I was recently asked to participate in the training sessions for the staff who will work in our two new Green Houses. My assigned topics were to review the philosophical underpinnings of the Green House philosophy, as well as the history of culture change efforts here at Londonderry Village. We have been working for about 15 years to eliminate the institutional caregiving practices that are pretty much still the norm in many nursing homes across the USA. I am very proud of the progress we have made, but there is still work to be done.
There are some unique Green House concepts that I would like to tell you about. First is the “Green House Model.” The term “Green House” is copyrighted, and an organization that wants to use that term must agree to abide by the terms of the “Model”. Parts of the Model reflect design parameters (i.e., all private rooms), some involve care practices (i.e., all food is cooked in the House), some involve staffing patterns, and others reflect core philosophical beliefs (i.e., all elders are capable of personal growth). The Model is central to the Green Houses, but it is not static; the Model has changed over time and will continue to evolve as research shows what elements of the model are the most (or perhaps least) important to the welfare of the elders in the Houses.
Another unique concept is referred to as “institutional creep”. This is the insidious tendency to backslide into institutional practices. Here is an example: the nurses in a particular Green House understood that the Green House Model does not allow medication carts, as this is a very medical/institutional artifact. As the nurses missed having a med cart, they pooled their personal money and purchased a residential-looking tea cart for their Green House…and then loaded it up with everything needed to make it a med cart! The Shahbazim in the House cried “foul”, pointing out that the tea cart was being used as a med cart, and was therefore a violation of the Model. And they were right! The cart was removed. The nurses had good intentions, but were retreating into an institutional practice that was very comfortable to them. That is institutional creep!
There are a lot of garden-related metaphors in the Green House philosophies. One that we tend to forget about is the concept of “Frost”. As the seasons change, frost eventually comes to every garden and stops the growth until the warm weather returns. But with careful tending, the garden will return and flourish. The Green House analogy is that every Green House will go through good times and bad times…just like a garden. We should expect it to happen. There will be times when it just doesn’t feel like it is working as well as it used to. But with careful tending, each House will return to its former rhythm. It sort of sounds like life in general, doesn’t it?
Thanks for Listening,
Jeff Shireman, President