responsive knowing

16. ADL Support RELATIONSHIP BASED CARE  Individualized normalization  choice

17. ADL Support habilitation

18. ADL Support food at will conviviumn

19. ADL Support Meaningful engagement

20. Chronic Disease Management Powerful Strength Based Collaboration RESPECT

21. Chronic Disease Management Medication Review Medication Management Alternative therapies Minimizing med pass frequency

22. Operational Drivers SMALL HOUSE outcomes driven TRADITIONAL NH process driven Quality measurement Policy and procedure Creation and monitoring

23. Servant Leadership outcomes based/ house based Leadership Mentoring - role modeling – coaching-rounds Compliance based /office based management Meetings - report writing- critiquing

24. Empowered Team Housekeeping coordinator Team coordinator Food coordinator Activities coordinator Scheduling coordinator

25. Workforce Decreased bureaucracy Increased empowerment Empowered work teams

26. Implementation Individual coordinator & timeline and maps Timed staged goals for groups and individuals  Clinical  Dietary  Human resources  IT  Training  Supplies and equipment  Move in planning  Regulatory compliance

27. SH in the Big House It’s NOT about the house. It’s about the Resident What can you do ?

28. How Can You create patterns of home? improve access to food and outdoors? eat family style/provide food at will? provide consistent assignment? replace supplements with food? improve person-environment fit? decrease medication passes and # of meds? empower staff? decrease bureaucracy ? decrease walking distances? improve lighting?