Last month, I was treated to a tour of a Green House Project home at Porter Hills, a long-term care provider in Grand Rapids, Michigan. In today’s post I would like to share with you what I saw from a caregiver’s perspective.
The house is meant to blend in with the surrounding neighborhood. I know nothing about architectural styles, but I can tell you that when I was looking for the house prior to the workshop, I drove past it not realizing what it was. This despite a sign – and my defense, a rather modest sign – with an arrow indicating “Green House this way.” Other than the extra parking spots, there was nothing on the outside to suggest it was anything other than just another house in the neighborhood.
As our group gathered around the front entrance of the house, our tour guide explained that everyone enters the house through the front door. This includes staff. They are required to ring the doorbell and wait for someone to answer it like any visitor. The tour guide pointed out that in our own homes people don’t walk in without ringing the doorbell, even if they’re expected. She added that studies have been done indicating that when the doorbell rings, care improves. I’m sure if Dr. Pavlov was alive today, he would be pleased to hear it. Whatever it takes, I say.
After we entered the house, the tour guide pointed to a restroom door near the entrance. The door had a sign next to it that read “Powder Room” with corresponding Braille dots. Regulations require such signs, one of several unhome-like but minor compromises Green House Project practitioners must make to get the proper certifications. They do their best to make the signs as unobtrusive as possible, such as labeling the restroom “Power Room” in subdued colors rather than the unmistakably clear, but crude “TOILET” that blasts at you as you walk down the corridors of more institutional-like facilities.
The first thing I noticed when we walked into the house was how quiet it was. There was a small group of caregivers and residents – let’s use the Green House nomenclature going forward – there was a small group of shabazim and elders gathered around the home’s communal dining table having their lunch. There was none of the institutional bustle you see in larger homes during the mid-day meal. Part of this was simply due to it being a smaller home with fewer people, but there was also a lack of any sense of the kind of meal-time urgency that is imposed on caregivers and residents elsewhere. This was life being lived at the pace of those who actually live there.
I also noted that – and I don’t mean to be disrespectful here – that the elders gathered around the table indeed looked like what, based on 35 years in long-term care, I would think of as skilled nursing residents. Of course, I would have had to spend some time with both the shabazim and elders to get a better sense of the level of care they needed, but this was a definite indication to me that this was not just an extra nice assisted living facility posing as a skilled nursing home.
After a brief greeting, our group moved into an adjoining room which I would describe as a small activity room. There was a smaller table for elders not wishing to eat at the communal dining table. The shelves where lined with books and games, all supplied by the elders and their families. There was also a reasonably sized TV with video games available. The tour guide told us group activities are typically not planned, but do occur spontaneously. Also, they don’t normally invite outside groups in to entertain the elders. Yes, it’s possible: life after 60 can indeed be lived well without bingo.
We proceeded to the kitchen area. This was open to the dining area with a serving island to separate the two spaces. Other than a commercial dishwasher (they originally installed residential dishwasher, but it couldn’t handle the volume) and a commercial stove, it looked like a large country-style kitchen in a residential home. All the meals are prepared by the shabazim on site. Breakfast is served as the elders rise, there is no set time or menu. The island had spaces where elders could “belly up to the bar” and assist the shahbaz with food prep. I believe they could eat there as well if they wanted.
We were shown the walk-in pantry. This was nicely stocked with a variety of items, but not in huge bulky containers like you would see in an institutional setting. More like something you would see at my house. Or yours. The tour guide said she regretted not having a door installed leading from the kitchen directly into the pantry. Not a big deal, unless you live or work there and have to walk around 30 times a day.
Next came the laundry room. The shabazim do the elder’s personal laundry (they do not mix different elders’ clothes in the same load) and the towels and wash clothes are sent out. Another regret from the tour guide: they bought a stackable washer and dryer set to save room, but this actually put the controls of the appliance on top well out of the reach of the typical shahbaz. I’m about 6’ and I think I would have had to go up on my tippy-toes to reach the buttons. A step stool tucked in a corner supported the tour guide’s assessment.
I bring up both the missing door between the pantry and kitchen and the stackable washer & dryer to illustrate a point. These homes are highly individualized. There is no mold or set blueprint. They do share certain characteristics, such as the “Great Room” open floor plan, the large communal dining table (more on this in a future post) and large private bedrooms with full baths. These are physical characteristics that are consistent with the philosophy and core values of the Green House Project. However, since each home is individualized, every home has to work out problems related to specific details of the physical layout and furniture and appliances. They are especially concerned to keep both the interior and exterior décor consistent with the surrounding community. That being said, there is a growing body of practical knowledge in developing and sustaining these homes and the Green House Project has a system in place that allows this knowledge to be shared with the developers and staff in both new and existing homes. This is a dynamic and flexible process, always seeking to grow and improve. There probably won’t be a stackable washer and dryer in the next Green Home they build.
On to the living room. This was also open to the dining area, just around the corner from the kitchen area. This consisted of comfortable looking couches and chairs – maybe recliners, I hope so – situated around a fire place. I didn’t look, but I assume the fire place was fueled by propane. Such a pleasant ambience and I found myself wanting to just put my feet up and hang out for a while.
Instead, we were led out the door (again, marked with regulation warning signs that you wouldn’t see in any other residential home – another minor compromise) and into an enclosed courtyard. The courtyard had a variety of plants and some kind of small fountain. And a cooking grill, which we were told gets frequent use in the warmer months. The elders have free access to the courtyard as they please. There were plenty of windows to make it easy for staff inside the house to observe elders in courtyard as necessary.
We were shown the nurse’s office just off the Great Room area. It was very small and inconspicuous. I did note the presence of nursing charts and, of course, a computer monitor. Other than that, I didn’t see any medical equipment lying about and it appeared no different than any small office in a residential home. We were also told that there was an administrator’s office, another regulatory requirement. Apparently, this office was even smaller than the nurse’s station and no one in the group seemed particularly interested in seeing it.
We then got to see one of the elder’s bedrooms. As promised, it was private, pretty big and had a full bath. Elders new to the home are encourage to bring their favorite chair or other small piece of furniture. There was a pull out wall unit where nursing supplies were kept. The most impressive feature of the room – at least for me – was the “ceiling lift.” Yes, a compact mechanical lift suspended from the ceiling that could be moved along tracks – picture the kind of ceiling tracks used for privacy curtains. There was a space between the ceiling and the top of the wall separating the bathroom from the rest of the bedroom, so that an elder could easily be moved from bathroom to the bed or any other point in the room. If you’ve ever worked direct care, you know what kind time-saver this sort of set up would be.
They don’t use any other lifts in the home. In fact, I didn’t see any medical equipment of any kind anywhere. I’m not sure how they do transfers outside the bedrooms other than a one or two person lift. I’m thinking in some situations that might pose some difficulties or impose some limitations.
That was pretty much it. My overall impression was very favorable. Being there does indeed feel like home and not like you’re in a care facility. You can see what a constant struggle it must be to keep all the institutional implements and habits from creeping back into the home.
I have more to say and much more to explore regarding the Green House Project, but this post has long enough, so I’ll be back in future posts with more on the Green House Project.
For more information on the Green House Project, visit their website at www.thegreenhouseproject.org or check out my recent posts related to the Green House Project: www.cnaedge.com/2015/06/19/something-worth-exploring and www.cnaedge.com/2015/06/07/imagine-this