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How Do We Balance Our Safety Needs with Our Human Needs?

I had the pleasure of talking with my friend Susan Ryan, Sr. Director of the Green House Project (GHP) about her reflections over what has occurred this past year and a half. The GHP is an organization with a mission to transform the institutional model of long-term care by creating “radically non-institutional eldercare environments” (small homes with12-14 elders/homes) where real relationships and meaningful life can occur. They are growing rapidly and currently have 359 small homes throughout the U.S.
Since the pandemic started, the GHP has received numerous awards and recognition for their success in keeping their elders safe from the spread of COVID while other LTC locations experienced high levels of COVID. I appreciated Susan’s time to answer some of my questions about their model of care and their successes:

AE: The GHP had wonderful success avoiding elder infections and death from COVID. What are the key aspects of your design that helped protect elders and staff?
SR: GH was made for this moment. The GH model is one of the best infection mitigation models – private bedrooms and baths with 12 residents in each small home. Each place had its own kitchen and they could meet individual needs of the elders with 24/7 access for nutrition/hydration. Each home has access to outside – this increases mobility and decreases depression. A lot of gardens happened during the pandemic – this can give purpose. And instead of being confined to their own rooms, the model afforded the opportunity for social connection.

We wanted to say “yes” to the elders and we asked how could we achieve our safety goals and continue to achieve our needs for connection and relationships.

The pendulum always swings to the side of safety – but it was at the expense of elders’ total health and wellbeing…. The classic model became repressive and depressive during the pandemic.

We have 359 homes – we really grew during the pandemic.

We have a universal model with the care team – therefore there were fewer people entering the house, therefore less potential exposure to COVID infections.

AE: Looking back at the last year and a half, have the GHH’s made any significant changes in their model to be even better prepared for future outbreaks?
SR: The model did well, we want to be more intentional about the education side. How can we rethink our education and delivery methods so we can use technology for virtual delivery of materials, maybe creating more bite-size opportunities?

I like to think of the GHP as disruptors – COVID didn’t cause the systemic failures but it showed how inadequate the system is. LTC now is really bad – the pendulum is swinging to home care – but we shouldn’t abandon the LTC system.

Tweaking the LTC system isn’t enough – we need to disrupt it!

AE: The majority of the elders in LTC are living with dementia. What was important for the elders who were living with dementia in your Homes?
SR: Deep knowing relationships. We have consistent staffing so we are able to know their individual rhythms. We had an elder who had worked on farms and the team knew that it would be meaningful for him in the spring and summer to take him outside to observe the crop plantings – this was his rhythm that he had had for many years.

A lot of our Homes did gardens. This got people outside – knowing who that person is and what might be meaningful for them

AE: Taking the elder outside to observe the crop planting sounds like an example of the Power of Normal. You were empowering him to experience an event that was normal for him.
SR: Yes, we don’t just focus on their safety but on their entire wellbeing, which is also being an Advocate for them, another Best Life principle.

AE: Were there any unique challenges to providing a meaningful experience for the elders during the pandemic restrictions?
SR: Deep knowing is so important and there was a challenge around maintaining the work force. There were so many changing protocols – if someone was exposed or tested positive, they had to leave for a while. Workforce changes impacted the deep knowing and consistent relationships.

Wages and compensation are always important as is respect for the workforce. How can we reframe the job? Equally important as valuing the elder is also valuing the work force. Give them a seat at the table – for care plans, for organizational issues – listen to them, it’s part of looking at the entire LTC system.

The GHP has consistently done very well, even during the pandemic, maintaining occupancy, keeping low staff turnover, and also maintaining daily costs compared to data collected from traditional facilities.

AE: That is amazing to have that data! Congratulations! From my experience working with the GHP team, I know how committed your organization is to transforming LTC. I think you statement on your website is wonderful: GHP is founded on the belief that everyone has the right to age with dignity.

Have a great day!

If you work in Assisted Living or Nursing Homes and want to make your dementia care program even better email or call me for a free consultation.

Anne Ellett, N.P., M.S.N.
AANC Certified Gerontological Nurse
Founder, Executive Director - Memory Care Support
www.MemoryCareSupport.com
AEllett@MemoryCareSupport.com
Ph. 949 933-6201

The NY Times published a lengthy article this month about the high rates of anti-psychotic drug use to sedate residents living with dementia in nursing homes (NH). Even though CMS requires NH’s to report any usage of these risky medications, the NH is exempt from reporting if the medication is prescribed for a patient with a diagnosis of schizophrenia.

In 2012, the data on usage of antipsychotic medications began to be publicly available as part of each NH’s quality rating. However, by adding the diagnosis of schizophrenia to a person’s chart, the NH did not have to report the usage – no surprise, the percent of residents with a schizophrenia diagnosis has increased 70 percent since 2012!

Discrepancies in the actual reported percent of residents taking the antipsychotics in NH’s was alarming. Some NHs reporting zero usage while actually more than 20 or 30% of residents were on antipsychotics.

Antipsychotic drugs like Seroquel, Zyprexa and Abilify are especially risky for people living with dementia. The medications can be sedating and also increase risk of falls and heart problems. Studies showed that the drugs nearly doubled the risk of death for older dementia patients.

Dementia care is complex and senior care facilities often run short staffed, in part due to low wages and minimal training about how to handle the needs of their dementia residents. The usage of the antipsychotic medications increased even more during the COVID shutdown. How much it increased is hard to determine due to inaccurate reporting by NH’s of their data.

You can read the article in full here.