Green House Project 2.0

information

For more information contact: thegreenhouseprojectinquires@thegreenhouseproject.org

WEBSITE www.thegreenhouseproject.org

PHONE

The Green House Project 2.0 a cultural transformation guide

410.246.3806

ADDRESS

The GREEN HOUSE Project 849 International Drive, Suite 100 Linthicum, MD 21090

In collaboration with:

In collaboration with:

NOVEMBER 2020

“Can I create a Green House home in an existing building, when the Care Community building was built to very different model of care delivery?”

The answer is sometimes

A Resource for Cultural Transformation in Traditional Care Settings

By Maggie Calkins

While everyone agrees that change is difficult—especially radical change – it has been happening, albeit slowly, in long-term care. From the first households for individuals living with dementia developed in the late 1980’s, before person-centered care was even a recognized concept, to having hundreds, perhaps thousands of Green House, Small House and household models in 2020, we’ve come a long way.

We’ve learned how important—now essential—it is for people to continue to live in a residential setting, be deeply known by a select team of care partners, and have opportunities to live life the way they want to, regardless of abilities or limitations. It is better for people with physical changes, better for people with neurocognitive changes, better for staff and better for families. Maybe the only group that loses out are pharmaceutical companies, because people need fewer medications in these settings.

“Good design for the most vulnerable, is good design for everyone.” Emi Kiyota

It took courage to be willing to step so far outside the “normal” or tradition of everything we thought we knew about long term care.

Many people (actually, if we are being honest, almost everyone who had any connection to long-term care) knew there was room for improvement, but few realized how dramatic the change could be.

It took the formation of the Green House Project (GHP) and its novel Green House model to demonstrate that not only was there a better way, but that it works from a business perspective as well as a quality of life and quality of care perspective.

It takes a systems approach: the team must be willing to change everything from the environment to organizational hierarchy to how teams are managed to having residents and families involved in important decisions. To make this change and demonstrate its efficacy, it was necessary to push it to its limits. So initially, all Green House homes had to be modeled after the single-family home concept. Over time, this has been able to flex in some important ways, such as have multiple households in a single structure, reflecting a more apartmentbuilding style.

Now it is time to flex once more and learn how to modify the existing stock of traditionally designed nursing homes and assisted living communities to embrace the same concepts of meaningful life, real home and empowered staff. These are buildings that still have useful life in them, which care communities cannot afford to just “throw away”. This design guide is formatted to help communities navigate the process of evaluating how their current spaces can be reimagined and reconfigured to better support the philosophical, organizational, operational changes that bring about person-directed, relationshiprich living environments.

“Can I create a Green House home in an existing building, when the Care Community building was built to very different model of care delivery?”

The answer is sometimes

A Resource for Cultural Transformation in Traditional Care Settings

By Maggie Calkins

While everyone agrees that change is difficult—especially radical change – it has been happening, albeit slowly, in long-term care. From the first households for individuals living with dementia developed in the late 1980’s, before person-centered care was even a recognized concept, to having hundreds, perhaps thousands of Green House, Small House and household models in 2020, we’ve come a long way.

We’ve learned how important—now essential—it is for people to continue to live in a residential setting, be deeply known by a select team of care partners, and have opportunities to live life the way they want to, regardless of abilities or limitations. It is better for people with physical changes, better for people with neurocognitive changes, better for staff and better for families. Maybe the only group that loses out are pharmaceutical companies, because people need fewer medications in these settings.

“Good design for the most vulnerable, is good design for everyone.” Emi Kiyota

It took courage to be willing to step so far outside the “normal” or tradition of everything we thought we knew about long term care.

Many people (actually, if we are being honest, almost everyone who had any connection to long-term care) knew there was room for improvement, but few realized how dramatic the change could be.

It took the formation of the Green House Project (GHP) and its novel Green House model to demonstrate that not only was there a better way, but that it works from a business perspective as well as a quality of life and quality of care perspective.

It takes a systems approach: the team must be willing to change everything from the environment to organizational hierarchy to how teams are managed to having residents and families involved in important decisions. To make this change and demonstrate its efficacy, it was necessary to push it to its limits. So initially, all Green House homes had to be modeled after the single-family home concept. Over time, this has been able to flex in some important ways, such as have multiple households in a single structure, reflecting a more apartmentbuilding style.

Now it is time to flex once more and learn how to modify the existing stock of traditionally designed nursing homes and assisted living communities to embrace the same concepts of meaningful life, real home and empowered staff. These are buildings that still have useful life in them, which care communities cannot afford to just “throw away”. This design guide is formatted to help communities navigate the process of evaluating how their current spaces can be reimagined and reconfigured to better support the philosophical, organizational, operational changes that bring about person-directed, relationshiprich living environments.

MEANINGFUL LIFE A foc us on r e lati on s hip -ri ch , el d e r-d ire ct e d l ivin g ; e ld e rs h av e a ut onom y a nd contro l

The Green House model is based on three core values and associated essential practices.

ov er t he rh yt h ms o f t he d a y.

EMPOWERED STAFF A f ul ly e m p o w e re d wo rk f or ce o f hi gh h pe rfo rmin n g t e am s in a c o ac hing c u ltt u re . Ra a d i cal re de s ig n o f th e tr ad iti on all h ier arc h ic al s ys t em.

REAL HOME Th e b u il t e n vir on m e nt cre at e s i nte nti o nal c om m u ni ti es of b el ong i ng , l ev e r ag e s t he p ow e r of no rm al a nd re mov es in sti tuti o nal ar tif act s.

MEANINGFUL LIFE A foc us on r e lati on s hip -ri ch , el d e r-d ire ct e d l ivin g ; e ld e rs h av e a ut onom y a nd contro l

The Green House model is based on three core values and associated essential practices.

ov er t he rh yt h ms o f t he d a y.

EMPOWERED STAFF A f ul ly e m p o w e re d wo rk f or ce o f hi gh h pe rfo rmin n g t e am s in a c o ac hing c u ltt u re . Ra a d i cal re de s ig n o f th e tr ad iti on all h ier arc h ic al s ys t em.

REAL HOME Th e b u il t e n vir on m e nt cre at e s i nte nti o nal c om m u ni ti es of b el ong i ng , l ev e r ag e s t he p ow e r of no rm al a nd re mov es in sti tuti o nal ar tif act s.

Core Elements SCALE

PRIORITIZING VALUES The GREEN HOUSE model significantly changes the priorities care communities place on differing values.

Staff efficiency is secondary to elder autonomy and comfort. The paternalistic philosophy of “we know what’s best for you” gives way to an understanding that the person receiving care has the right to selfdetermination.

Therefore, when considering the first step in any project, it is important to prioritize a few environmental values.

What is sacred, and what might need to be more flexible?

We start with the assumption that the goal is to create households that reflect the Green House model to the greatest extent feasible. But what is a household?

There are relatively few core elements that define a household. While ideally, every care community can incorporate all these core elements, in some instances it just may not be possible. Homes may need to be larger and serve (more than 12 elders); it may not be possible to group all elements of a Hearth together, or even to have a separate and independent kitchen. Making the decision to not conform to one or any of these is difficult. That is why it is so important to determine, at the beginning of the process, what is sacred, and what can be flexible?

I n t h e Gre e n H o u s e Mo o d e l, l h o u se h ol d s ar e c o mp r i se d o f 1 0- 12 e l d e r s a n d a ded ed ic icated ed tea m of c ar e pa rt ne r s .

