Small is Big: The Nursing Home Revolution | Otterbein Senior Lifestyle Choices

A story on small houses on NurseConnect.

https://www.nurseconnect.com/resources/ArticleProfile.aspx?Id=415618

By Megan M. Krischke, contributor

Dec. 2, 2011 - There is a quiet but powerful revolution happening in elder care — a complete rethinking of the nursing home model. This new model, known as the small house model, has done away with the institutionalizing of people requiring long-term medical care.
Bill Thomas, M.D., a Harvard trained geriatrician, has been a key leader in this movement to transform elder care. Through his work with the elderly, he has named three soul-killing afflictions that plague people residing in nursing homes: loneliness, helplessness and boredom.

Thomas was inspired to discover a remedy to these plagues; through his research and discovery process, the idea of Green Houses—a particular model of small house nursing homes — was born. The first Green House opened in Tupelo, Miss., in 2003. As of September 2011, there are 113 Green Houses operating in 29 states and 227 more in the development stages.

“The Green House takes its name from its focus on creating an environment of growth. Green Houses follow a specific set of philosophies and principles, but the basic idea is this: to take control away from an institution and give it back to the elders,” stated Anna Ortigara, RN, MS, FAAN, resource development director for the Green House Replication Project, which partners with long-term care organizations to provide the tools and resources needed to develop Green Houses.

“This project transforms the traditional long-term care model to focus more on the elder's holistic needs,” reflected Samantha Snapp, RN, director of nursing at Jefferson County Nursing Home, a Green House site, in Dandridge, Tenn. “It also creates an environment where the elders are sustained, nurtured, protected and loved like never before. It places value back onto the elder, which has been removed by our society. This project allows the elder to receive the 24-hour care they need and feel as if they are home.”

“Everything is centered around the home, so you have more flexibility. You don’t have to meet the needs of a bunch of departments; you get to meet the needs of the people who live there. If someone sleeps until 11 a.m., it isn’t a problem; it is easy to make a quick breakfast in the kitchen,” said Ortigara.

A typical small house has between six and 12 residents, each with his or her own private room and bath. There is a shared living area, kitchen, patio and yard. They are skilled nursing facilities, which typically have a CNA helping to manage each home and an RN or LPN overseeing the clinical needs of residents in two or three home, 24 hours a day.

In pursuit of their vision “to lead the United States in liberating elders and those who serve them from the mindset of institutional care,” Otterbein Senior Lifestyle Choices, a health and human service ministry in Ohio, has created five small house neighborhoods, five houses with 10 residents each, since 2007.

“We have created a model that is a home, not ‘home-like’ or ‘person-centered’ or any other current terms to describe minimal changes in the institutional nursing home,” said Sue McConn, vice president of Otterbein Skilled Nursing & Rehab Neighborhoods. “Elders live in their home. We, as providers, are visitors in their home. They direct the home — when to rise, what to eat, where to go, what programs they want.”

“One of the key differences is privacy. In a traditional nursing home, all kinds of people are walking through. In our homes there is a doorbell; only people who are let in come in,” remarked Ortigara.

“Additionally, we see many more families visit and lots more grandchildren,” added McConn. “Since Otterbein neighborhood houses look just like grandma’s house, kids are much more likely to come and spend time.”

Not only do these homes benefit their residents, but they are great environments for nurses to work, as well.

“Nurses coming from a traditional nursing home to work in one of our homes would notice some significant differences in the work,” noted McConn. “They would see, first and foremost, that their work is to assure clinical care of the elder. They would not be supervising staff and directing elder assistants (STNAs) on what to do and when. Nurses would find that they would be able to use their clinical assessment skills with an emphasis on keeping the elders out of acute care, managing chronic conditions, and promoting a dignified, peaceful death. Our nurses have time to actually sit with elders and rehab guests, and have a cup of coffee or engage in an activity.”

“The smallness allows you to get to know patients on a deeper level,” added Ortigara. “There are a lot of opportunities for teaching, mentoring and educating. We ask nurses to become care role models, geriatric experts, care partners, mentors and teachers. It is a rich, professional nursing role. We expect that nurses will be highly collaborative team members with the others who work in the home.”

“The Green House environment allows you as a nurse to give the care you have always strived for. It allows you the time to focus on the elder as a person. You do feel good about the work you do each and every day,” emphasized Snapp.

The good news is that the model appears to be sustainable.

“Several recent studies, each limited in scope but with mutually reinforcing findings, provide growing evidence that The Green House model’s operations are comparable in cost to traditional nursing home operations, as well as nursing homes implementing other culture change practices,” says Rachel Scher, a marketing and resource specialist for the Green House Replication Project.

And, as hoped, the small houses are places of health and growth:

“There is a woman, 104 years old, who came into one of our houses from a traditional nursing home, wheelchair bound, socially isolated and uninvolved,” McConn explained. “Today, she is walking with a walker, recently went with family for a long weekend vacation to the Smoky Mountains, and is always found at the head of the table welcoming people into her home. That is the paramount benefit.”

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