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

Tupelo Mississippi 2001

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

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

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

The Effects of the Institution

Components

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

Housing access to all areas of the house

Housing Friendly Furniture and Good Lighting

Housing privacy and opportunities for personalization

Housing Short walking distances Wheelchairs are evil

Housing Person environment fit

Easy Access to Outdoor Space Housing

ADL Support RELATIONSHIP BASED CARE  Responsive knowing

ADL Support RELATIONSHIP BASED CARE  Individualized normalization  choice

ADL Support habilitation

ADL Support food at will conviviumn

ADL Support Meaningful engagement

Chronic Disease Management Powerful Strength Based Collaboration RESPECT

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

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

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

Empowered Team Housekeeping coordinator Team coordinator Food coordinator Activities coordinator Scheduling coordinator

Workforce Decreased bureaucracy Increased empowerment Empowered work teams

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

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

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?