HEARTH T he h e a r t h i s c on s i d e r e d t he h e a r t of t h e ho m e a n d c o m p r i s e d of t h e kitch en , livin g ro om a n d d i n i n g r o o m. T he s e a re t h r e e e s s e nt i a l i n g r e d i e n t s t o c re a t i n g h o m e.

PRIVATE ROOM H a v i ng t he c h o i c e o f a p r i v a t e r oo m i s a c o rn e r s to ne o f t h e G r e e n Ho u s e m odel. Un fortu n a tely , i t i s n o t a p a r t of m os t t r a d i t i o na l n ur s i n g h o m e bu i l d i ng s, t ho u g h th ere are ma n y wa y s to c o n v e r t s h a r e d b e d r o om s , so t h e y of f e r m o r e p ri v a c y t o e v e r y o ne .

THE FRONT DOOR A f r o nt d oo r i n d i c a t e s t h e e n t r y t o a d w e l l i n g wh e re p e op l e l i v e r a th er th an a s en s e of i n s t i t ut i on a l c om i ng a n d g o i n g . T h e f r o n t d o or t o a h o u se h ol d a l s o s h a pes beh a vio r u pon e n t r a n c e a n d c r e a t e s e x p e c t a t i o n s r e l a t e d t o h o m e . A n i m p o r ta nt co rolla ry o f th is is th e l o c a t i o n o f t h e f r o n t d o or . I t s ho u l d b e p u b l i c l y a c c e s s i b l e . N o o n e s h ou ld pas s th rou gh on e h ou s e h o l d t o g e t t o a n ot h e r ho u s e h ol d .

AUTONOMOUS FUNCTIONING/INDEPENDENCE H o us e ho l d s o p e r a t e e s s e n t i a l l y i n d e p e n d e nt l y f r om on e a n ot h e r . Determin in g th e exten t to wh i c h e a c h h o us e h ol d c a n b e a u t o no m o us c a n b e c h a l le n g i n g wh i l e al so providin g in credible o p p o r t un i t y .

SITE S i t e c on s i d e r a t i o ns f oc us o n m a n a g i n g v e h i c u l a r tr af f i c a n d m a i n t ain in g a fa milia r n e i g hb o r h oo d c h a r a c t e r . T hi s i s of t e n d i f f i c u l t i n a n e x i s t i ng b u i l d i n g th at ma y be s u rrou n ded b y p a r k i n g l ot s a n d ou t b u i l d i n g s .

Core Elements SCALE

PRIORITIZING VALUES The GREEN HOUSE model significantly changes the priorities care communities place on differing values.

Staff efficiency is secondary to elder autonomy and comfort. The paternalistic philosophy of “we know what’s best for you” gives way to an understanding that the person receiving care has the right to selfdetermination.

Therefore, when considering the first step in any project, it is important to prioritize a few environmental values.

What is sacred, and what might need to be more flexible?

We start with the assumption that the goal is to create households that reflect the Green House model to the greatest extent feasible. But what is a household?

There are relatively few core elements that define a household. While ideally, every care community can incorporate all these core elements, in some instances it just may not be possible. Homes may need to be larger and serve (more than 12 elders); it may not be possible to group all elements of a Hearth together, or even to have a separate and independent kitchen. Making the decision to not conform to one or any of these is difficult. That is why it is so important to determine, at the beginning of the process, what is sacred, and what can be flexible?

I n t h e Gre e n H o u s e Mo o d e l, l h o u se h ol d s ar e c o mp r i se d o f 1 0- 12 e l d e r s a n d a ded ed ic icated ed tea m of c ar e pa rt ne r s .

HEARTH T he h e a r t h i s c on s i d e r e d t he h e a r t of t h e ho m e a n d c o m p r i s e d of t h e kitch en , livin g ro om a n d d i n i n g r o o m. T he s e a re t h r e e e s s e nt i a l i n g r e d i e n t s t o c re a t i n g h o m e.

PRIVATE ROOM H a v i ng t he c h o i c e o f a p r i v a t e r oo m i s a c o rn e r s to ne o f t h e G r e e n Ho u s e m odel. Un fortu n a tely , i t i s n o t a p a r t of m os t t r a d i t i o na l n ur s i n g h o m e bu i l d i ng s, t ho u g h th ere are ma n y wa y s to c o n v e r t s h a r e d b e d r o om s , so t h e y of f e r m o r e p ri v a c y t o e v e r y o ne .

THE FRONT DOOR A f r o nt d oo r i n d i c a t e s t h e e n t r y t o a d w e l l i n g wh e re p e op l e l i v e r a th er th an a s en s e of i n s t i t ut i on a l c om i ng a n d g o i n g . T h e f r o n t d o or t o a h o u se h ol d a l s o s h a pes beh a vio r u pon e n t r a n c e a n d c r e a t e s e x p e c t a t i o n s r e l a t e d t o h o m e . A n i m p o r ta nt co rolla ry o f th is is th e l o c a t i o n o f t h e f r o n t d o or . I t s ho u l d b e p u b l i c l y a c c e s s i b l e . N o o n e s h ou ld pas s th rou gh on e h ou s e h o l d t o g e t t o a n ot h e r ho u s e h ol d .

AUTONOMOUS FUNCTIONING/INDEPENDENCE H o us e ho l d s o p e r a t e e s s e n t i a l l y i n d e p e n d e nt l y f r om on e a n ot h e r . Determin in g th e exten t to wh i c h e a c h h o us e h ol d c a n b e a u t o no m o us c a n b e c h a l le n g i n g wh i l e al so providin g in credible o p p o r t un i t y .

SITE S i t e c on s i d e r a t i o ns f oc us o n m a n a g i n g v e h i c u l a r tr af f i c a n d m a i n t ain in g a fa milia r n e i g hb o r h oo d c h a r a c t e r . T hi s i s of t e n d i f f i c u l t i n a n e x i s t i ng b u i l d i n g th at ma y be s u rrou n ded b y p a r k i n g l ot s a n d ou t b u i l d i n g s .

INDICATORS TO STUDY

Site ENTRANCE

ENTRANCE

In the Green House m odel, site considerations foc us on

Typic a l l y, a tra d ition al buil d ing w il l h ave a m a in entran ce th at

Con si d e r a cces s fo r suppo rt s er v ices .

m anaging vehic ular traf f ic

l e ad s to w ing s o r units. Th e goa l is to c reate a sepa rate entr y

traf f ic i n a n d o ut of th e h o us eh ol d , a l o n g w i th th e n e ce s si ty

and m aintaining a fam iliar

to e a c h ho us eh ol d . In the Green Ho us e m o del , a f ront d oo r is a n

fo r (v i si b l e) c a r ts .

ne ighborhood c h arac te r.

im po rta nt d esig n el em ent that h el ps to set th e sta ge fo r th e res t

s uppo rt h o us eh o l d n eed s (foo d , l a un d r y, tra s h , m ed ic al s uppl i es ,

This is of ten dif f ic ult in an

of th e h ouseho l d ex per ience. Ca n so m e o r a l l ho useho l d s h ave a

treatm ents a n d m ed ic atio n s) . Bec aus e a h o us eh ol d is s m a l l e r

existing building that m ay

f ront d oo r entr y d irec tl y f ro m the o utsid e? It m ay b e po ss ib l e to

i n si ze, d el i ver y m eth o d s , sto ra ge c a pa c ity a n d d eli ver y tim es

be surrounde d by parking

c reate new entran ces d irec tl y into ho us eh ol d s , either f ro m th e

per wee k sh o ul d b e m a xi m i zed fo r ef f ic i en c y. Del i ever ies a n d

lots and outbuildings.

outs id e, a co ur tya rd , o r w ithin co nn ec ting co rr id o rs . Th is m ay

rem ova l of ite m s suc h a s tra s h n e ar a b a c k ex it i s i d ea l b ut n ot

The site layout is direc tly

require so m e new co ns tr uc tio n, in c l ud ing pos sib l y a m ul ti- s to ry

e ss enti a l .

related to the entrance(s)

e ntra n ceway. If you c a n c reate f ro nt d oo rs f ro m the o uts id e, is i t

of the house h olds, bec aus e

poss ibl e fo r th e pa rk ing to b e lo c ated a dj acent to ea c h of th es e

of the im portance of this issue, it is address ed in

e ntries?

