‘Meaningful’ environment underpins 'Green House' care

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Published: December 11,2006

TUPELO — This North Mississippi city, known around the world as the birthplace of Elvis, is also the birthplace of an innovative way of caregiving for elders, the “Green House” model. Mississippi Methodist Senior Services (MMSS) built the first Green House in the country, the Green Houses at Traceway. The concept has drawn the attention of about 300 other organizations interested in doing something similar.
Imagine a nursing home that looks more like a real home and less like a hospital and you get the idea of what the Green House concept is about. Richard McCarty, president of The McCarty Company, said the Green Houses at Traceway represent an ongoing commitment to providing a meaningful environment for elders.

“MMSS decided to pursue a unique approach to delivering care, based upon the Eden principles developed by Dr. William Thomas,” McCarty said. “MMSS and The McCarty Company have developed the first Green House project to be built in the United States. The Green House concept is intended to further de-institutionalize nursing home life and provide a ‘warm, green and smart’ environment where elders can engage in meaningful life activities, thereby eliminating the plagues of loneliness, helplessness and boredom.”

The McCarty Company’s design team worked directly with Thomas in developing the country’s first Green House.

“We have had the opportunity to participate in his training programs, and as a company, fully embrace his concepts for change,” McCarty said.

The mission is to make a conceptual shift from “facility” to “home.” Each of the homes have elders in private rooms with private bathrooms surrounding a large living area called “the Hearth,” complete with a fireplace, an open kitchen with a breakfast bar and a large family-style dining table.

“The relationship of the private rooms to the Hearth allows the elders to easily control their own level of social engagement by closing their own door for privacy, opening their door to observe activities in the Hearth, or to join the group and engage in various activities,” McCarty said. “Each home has been designed to encourage participation in the activities of life such as menu planning, preparation of meals (or at least watching), setting the table and recreational activities.”

McCarty said one of the biggest design challenges was to control construction costs so the houses would meet regulatory guidelines and fall within Mississippi Medicaid reimbursement levels because the Green House has more square footage per elder than a traditional nursing home.

McCarty has been involved in many different types of building design and construction. Working on the Green House project has been a highlight.

“Without a doubt it has been the most rewarding professional experience of my career,” he said.

Greg Warnick, executive director of the retirement community, said the Green Houses have proven to be very popular.

“It doesn’t look like an institution with long corridors and shared rooms,” Warnick said. “It looks like a home. Everyone has his or her own bathroom and shower. It is a very open floor plan with a large hearth area and open kitchen. But it has all the necessary things needed to care for elders in a skilled nursing environment.”

Traceway has a total of 10 Green Houses that are part of the skilled care portion of the full-service retirement community. Four houses have 10 elders and six have 12. The first four opened in May 2003, two more opened in May 2005 and four more in November 2005.

Green Houses incorporate more than just different architectural designs. There is also a unique management style. Certified nursing assistants with special training are called shahbazim, a Persian word that means “royal falcon.” Warnick said the role of a shahbaz is to protect, sustain and nurture the elders in the house.

“They do so much more than a traditional nursing assistant,” Warnick said. “They provide activities, cook and clean, and give basic care to the elders. It is a much more relaxed environment. They work together as a self-managed work team that does its own scheduling and food ordering, and work together as a team to solve the problems of the team and address the concerns of the elders and the families instead of the top management resolving all the problems for them.

“The goal of this is the elder is the center of the model. We still have nurses who come into the house and provide any clinical treatment the elder needs, but there isn’t a traditional nurses’ station that you would see in traditional nursing home. Nurses work with the shahbazim, not in a supervisory role but a collaborative one.”

When you walk into a Green House, instead of a sterile, antiseptic odor, you are more likely to smell something cooking. You are also likely to see baked goods sitting out on the counter.

“It is a wonderful change from the way nursing homes usually smell,” Warnick said. “It smells really good.”

MMSS also has two assisted living Green Houses on its campus in Raymond, and is working to develop Green Houses in Yazoo City.

More than 20 Green House projects have been built or are under construction elsewhere in the U.S., and Warnick said they have fielded literally hundreds of inquiries from across the country from groups interesting in repeating the Green House concept in their area.

Contact MBJ contributing writer Becky Gillette at bgillette@bellsouth.net.

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