Transforming Elder Services in New York

A Joint Effort Between St. John’s Home & NYS Department of Health

Summary

St. John’s Senior Communities is leading the way in transforming nursing home services for elders. In partnership with New York State Department of Health, St. John’s will be the first in the nation to bring elders back to their hometowns, to live in homes, throughout the greater Rochester community.

The vehicle for change chosen by St. John’s is the Green House® model. In this model, with its Eden Alternative foundational elements, elders are valued, respected, and reintroduced to a home environment, in which they will live during their final years. St. John’s intends to extend the principles of this model to include a community approach that not only brings elders back to a home, but back to a home in their former communities.

It will take the next five to seven years to transform St. John’s via the Green House® model. This is a radical new approach to skilled nursing care, where each element – care philosophy, organizational structure, and architecture – is carefully crafted to remove “institutionalization” from long-term care. Warm, caring relationships are the basis of each day. Residents, referred to as “elders,” live as part of a “family” in the community while still benefiting from the full range of clinical services provided by St. John’s.

St. John’s is planning to build 20 Green House® homes throughout various neighborhoods in our community. Each house will be home to 10 elders and it will be adjacent to at least one another Green House® residence.

Community Green House® Benefits:

• Provides an opportunity for Elders who need care to stay within their home town, near their families, neighbors, and/or congregations

• Elders in St. John’s Home may chose to return to their home communities

• Allows community’s members to be actively involved in the care of elders

• Allows elders access to community resources

• Provides an opportunity for local employment and services

• Provides an opportunity for community service (volunteers, Boy and Girl Scouts, school age asset building, etc.)

What we need from you:

• Partnering opportunities

• Feedback on the community Green House® model

• Potential sites

The Green House® Project

Green House® Philosophy

The goal of the Green House® project is to create living environments for the elderly, frail and disabled that are rich in meaning, vitality and joy. The focus is on autonomy, dignity, choice and keeping decision making as close to the elder as possible.

The Green House® model can be defined as an “intentional community” – a place where a group of unrelated people join together and share the rhythm of daily life to serve a noble purpose, (in this case, the care of frail elders).

Sponsored by the Robert Wood Johnson Foundation

Sponsored by a $10 million grant from the Robert Wood Johnson Foundation, the Green House® concept is a specific, licensed national model for skilled nursing care. Green House® homes are the next evolution of the Eden Alternative, founded by Dr. William Thomas, who pioneered culture change in nursing homes in the 1990s.

St. John’s, Rochester’s only registered Eden Alternative nursing home, has been selected as a demonstration project to create Green House® residences in New York State. NYS Department of Health is highly supportive of this innovative approach to care and is working in partnership with St. John’s to develop community Green House® residences.

St. John’s Plan

St. John’s is planning to build 20 Green House® homes, placing them in neighborhoods in our community. Our first community Green House® homes will be located in Henrietta, roughly five miles away from our main campus. At the same time as Green House® homes are established in the community, St. John’s will reconstruct the current St. John’s nursing home into multi-story Green House® homes within the existing buildings at our 150 Highland Avenue campus. The cost for the entire project including 20 Green House® homes in the community and 27 Green House® homes in the nursing home will approximately $55 million. The State of New York will require an equity contribution of 15 percent of the total project costs, which we will raise in a capital campaign.

A Home for Ten Elders

Each community Green House® residence will be home for ten elders, located in a neighborhood in the Rochester area. Designed like a large ranch-style family home, each has a “hearth,” a central dining area with adjacent kitchen and living room, complete with fireplace. The hearth is easily accessible from large, private bedrooms, each with a private bath. The community model is most efficient when two Green House® homes are located adjacent to each other.

Family Meals

Elders, their family members, friends and care giving staff share meals together around a large dining table, recreating the traditional family meal. If they are willing and able, elders can cook meals, prepare desserts and snacks and help with activities like caring for pets or plants or folding laundry. Even with severe disabilities, residents experience and participate in a high

quality of life. Discreet, ceiling-mounted lift technology ensures that they will have the assistance they need to be involved in the life of their Green House® home.

Comprehensive Care

Direct care is provided by a new kind of universal worker, called a Shahbaz, who is charged to help bring forth the abilities that reside within each elder. These workers have training in personal care, safe food handling, cooking, activities and light housekeeping. They work collaboratively with a clinical support team of nurses, doctors and social workers who visit the house.

A clinical support team consisting of nurses, social workers, physicians, therapists, nutritionists and pharmacists provides state-of-the-art care, but does so according to a revamped philosophy that places the needs of the individuals first. Nursing staff collaborates with elders and their families to customize care for each person, so that residents function more independently.

Results from several prototype Green House® homes around the US are promising. Green House® operators report increased occupancy, higher satisfaction levels from residents, family and staff, less decline in “Activities of Daily Living,” dramatic decrease in staff turnover, reduced incidence of depression, less use of medications, and strong testimonials to improved functionality and overall quality of life by elders’ family members. Operating costs are proving to be equivalent to current nursing home costs.

Summary

In summary, the Green House® model is a revolutionary approach to long-term care, and St. John’s is committed to bringing it to neighborhoods in our community. Plan highlights include:

• 20 Green House® homes will be created in neighborhoods in the Rochester area. This decentralized approach is a first in the United States.

• 27 multi-story Green House® homes will be created within the St. John’s current campus, replacing the traditional nursing home internal structure.

• The national Green House® movement is sponsored by a $10 million grant from the Robert Wood Johnson Foundation.

• Green House® homes offer comprehensive care for the elderly in a radical new way, eliminating “institutionalization” from long term care.

• Green House® homes results show significantly improved quality of life and increased resident/family satisfaction.

• Green House® homes can operate at the current operation cost level for traditional nursing homes.

• Our total project cost is $55 million.

First Green House® Fact Sheet

New York State Department of Health licensed Long Term Care facility

Within close proximity to St. John’s Home

Two adjacent homes on one site

Ten elders in each home

~One acre per home

Approximately 6,500 square feet per house

Ten rooms with private baths

Large hearth area adjoining a kitchen that allows elders to participate in meal preparation

Laundry, spa, pantry, ample storage

2-car garage

Parking for staff & visitors—driveway parking for 2 staff, plus parking for 4 visitors per house. Parking can be on street or nearby as appropriate for neighborhood.

On bus line

Indoor and outdoor activity space and gardens; perhaps common outdoor space between two Green House® residences

Future Green House® Plan

In next 5-7 years, build 20 Green House® homes in residential settings throughout Monroe County and reconstruct the existing campus to create a new community with 27 multi-story Green House® homes.