Th e go a l i s to m in i m ize

Co n s i d er w h at s uppl ie s a re req uired to

“In the Green House model, a front door is an important design element that helps to set the stage for the rest of

dif ferent sec tions .

the household

THINGS TO CONSIDER

experience.�

INDICATORS TO STUDY

Site ENTRANCE

ENTRANCE

In the Green House m odel, site considerations foc us on

Typic a l l y, a tra d ition al buil d ing w il l h ave a m a in entran ce th at

Con si d e r a cces s fo r suppo rt s er v ices .

m anaging vehic ular traf f ic

l e ad s to w ing s o r units. Th e goa l is to c reate a sepa rate entr y

traf f ic i n a n d o ut of th e h o us eh ol d , a l o n g w i th th e n e ce s si ty

and m aintaining a fam iliar

to e a c h ho us eh ol d . In the Green Ho us e m o del , a f ront d oo r is a n

fo r (v i si b l e) c a r ts .

ne ighborhood c h arac te r.

im po rta nt d esig n el em ent that h el ps to set th e sta ge fo r th e res t

s uppo rt h o us eh o l d n eed s (foo d , l a un d r y, tra s h , m ed ic al s uppl i es ,

This is of ten dif f ic ult in an

of th e h ouseho l d ex per ience. Ca n so m e o r a l l ho useho l d s h ave a

treatm ents a n d m ed ic atio n s) . Bec aus e a h o us eh ol d is s m a l l e r

existing building that m ay

f ront d oo r entr y d irec tl y f ro m the o utsid e? It m ay b e po ss ib l e to

i n si ze, d el i ver y m eth o d s , sto ra ge c a pa c ity a n d d eli ver y tim es

be surrounde d by parking

c reate new entran ces d irec tl y into ho us eh ol d s , either f ro m th e

per wee k sh o ul d b e m a xi m i zed fo r ef f ic i en c y. Del i ever ies a n d

lots and outbuildings.

outs id e, a co ur tya rd , o r w ithin co nn ec ting co rr id o rs . Th is m ay

rem ova l of ite m s suc h a s tra s h n e ar a b a c k ex it i s i d ea l b ut n ot

The site layout is direc tly

require so m e new co ns tr uc tio n, in c l ud ing pos sib l y a m ul ti- s to ry

e ss enti a l .

related to the entrance(s)

e ntra n ceway. If you c a n c reate f ro nt d oo rs f ro m the o uts id e, is i t

of the house h olds, bec aus e

poss ibl e fo r th e pa rk ing to b e lo c ated a dj acent to ea c h of th es e

of the im portance of this issue, it is address ed in

e ntries?

Th e go a l i s to m in i m ize

Co n s i d er w h at s uppl ie s a re req uired to

“In the Green House model, a front door is an important design element that helps to set the stage for the rest of

dif ferent sec tions .

the household

THINGS TO CONSIDER

experience.�

INDICATORS TO STUDY

The House & the Front Door This is the m ain

SCALE

organizational construc t of the Green House

Th e Gree n Ho use m o d e l is d ef in e d by 12 elde rs li vi ng in o ne hom e

m odel: people live in

togeth e r b ec a use it is es s entia l to m a i nta in a rea l se nse of hom e. A s

a house (or apartm ent)

a g ro up of el d e rs l i v in g togeth e r m ove s f ro m 12 to 15 , 1 6 o r m o re,

w hic h is the place they

i t b e com e s i n c re a si n g l y d i f f ic ul t to m a i ntai n a sense of thi s g ro up

The re are two

b ei n g a n inte ntio n a l co m m un i ty, a n d s pa ces becom e la rger in sc a le.

c ruc ial elem e nts of the

On e of th e m o s t co m m o n ways of c reati ng sm a lle r sc ale i s fo und

house . One is s c ale - how

w h e n l a rger tra d iti on al “un its� h ave m ulti ple w i ng s of bedro o m s

m any people live in this

th at l e a d to a centra l h ub a re a . Co nver ti ng ea c h w ing i nto i ts ow n

c all hom e.

house?

The other is a s et

h ous eh o l d c a n b e a re l ati vel y e asy soluti o n.

C ha llenges i nc lude

of spatial relationsh ips

reco nf i g uri n g ex is tin g b e d roo m s to c re ate a n a ccepta ble num b er

that are alm ost universally

a n d co nf i g urati o n s (pr ivate vs sh ared ) of be dro o m s, c reati ng and

consiste nt ac ros s the U S,

potenti a l l y co - l o c ati n g th e h ea r th are a s of the house ho ld ( ki tc hen,

m oving f rom m ore public

l i v in g roo m a n d d i n in g ro om).

are as of the house to m ore

THINGS TO CONSIDER

private areas.

INDICATORS TO STUDY

The House & the Front Door This is the m ain

SCALE

organizational construc t of the Green House

Th e Gree n Ho use m o d e l is d ef in e d by 12 elde rs li vi ng in o ne hom e

m odel: people live in

togeth e r b ec a use it is es s entia l to m a i nta in a rea l se nse of hom e. A s

a house (or apartm ent)

a g ro up of el d e rs l i v in g togeth e r m ove s f ro m 12 to 15 , 1 6 o r m o re,

w hic h is the place they

i t b e com e s i n c re a si n g l y d i f f ic ul t to m a i ntai n a sense of thi s g ro up

The re are two

b ei n g a n inte ntio n a l co m m un i ty, a n d s pa ces becom e la rger in sc a le.

c ruc ial elem e nts of the

On e of th e m o s t co m m o n ways of c reati ng sm a lle r sc ale i s fo und

house . One is s c ale - how

w h e n l a rger tra d iti on al “un its� h ave m ulti ple w i ng s of bedro o m s

m any people live in this

th at l e a d to a centra l h ub a re a . Co nver ti ng ea c h w ing i nto i ts ow n

c all hom e.

house?

The other is a s et

h ous eh o l d c a n b e a re l ati vel y e asy soluti o n.

C ha llenges i nc lude

of spatial relationsh ips

reco nf i g uri n g ex is tin g b e d roo m s to c re ate a n a ccepta ble num b er

that are alm ost universally

a n d co nf i g urati o n s (pr ivate vs sh ared ) of be dro o m s, c reati ng and

consiste nt ac ros s the U S,

potenti a l l y co - l o c ati n g th e h ea r th are a s of the house ho ld ( ki tc hen,

m oving f rom m ore public

l i v in g roo m a n d d i n in g ro om).

are as of the house to m ore

THINGS TO CONSIDER

private areas.

