Ave Maria's New Green House® Project Rethinks Nursing Care

Ave Maria's New Green House® Project Rethinks Nursing Care

Ave Maria's New Green House® Project Rethinks Nursing Care
When Frank Gattuso strides through Ave Maria, a nursing home in Bartlett, he sees not what is — but what is to come.

Since the mid-1950s, this spacious, well-tended facility has provided round-the-clock care for the elderly and disabled. The average age of nursing home residents here is 90 and women outnumber men by roughly 8 to 1. Patient rooms are spacious and clean, the staff attentive, but as the nonprofit's executive director, Gattuso recognizes their shortcomings as well.

"When adult children come in and see that we're nice compared to other facilities, it's still not quite what they had in mind," he said. "Lots of seniors are coming (here) from assisted living where they've had private rooms. When they come from that environment, they don't want to give up their privacy — and they want to downplay the medicinal side of care."

Consumers want their loved ones cared for with dignity at this stage of life. But that dignity is hard to come by when elders must live together in semiprivate rooms and totter to communal bathrooms a considerable distance down the hall. The hospital-like setting can also be demoralizing. At Ave Maria, an original wing built in the 1950s is still in use. The tile-lined walls, a woozy shade of green, make this part of the facility feel significantly colder. The 50-foot long corridors, about the width of a basketball court, make walking from one end of the hall to the nurses station an impossibility for most.

While nursing homes provide much needed care for the frail, some professionals in the healthcare industry acknowledge the hospital model on which nursing homes were built more than five decades ago is outdated.

That's why Gattuso and his board of trustees have chosen to grow in a new direction.

When Ave Maria leaders break ground next year for the $5 million expansion, they'll be developing the Green House Project®, a collection of four, 7,500 square-foot brick homes designed to house 40 seniors (10 residents per building) in a more private, homelike setting. It will be the first such facility of its kind in Tennessee.

"We recognize that what we're doing is okay— it's what's been done in this country for 50 or 60 years— but it's time to do something different. (The Green House concept) is not an institution. When you see the homes, you think 'I could live here,'" said Gattuso. "You can eat and socialize when you want. You have privacy. You have dignity."

A new kind of care


Numerous national studies indicate public opinion is evenly divided over whether nursing homes currently do a good job caring for the elderly. Overall, public perception of nursing home quality is low, with neglect and abuse cases often making front page news. A recent survey conducted by AARP found that "fewer than 1 percent of individuals over 50 with a disability want to move to a nursing home." Yet when a loved one requires 24-hour skilled care, families find there are few alternatives.

The Green House is an outgrowth of the Eden Alternative, concepts developed by Dr. William H. Thomas, a Harvard-trained geriatrician and crusader for nursing home reform. Having long tended the elderly, Thomas recognized that the well-being of many of his patients was being compromised by the institutionalized settings in which they received care. Nursing homes functioned as a home in name only.

So Thomas went to the Robert Wood Johnson Foundation several years ago with the Green House concept. Now, in partnership with the nonprofit, NCB Capital Impact, the foundation is spending $10 million to replicate his model across the country. So far, 41 Green House projects have been built.

"Thomas' idea was to break up a big building to create a home. Instead of institutionalized care, you have a private room with a private bath," noted Greg Warnick, executive director of Traceway Retirement Community in Tupelo, Miss., where the nation's first Green House was built in 2003.

Another important element is the home's hub or what Thomas terms the hearth: the living room, dining room, and kitchen area. "We wanted there to be a heart, a center, a focus of the house. So, you know, what you have in the hearth is sort of food on one end, fire on the other, and a place to share convivium or the pleasure of a good meal sort of in the middle," he said during a televised interview with NewsHour on PBS earlier this year.

The Ave Maria homes will be have a central living area and patio, with bedrooms that fan out from the hub. Caregivers will be able to see residents from across the facility, and residents will be free to rise and eat when they choose, or become engaged in household activities. "They'll be able to smell cookies baking, so they can go and have a cookie," said Gattuso. "They're seeing it, they have access to it. This is so much better than what we're doing. The challenge will be keeping it within budget. How do we make it work to its best potential without messing with the principle?"

Empowering staff


The model also reorganizes work staff and flattens the administrative hierarchy. Caregivers receive 120 hours of additional training to become certified nursing assistants. Thomas calls them Shahbazim, a Persian word for royal falcon. Two to three shahbazim are responsible for the day-to-day running of the household, doing everything from cooking and cleaning to personal care for the residents. Nurses still provide direct nursing care, but they and the assistants are part of a team consisting of social workers, therapists, physicians, dietary professionals, and pharmacists who attend the residents.

"These workers didn't have a lot of input (about) caregiving in the old model," said Warnick. "But now they are hands-on caregivers who also cook, clean, provide activities, and interrelate with the elders. They work with a coach to ensure that they're working like a team so they can protect, sustain, and nurture the elders — that's what they're there for. Those who are closest to the elders should have more say and autonomy."

Some workers who've already made the transition admit their job is more demanding, but also more fulfilling. Residents benefit, too. Warnick remembered one patient — who'd basically given up — light up the first day at lunch. "She started feeding herself again. We see people almost gaining their personalities back and coming back to life. People who'd not been doing well in a traditional model would have a twinkle in their eyes again."

Warnick said board members initially voted to build just four buildings in 2003, but they were so well-received, six more were erected in 2005. The old nursing home facility is now used primarily for patients needing short-term rehabilitation.

The Ave Maria project will increase the number of private rooms offered from three to 40; all beds will be designated for Medicare Part A services (skilled nursing care). Gattuso said they will continue to serve elders of all faith and economic backgrounds.

The Green House Project may represent the beginning of a new chapter in nursing care. From Gattuso's standpoint, that's a good thing.

"I know when I'm 80 I don't want to be bunking with anyone," he said. "I'll want my own room."