INDICATORS TO STUDY

The House & the Front Door SPATIAL RELATIONSHIPS The transition f rom

Pe ople livin g in a com m un ity kn oc k on f ront d oors an d re spec t the sanc tity

public to private that is com m on in m ost hom e s in this country

of on e’s hom e . Th ey do n ot h ave oth e rs walk in g th rough th ei r hom e to get to th e n ext hous e . An e lde r ’s s e ns e of s e c ur ity is v ital to we ll b eing. For th is re as on , th e pre s en ce of a fam iliar f ront door for e ac h househ ol d i s an im por tant con s id e ration . A f ront door n ot on ly exude s warmth an d fam ili ar ity

(re gardle ss of w hether it is a f re e- standing house or con do or apartm e nt) is a powerf ul organizing

but ac k n ow le dge s an d conveys a se n s e of control ove r w h o e nte rs. This prac ti ce in a trad ition al c are com m un ity s ettin g c an an d s h ould look d if fere nt. Avoi ding pas s th rough h ouse h olds is pos s ibly th e m os t c h all en ging cons id e rati on for

cons truc t that conveys the se nse of hom e (se e diagram below). Most

trad ition al settings . Th e e ntr y into a typic al un i t n orm a ll y ope ns to a d oub le load e d cor r id or of b ed room s , w h ile s h are d s pace s , in c lud in g the nursing station, are of te n ce ntrally loc ate d , to ke e p trave l d is tan ce f rom the farth e st room s to th e n urs in g s tation w ith in code re q uire m e nts .

THINGS TO CONSIDER

c ritic al he re is loc ating the He arth areas as c lose as pos sible to the f ront door.

Th e c h alle n ge s to s c ale an d fam iliar re s ide ntial s patial re l ati onships c an be gre ater w h e n exis tin g un its d o n ot have m ultiple s hor te r w in gs f rom a central hub, b ut are m ore line ar w ith th e e ntrance at on e e n d , or have s e q ue nti al w in gs (re quir ing pe ople an d s uppor t m ate r ials to go through one unit (the pas s - th rough un it) to get to an oth e r un it. Pote ntia l solutions m ay inc l ude :

FRONT DOOR

PUBLIC AREAS

SEMI PRIVATE AREAS

c re atin g new f ront e ntran ce s an d poss ibly eve n He arth are as to househol ds f rom outs id e or f rom a cour tyard; c re atin g n e igh bor h ood space s (c afé, l ibrar y, etc .) in th e f ront par t of ve r y lon g w in gs , s o the h ous e h old is ess enti al l y th e PRIVATE AREAS

bac k h alf of the exis ting un it. Whe n c re atin g th e f ront door to eac h house hold , tr y to s e parate th e f ront d oor f rom th e cod e re q uire d d oub le d oors th at c re ate se parate s m oke com par tm e nts an d f rom th e s e r vice d oor th at prov ide s suppl ie s an d re m ove s tras h .

INDICATORS TO STUDY

The House & the Front Door SPATIAL RELATIONSHIPS The transition f rom

Pe ople livin g in a com m un ity kn oc k on f ront d oors an d re spec t the sanc tity

public to private that is com m on in m ost hom e s in this country

of on e’s hom e . Th ey do n ot h ave oth e rs walk in g th rough th ei r hom e to get to th e n ext hous e . An e lde r ’s s e ns e of s e c ur ity is v ital to we ll b eing. For th is re as on , th e pre s en ce of a fam iliar f ront door for e ac h househ ol d i s an im por tant con s id e ration . A f ront door n ot on ly exude s warmth an d fam ili ar ity

(re gardle ss of w hether it is a f re e- standing house or con do or apartm e nt) is a powerf ul organizing

but ac k n ow le dge s an d conveys a se n s e of control ove r w h o e nte rs. This prac ti ce in a trad ition al c are com m un ity s ettin g c an an d s h ould look d if fere nt. Avoi ding pas s th rough h ouse h olds is pos s ibly th e m os t c h all en ging cons id e rati on for

cons truc t that conveys the se nse of hom e (se e diagram below). Most

trad ition al settings . Th e e ntr y into a typic al un i t n orm a ll y ope ns to a d oub le load e d cor r id or of b ed room s , w h ile s h are d s pace s , in c lud in g the nursing station, are of te n ce ntrally loc ate d , to ke e p trave l d is tan ce f rom the farth e st room s to th e n urs in g s tation w ith in code re q uire m e nts .

THINGS TO CONSIDER

c ritic al he re is loc ating the He arth areas as c lose as pos sible to the f ront door.

Th e c h alle n ge s to s c ale an d fam iliar re s ide ntial s patial re l ati onships c an be gre ater w h e n exis tin g un its d o n ot have m ultiple s hor te r w in gs f rom a central hub, b ut are m ore line ar w ith th e e ntrance at on e e n d , or have s e q ue nti al w in gs (re quir ing pe ople an d s uppor t m ate r ials to go through one unit (the pas s - th rough un it) to get to an oth e r un it. Pote ntia l solutions m ay inc l ude :

FRONT DOOR

PUBLIC AREAS

SEMI PRIVATE AREAS

c re atin g new f ront e ntran ce s an d poss ibly eve n He arth are as to househol ds f rom outs id e or f rom a cour tyard; c re atin g n e igh bor h ood space s (c afé, l ibrar y, etc .) in th e f ront par t of ve r y lon g w in gs , s o the h ous e h old is ess enti al l y th e PRIVATE AREAS

bac k h alf of the exis ting un it. Whe n c re atin g th e f ront door to eac h house hold , tr y to s e parate th e f ront d oor f rom th e cod e re q uire d d oub le d oors th at c re ate se parate s m oke com par tm e nts an d f rom th e s e r vice d oor th at prov ide s suppl ie s an d re m ove s tras h .

INDICATORS TO STUDY

Corridors / Circulation Spaces The reality is that m os t Care Com m unity proj ec ts w ill continue to have m ost bedroom s acce ssed f rom a corridor, us ually double loaded (m eanin g room s along both sides of the corridor). Thus , the m ain cons iderations w ill be travel distances and wayf inding.

TRAVEL DISTANCE

WAYFINDING

Gre en Ho use el ders are a b l e to m a intain m o b il ity and a uto n o my

Co rr id or d e si g n c a n b e c h a l l en g i n g w h en sh a red l i vin g spa ce s

in w here th ey go. In co ntra st, in m os t tra d itio na l bui ld in g s th e

(m ul ti purpos e/d in in g ro o m s) a re of f to o n e s id e of th e co rr id or,

dis ta n ce f rom an el d er ’s ro o m to co ngregate area s is s ub s ta nti a l .

a n d th us n ot v is ib l e f ro m d ow n th e co rr id o r. If th e v iew to th e l ef t

As

wal k in g

a n d to th e ri g ht a s o n e l e aves o n e’s b ed ro o m is es senti al l y th e

in de pend entl y or w ith as sis ta nce, a re put in w hee l c h a i rs a n d

sa m e. It i s h a rd er fo r e l d e rs to k n ow w h i c h way to tur n . C h a n ge s

h ave red uced exerc ise an d inc rea sed d epend ence. Th e l en g th of

in l ig htin g f i xture s, wa l l d éco r, cei l in g tre atm ent, a n d pos s ib l y

travel d is ta nce d o es not al l ow fo r a n el d er to v isua l l y as s es s

f l o o ri n g c a n b e us ed to d i f ferenti ate th e He ar th a re a f ro m th e

fa m il ia r s pa ces they c ho os e to eng a ge in fo r comfo rt, inte ra c ti o n

oth er en d of th e co rr id or. Wh il e h av i n g a d en or sun ro o m at th e

or pur po se.

o ppo s ite en d of th e co r ri d o r is n ot a b a d id ea , i f provi d e d it d oe s

a

resul t,

m any

el ders

are

una b l e

to

m a na ge

If f ur niture in cor r id ors is present, it m us t b e f ixed .

(c h ec k l o c al

n ee d to b e e a si l y i d e ntif ia b l e a s a d es tin atio n po int a n d h ave i ts

codes) . However, this d o es a l l ow el d ers to a m bul ate pa rt of th e

ow n c h a ra c te r th at d i f fe renti ate s it f rom pl a ces l ike th e He a rth .

dis ta n ce f ro m b ed ro o m to Hear th a nd have a pl a ce to s to p a n d res t.

Th es e rest a rea s sho ul d co ns ist of m o re tha n j ust a pa i r of c h a irs , by prov id ing c h a rac ter to m a ke th e res t sto p inv iting w ith th i n g s to lo o k at a n d interac t w ith a l o ng th e way.

“Changes

in lighting fixtures, wall décor, ceiling treatment, and possibly flooring can be used to identify the Heath area

THINGS TO CONSIDER

from the other end of the corridor.”

INDICATORS TO STUDY

Corridors / Circulation Spaces The reality is that m os t Care Com m unity proj ec ts w ill continue to have m ost bedroom s acce ssed f rom a corridor, us ually double loaded (m eanin g room s along both sides of the corridor). Thus , the m ain cons iderations w ill be travel distances and wayf inding.

TRAVEL DISTANCE

WAYFINDING

Gre en Ho use el ders are a b l e to m a intain m o b il ity and a uto n o my

Co rr id or d e si g n c a n b e c h a l l en g i n g w h en sh a red l i vin g spa ce s

in w here th ey go. In co ntra st, in m os t tra d itio na l bui ld in g s th e

(m ul ti purpos e/d in in g ro o m s) a re of f to o n e s id e of th e co rr id or,

dis ta n ce f rom an el d er ’s ro o m to co ngregate area s is s ub s ta nti a l .

a n d th us n ot v is ib l e f ro m d ow n th e co rr id o r. If th e v iew to th e l ef t

As

wal k in g

a n d to th e ri g ht a s o n e l e aves o n e’s b ed ro o m is es senti al l y th e

in de pend entl y or w ith as sis ta nce, a re put in w hee l c h a i rs a n d

sa m e. It i s h a rd er fo r e l d e rs to k n ow w h i c h way to tur n . C h a n ge s

h ave red uced exerc ise an d inc rea sed d epend ence. Th e l en g th of

in l ig htin g f i xture s, wa l l d éco r, cei l in g tre atm ent, a n d pos s ib l y

travel d is ta nce d o es not al l ow fo r a n el d er to v isua l l y as s es s

f l o o ri n g c a n b e us ed to d i f ferenti ate th e He ar th a re a f ro m th e

fa m il ia r s pa ces they c ho os e to eng a ge in fo r comfo rt, inte ra c ti o n

oth er en d of th e co rr id or. Wh il e h av i n g a d en or sun ro o m at th e

or pur po se.

o ppo s ite en d of th e co r ri d o r is n ot a b a d id ea , i f provi d e d it d oe s

a

resul t,

m any

el ders

are

una b l e

to

m a na ge

If f ur niture in cor r id ors is present, it m us t b e f ixed .

(c h ec k l o c al

n ee d to b e e a si l y i d e ntif ia b l e a s a d es tin atio n po int a n d h ave i ts

codes) . However, this d o es a l l ow el d ers to a m bul ate pa rt of th e

ow n c h a ra c te r th at d i f fe renti ate s it f rom pl a ces l ike th e He a rth .

dis ta n ce f ro m b ed ro o m to Hear th a nd have a pl a ce to s to p a n d res t.

Th es e rest a rea s sho ul d co ns ist of m o re tha n j ust a pa i r of c h a irs , by prov id ing c h a rac ter to m a ke th e res t sto p inv iting w ith th i n g s to lo o k at a n d interac t w ith a l o ng th e way.

“Changes

in lighting fixtures, wall décor, ceiling treatment, and possibly flooring can be used to identify the Heath area

THINGS TO CONSIDER

from the other end of the corridor.”

INDICATORS TO STUDY

Hearth: Kitchen, Dining and Living Rooms Both the concept behind

KITCHEN

the He arth and the

A c are com m un ity m us t f irst d eter m ine how fo o d w il l b e prepa red

im portance it c arries for

a nd s erved b efo re d esig ning the kitc hen a rea . In Gre en Ho us e

daily rituals and routines

h om es, al l m ea l s a re prepa red f ro m sc ratc h in the kitc h en of e a c h

are essential to the Green

h om e. Ca n th e sa m e b e a cco m m o d ated in th e c a re co m m un ity?

House m odel. Bringing

If th e f irst a nswer is “no”, then c a ref ul l y co nsid er th e rea s on s fo r

people together in

that res po ns e. There m ay b e tim es w hen “n o” is the b e s t a n s wer—

fam iliar spaces that are

for in sta nce if the h ouseho l d a cco m m o d ates 2 0 o r m ore el d ers , i t

re side ntial in sc ale and

m ay n ot b e feas ib l e to c reate a k itc h en that b oth feel s re si d e ntia l

c harac ter, w he re people

in c ha ra c ter a nd h as suf f ic ient c a pa c ity to coo k that m a ny m e a l s.

c an continue to do the

However, co nsid er w hether rel o c atin g c ur rent d ieta ry s taf f f ul l -

things they have always

tim e em pl oyees into eac h ho us eh ol d to s uppo r t the pro ce ss of

done, is an antidote to

cookin g w ith in th e ho useho l d . Or co nsid er w hether two m ea l s a

the institutionalization

day co ul d b e prepa red in eac h ho us eh ol d . Is it pos sib l e to co o k

c harac te r of traditional

two m ea l s a d ay in eac h ho useho l d ? Co nsid er a Qui c k- Ch il l /

nursing hom es. All three

Rether m system w hic h c an give very h igh qua l ity a n d l ots of

elem ents of the Hearth, the kitc he n, the dining room and the livin g room are equally im portant.

variety, genera l l y reduc in g co sts d ue to wa ste.

An oth e r i m po rta nt co n s id e ratio n rel ate d to th e k i tc h en is h ow fo od a n d s uppl i es w i l l co m e in , a n d tras h / wa ste w i ll l eave. Wh en pos s ib l e, a b a c k d oo r to th e k itc h en ( j us t as m o s t h om es i n th e g reater co m m un ity h ave) red uce th e n eed fo r c a rts to co m e in th ro ug h th e f ro nt d o o r. C a rts a re n o i sy, in s titutio n a l c ue s th at d etra c t f ro m th e h om e . So m e co m m un i ties m ay d e c i d e th ey c a n o n l y af fo rd (or th e d e si g n w i l l o n l y a l l ow) o n e ki tc h e n b etwee n s h a re d h ous eh o l d s. Wh il e th i s m ay prov i d e so m e ef f ic ie n c ie s, d o n ot over l o ok th e im po r ta n ce of e l d ers b ei n g a b l e to acce ss fo o d a n d b eve ra ges 24/7, an d to pa rti c ipate m ea n i n g f ul l y i n th e m ea l preparati o n a c ti v itie s. Kee pin g s o m e el em ents of the k itc h en w ith i n e a c h h o us eh o l d w i ll b e im po r ta nt to c reate a rea l h o m e e nv i ron m e nt.

Fortunately, codes (NFPA and Building) no longer consider a kitchen that is serving 30 or fewer elders to be considered a hazardous area requiring a 2-hour separation.

INDICATORS TO STUDY

Hearth: Kitchen, Dining and Living Rooms Both the concept behind

KITCHEN

the He arth and the

A c are com m un ity m us t f irst d eter m ine how fo o d w il l b e prepa red

im portance it c arries for

a nd s erved b efo re d esig ning the kitc hen a rea . In Gre en Ho us e

daily rituals and routines

h om es, al l m ea l s a re prepa red f ro m sc ratc h in the kitc h en of e a c h

are essential to the Green

h om e. Ca n th e sa m e b e a cco m m o d ated in th e c a re co m m un ity?

House m odel. Bringing

If th e f irst a nswer is “no”, then c a ref ul l y co nsid er th e rea s on s fo r

people together in

that res po ns e. There m ay b e tim es w hen “n o” is the b e s t a n s wer—

fam iliar spaces that are

for in sta nce if the h ouseho l d a cco m m o d ates 2 0 o r m ore el d ers , i t

re side ntial in sc ale and

m ay n ot b e feas ib l e to c reate a k itc h en that b oth feel s re si d e ntia l

c harac ter, w he re people

in c ha ra c ter a nd h as suf f ic ient c a pa c ity to coo k that m a ny m e a l s.

c an continue to do the

However, co nsid er w hether rel o c atin g c ur rent d ieta ry s taf f f ul l -

things they have always

tim e em pl oyees into eac h ho us eh ol d to s uppo r t the pro ce ss of

done, is an antidote to

cookin g w ith in th e ho useho l d . Or co nsid er w hether two m ea l s a

the institutionalization

day co ul d b e prepa red in eac h ho us eh ol d . Is it pos sib l e to co o k

c harac te r of traditional

two m ea l s a d ay in eac h ho useho l d ? Co nsid er a Qui c k- Ch il l /

nursing hom es. All three

Rether m system w hic h c an give very h igh qua l ity a n d l ots of

elem ents of the Hearth, the kitc he n, the dining room and the livin g room are equally im portant.

variety, genera l l y reduc in g co sts d ue to wa ste.

An oth e r i m po rta nt co n s id e ratio n rel ate d to th e k i tc h en is h ow fo od a n d s uppl i es w i l l co m e in , a n d tras h / wa ste w i ll l eave. Wh en pos s ib l e, a b a c k d oo r to th e k itc h en ( j us t as m o s t h om es i n th e g reater co m m un ity h ave) red uce th e n eed fo r c a rts to co m e in th ro ug h th e f ro nt d o o r. C a rts a re n o i sy, in s titutio n a l c ue s th at d etra c t f ro m th e h om e . So m e co m m un i ties m ay d e c i d e th ey c a n o n l y af fo rd (or th e d e si g n w i l l o n l y a l l ow) o n e ki tc h e n b etwee n s h a re d h ous eh o l d s. Wh il e th i s m ay prov i d e so m e ef f ic ie n c ie s, d o n ot over l o ok th e im po r ta n ce of e l d ers b ei n g a b l e to acce ss fo o d a n d b eve ra ges 24/7, an d to pa rti c ipate m ea n i n g f ul l y i n th e m ea l preparati o n a c ti v itie s. Kee pin g s o m e el em ents of the k itc h en w ith i n e a c h h o us eh o l d w i ll b e im po r ta nt to c reate a rea l h o m e e nv i ron m e nt.

Fortunately, codes (NFPA and Building) no longer consider a kitchen that is serving 30 or fewer elders to be considered a hazardous area requiring a 2-hour separation.

INDICATORS TO STUDY

Elder’s Room and Bathroom A f undam e ntal princ iple

PRIVACY

of the Gre en House m odel

A s pa ce of on e’s ow n is im po r ta nt, in both psyc h o l og ic al a n d

is that eve ry elder has

c l in ic a l ways. Bein g a b l e to s ay, “I w ish to b e al one” a n d c l os e

a private bedroom and

your d o o r to others, o r b eing a bl e to ta ke a n ap o r s l e ep w ith o ut

private th ree- f ixture

e ith er a ro o m m ate or c a regiver co m in g in a nd d isturb i n g yo u

bathroom . Accom plishing

im proves sl eep hyg ien e a nd red uce fa l l s. Th e m inim um go a l in

the sam e type of s olution

a ny redesig n of b edro o m s pa ces is for eac h in d ivid ua l to h ave

in the Care Com m un ity

a cce ss to a w ind ow a nd a d o or to c l o se. Mo re id ea l is a l s o h av i n g

buildin g is c learly

A variety of creative solutions have been developed

a pri vate th ree- f ix ture b athro om (s ink, to il et a nd s howe r).

converting three

de sirous, but m ay not

rooms into two,

always be feas ible. Many c are com m unities us e the

redesigning toe-to-

oppor tunity to build new Gre en House hom es as

toe bedrooms so

a way to right s ize the

that there is a solid

Care Com m unity building, w hic h does allow for a

BATHROOM

pre ponderance of private

wall separating

In th e b ath ro o m , th e s a m e va l ues a ppl y. Id e al l y, two g ra b b a rs

room s . This sec tion

c an b e o n ei th er si d e of th e to i l et (or o n e a d d i ti on a l g ra b b a r

prim arily foc uses on

a l o n g w i th th e A DA - re q uired b a r o n th e wa l l ).

c hallenge s w h en this is not

Th e re is c l ea r

ev id en ce th at th is is m o re s uppo rti ve of th e way eld e rs tra n s fer

poss ible.

In m os t c a ses it is s till po ss ib le to provid e s to rage space fo r

o n a n d of f th e to i l et.

Hi g h co ntras t b etwe en th e to il et a n d

m e dic atio ns in ea c h bed roo m a nd a sm a l l staf f wor k a rea . Cei l in g

s urro un d i n g wa l l a n d f l oo r a re a is i m po rta nt v is uall y. In c l ud e a

m ounted l if ts m ay not b e fea sib l e in so m e b uil d ings d ue to l a c k of

l i g ht th at is fo c us ed o n th e to i l et a n d c a n s er ve as a n i g htl i g ht.

s uf f ic ient s truc tural suppo rt, b ut s om e com pan ies have syste m s

Deter m in e w ith yo ur co d e of f ic i a l s i f yo u c a n h ave a n e n sui te

that c a n b e m ounted o n the f l o or o r wa l l s. This w il l se rve m o re

s h owe r ( 2 wa l l s versus 3 wa l l s) a s th i s prov id es m uc h g re ater

a s a tran sfer sys tem , f ro m b ed to w heel c ha ir, b ut w i l l n ot go a l l

s pa ce fo r m an euvera b i l ity. Fin a l l y, b e s ure to prov id e s uf f ic i ent

the way into th e bathro o m .

s to ra ge fo r el d e rs’ to il etri es a n d s taf f s uppl i es .

the two sides and doors to each sleeping area, with shared access to the bathroom.

INDICATORS TO STUDY

Elder’s Room and Bathroom A f undam e ntal princ iple

PRIVACY

of the Gre en House m odel

A s pa ce of on e’s ow n is im po r ta nt, in both psyc h o l og ic al a n d

is that eve ry elder has

c l in ic a l ways. Bein g a b l e to s ay, “I w ish to b e al one” a n d c l os e

a private bedroom and

your d o o r to others, o r b eing a bl e to ta ke a n ap o r s l e ep w ith o ut

private th ree- f ixture

e ith er a ro o m m ate or c a regiver co m in g in a nd d isturb i n g yo u

bathroom . Accom plishing

im proves sl eep hyg ien e a nd red uce fa l l s. Th e m inim um go a l in

the sam e type of s olution

a ny redesig n of b edro o m s pa ces is for eac h in d ivid ua l to h ave

in the Care Com m un ity

a cce ss to a w ind ow a nd a d o or to c l o se. Mo re id ea l is a l s o h av i n g

buildin g is c learly

A variety of creative solutions have been developed

a pri vate th ree- f ix ture b athro om (s ink, to il et a nd s howe r).

converting three

de sirous, but m ay not

rooms into two,

always be feas ible. Many c are com m unities us e the

redesigning toe-to-

oppor tunity to build new Gre en House hom es as

toe bedrooms so

a way to right s ize the

that there is a solid

Care Com m unity building, w hic h does allow for a

BATHROOM

pre ponderance of private

wall separating

In th e b ath ro o m , th e s a m e va l ues a ppl y. Id e al l y, two g ra b b a rs

room s . This sec tion

c an b e o n ei th er si d e of th e to i l et (or o n e a d d i ti on a l g ra b b a r

prim arily foc uses on

a l o n g w i th th e A DA - re q uired b a r o n th e wa l l ).

c hallenge s w h en this is not

Th e re is c l ea r

ev id en ce th at th is is m o re s uppo rti ve of th e way eld e rs tra n s fer

poss ible.

In m os t c a ses it is s till po ss ib le to provid e s to rage space fo r

o n a n d of f th e to i l et.

Hi g h co ntras t b etwe en th e to il et a n d

m e dic atio ns in ea c h bed roo m a nd a sm a l l staf f wor k a rea . Cei l in g

s urro un d i n g wa l l a n d f l oo r a re a is i m po rta nt v is uall y. In c l ud e a

m ounted l if ts m ay not b e fea sib l e in so m e b uil d ings d ue to l a c k of

l i g ht th at is fo c us ed o n th e to i l et a n d c a n s er ve as a n i g htl i g ht.

s uf f ic ient s truc tural suppo rt, b ut s om e com pan ies have syste m s

Deter m in e w ith yo ur co d e of f ic i a l s i f yo u c a n h ave a n e n sui te

that c a n b e m ounted o n the f l o or o r wa l l s. This w il l se rve m o re

s h owe r ( 2 wa l l s versus 3 wa l l s) a s th i s prov id es m uc h g re ater

a s a tran sfer sys tem , f ro m b ed to w heel c ha ir, b ut w i l l n ot go a l l

s pa ce fo r m an euvera b i l ity. Fin a l l y, b e s ure to prov id e s uf f ic i ent

the way into th e bathro o m .

s to ra ge fo r el d e rs’ to il etri es a n d s taf f s uppl i es .

the two sides and doors to each sleeping area, with shared access to the bathroom.

INDICATORS TO STUDY

Support Spaces

Spa & Hair Care Most c are

If the c a re co m m unity is s til l usin g tub s that req uire el d ers to

com m unities have a

be l i f ted over th e sid e of th e tub , this is th e tim e to re pl a ce

beauty/barber s hop

the m . There a re m any o ptio ns for tubs that either el d ers c a n

space w here elders

a cce ss direc tl y or h ave a c ha ir that sl id es in w itho ut b ein g

c an access thes e

l if ted . Receiv ing a tub b ath s houl d b e a so oth ing an d re l a xi n g

service s. Where

experience. Th e rem ain ing d es ign co ns ideratio ns a re o peratio n a l ,

spa tubs have of ten

or d ĂŠco r rel ated . Ad d ing col o r to wa l ls via tex tures o r pai nt

been in a com m unity

reduces institutio na l a ppearan ce. There a re wo nd erf ul l y c reati ve

shower space,

wal l graphic s ava ila b l e these d ays . Add in g ar two r k , e spec i a l l y

oppor tunity exists to

a c ross f rom w here the el d er sits in th e tub , in a d di tio n to

reinvent s pace.

con sid er ing towel wa rm ers, m usic a nd a ro m a thera py, c re ate s a wel co m in g an d so othin g env ir inm ent. L ightin g s ho ul d b e in d irec t a nd a dj usta bl e. Staf f n eed to b e a b l e to ea sil y see th e sk i n of the el d er, b ut b r ight l ig hts d o n ot co ntr ib ute to a c al m i n g experience. Ca ref ul l y co ns id er the pl acem ent of m irro rs. Mi rro rs c an c reate negative ef fec ts . El d ers l iv ing w ith d em e ntia d o n ot of te n recog nize them s el ves a nd this c a n l ea d to fear.

Th e n um b er a n d l o c atio n of suppo rt spa ces a n d s torage w il l b e h ig h l y d epe n d e nt o n th e d e si g n of th e ex is tin g bui l d i n g . To th e exte nt po s s ib le , l oc ati n g th e se c l o s e to w h e re s taf f n ee d

THINGS TO CONSIDER

th e m w i l l red uce trave l d is ta n ces a n d m a x im i ze th e tim e s taf f c an s pe n d w ith th e el d ers . Th e q ue s ti o n of w h eth er l a un d r y is co m pl eted in ea c h h o us eh ol d n eed s to b e a d d res s ed . Th e a n s wer m ay rel ate to th e am o unt of s pa ce ava il a b l e in ea c h h ous eh o l d .

If th e re i s s pa ce fo r it, th e n it i s re co m m e n d e d to i n c l ud e th is in e ac h h o use h o l d , a s fewer item s ten d to get l o st. Howeve r, i f th e h o us eh o l d a cco m m o d ates 15- 20 el d ers , th e n um b er of m a c h i n es req ui red (a n d th us th e a m o unt of space), a n d th e n um b er of l o ad s th at n ee d to b e d on e m ay m a ke a centra l l a un d r y a rea a b ette r s o l uti o n .

Presumably all the direct caregivers will be trained as versatile workers, and thus will receive a higher compensation.

They do not need to spend their time hunting for supplies.

INDICATORS TO STUDY

Support Spaces

Spa & Hair Care Most c are

If the c a re co m m unity is s til l usin g tub s that req uire el d ers to

com m unities have a

be l i f ted over th e sid e of th e tub , this is th e tim e to re pl a ce

beauty/barber s hop

the m . There a re m any o ptio ns for tubs that either el d ers c a n

space w here elders

a cce ss direc tl y or h ave a c ha ir that sl id es in w itho ut b ein g

c an access thes e

l if ted . Receiv ing a tub b ath s houl d b e a so oth ing an d re l a xi n g

service s. Where

experience. Th e rem ain ing d es ign co ns ideratio ns a re o peratio n a l ,

spa tubs have of ten

or d ĂŠco r rel ated . Ad d ing col o r to wa l ls via tex tures o r pai nt

been in a com m unity

reduces institutio na l a ppearan ce. There a re wo nd erf ul l y c reati ve

shower space,

wal l graphic s ava ila b l e these d ays . Add in g ar two r k , e spec i a l l y

oppor tunity exists to

a c ross f rom w here the el d er sits in th e tub , in a d di tio n to

reinvent s pace.

con sid er ing towel wa rm ers, m usic a nd a ro m a thera py, c re ate s a wel co m in g an d so othin g env ir inm ent. L ightin g s ho ul d b e in d irec t a nd a dj usta bl e. Staf f n eed to b e a b l e to ea sil y see th e sk i n of the el d er, b ut b r ight l ig hts d o n ot co ntr ib ute to a c al m i n g experience. Ca ref ul l y co ns id er the pl acem ent of m irro rs. Mi rro rs c an c reate negative ef fec ts . El d ers l iv ing w ith d em e ntia d o n ot of te n recog nize them s el ves a nd this c a n l ea d to fear.

Th e n um b er a n d l o c atio n of suppo rt spa ces a n d s torage w il l b e h ig h l y d epe n d e nt o n th e d e si g n of th e ex is tin g bui l d i n g . To th e exte nt po s s ib le , l oc ati n g th e se c l o s e to w h e re s taf f n ee d

THINGS TO CONSIDER

th e m w i l l red uce trave l d is ta n ces a n d m a x im i ze th e tim e s taf f c an s pe n d w ith th e el d ers . Th e q ue s ti o n of w h eth er l a un d r y is co m pl eted in ea c h h o us eh ol d n eed s to b e a d d res s ed . Th e a n s wer m ay rel ate to th e am o unt of s pa ce ava il a b l e in ea c h h ous eh o l d .

If th e re i s s pa ce fo r it, th e n it i s re co m m e n d e d to i n c l ud e th is in e ac h h o use h o l d , a s fewer item s ten d to get l o st. Howeve r, i f th e h o us eh o l d a cco m m o d ates 15- 20 el d ers , th e n um b er of m a c h i n es req ui red (a n d th us th e a m o unt of space), a n d th e n um b er of l o ad s th at n ee d to b e d on e m ay m a ke a centra l l a un d r y a rea a b ette r s o l uti o n .

Presumably all the direct caregivers will be trained as versatile workers, and thus will receive a higher compensation.

They do not need to spend their time hunting for supplies.

INDICATORS TO STUDY

Neighborhood Spaces Som e Green Ho us e proj ec ts inc l ud e a co m m unity b uil di n g w h ere peo pl e f rom d if ferent h om es c an gath er fo r a c tiv ities o r spe c ia l events a n d m e al s. Mos t c are co m m unity b uil d ing s w il l have a num b er of ex is tin g s h ared so c ia l s pa ces that c a n ser ve th e sa m e f unc tion . Wh en po ss i b l e, g roup at l ea s t s om e of these together to c reate a syn e rg y cente r. Th i s c an c reate s oc ia l d ens ity that m a ke the neigh bo r ho od a n atura l d raw.

Food a nd b evera ge of fer ing s s uc h as cof fee a nd j uice b a r, a c afĂŠ , o r a popco rn an d ice c ream sh op a l so ser ve to attra c t peo pl e b oth el d ers a nd their gues ts. Depen d ing on the s ize of the c are co m m un i ty, th e re

THINGS TO CONSIDER

m ay b e on e o r m o re of th es e neigh bo r ho od s etting s.

Con sid er usin g sta nd a rd co m m erc ia l d esig n pr inc i pl es fo r th e se n eig h bo r ho od sh ops.

Peopl e m ight prefer a newer s tyl e Star b uc k ’s

type cof fee s ho p to a kits c hy (typic a l l y fake l oo k ing ) , o l d fa sh io n ed country s to re. This is a great pl ace to invo lve eld ers a n d th e ir fam i l y m e m b ers in d esig ning the l oo k, feel , a nd f unc tio n of th e spa ce . A s k pe opl e w hat wa s their favo rite pl a ce in th e com m un ity to h a n g o ut a nd m eet f r ien ds . Ta ke pic tures of these pla ces, an d ta l k a b o ut w h at e l em ents a re im por tant (m ig ht b e l o c ation , q ual ity of th e fo od , q ua l ity of the s taf f, o r s om e as pec ts of the d esig n) .

Ask people what was their favorite place in the community to hang out and meet friends. Take pictures of these places, and talk about what elements are important.

INDICATORS TO STUDY

Neighborhood Spaces Som e Green Ho us e proj ec ts inc l ud e a co m m unity b uil di n g w h ere peo pl e f rom d if ferent h om es c an gath er fo r a c tiv ities o r spe c ia l events a n d m e al s. Mos t c are co m m unity b uil d ing s w il l have a num b er of ex is tin g s h ared so c ia l s pa ces that c a n ser ve th e sa m e f unc tion . Wh en po ss i b l e, g roup at l ea s t s om e of these together to c reate a syn e rg y cente r. Th i s c an c reate s oc ia l d ens ity that m a ke the neigh bo r ho od a n atura l d raw.

Food a nd b evera ge of fer ing s s uc h as cof fee a nd j uice b a r, a c afĂŠ , o r a popco rn an d ice c ream sh op a l so ser ve to attra c t peo pl e b oth el d ers a nd their gues ts. Depen d ing on the s ize of the c are co m m un i ty, th e re

THINGS TO CONSIDER

m ay b e on e o r m o re of th es e neigh bo r ho od s etting s.

Con sid er usin g sta nd a rd co m m erc ia l d esig n pr inc i pl es fo r th e se n eig h bo r ho od sh ops.

Peopl e m ight prefer a newer s tyl e Star b uc k ’s

type cof fee s ho p to a kits c hy (typic a l l y fake l oo k ing ) , o l d fa sh io n ed country s to re. This is a great pl ace to invo lve eld ers a n d th e ir fam i l y m e m b ers in d esig ning the l oo k, feel , a nd f unc tio n of th e spa ce . A s k pe opl e w hat wa s their favo rite pl a ce in th e com m un ity to h a n g o ut a nd m eet f r ien ds . Ta ke pic tures of these pla ces, an d ta l k a b o ut w h at e l em ents a re im por tant (m ig ht b e l o c ation , q ual ity of th e fo od , q ua l ity of the s taf f, o r s om e as pec ts of the d esig n) .

Ask people what was their favorite place in the community to hang out and meet friends. Take pictures of these places, and talk about what elements are important.

Transformation Requires Sustainable Change Reinventing ex is tin g h ea l thc are b uil d ing stoc k is the f i rst s tep

F or forward-thinking providers who truly want to make a deep impact on the lives of elders and staff, the Green House 2.0 Cultural Transformation initiative transforms the way traditional providers think about and deliver care, with proven tools to create truly person-directed, relationship-rich living environments that also give organizations a competitive advantage.

in tr ul y s us ta ina b l e c ha n ge. Witho ut proven processe s i n pl a ce,

The Green House

m a ny prov id ers fa l l b ac k into in stitutio na l m o d e l s of c a re.

Cul tural Tra nsfo r m atio n fo c uses o n three co m po nents es se ntia l

2.0 Cultural

to a c h ievin g d eep, a b id in g c ulture c ha nge: b el ief s , b eh av io rs , a n d sys te m s . As sessin g und er l ying bel ief s a nd b ehav io rs i nfo rm s th e

Transformation

c reation of a pl a n that o ptim izes ex isting s treng ths a n d res ul ts

initiative is

in “sl ip- res ista nt” c ha nge v ia fo ur pha ses that b uil d upo n o n e a nother : 1.

designed to

A s s e s s : Id e nt i f y key f i n a n c i a l , o rg a n i z at i o n a l , a n d c l inic al ind ic ators n ecess ar y fo r tr ue trans fo rm atio n .

2.

3.

4.

work alongside

Al i g n : Deve l o p a n d co m m u n i c ate a u n i f i e d v i s i o n of c u l t u ra l t ra n s fo r m at i o n ro ote d i n Gre e n Ho u s e co re

Wo rk in g i n conj un c ti o n w ith d e si g n a n d d eve l o pm ent tea m s ,

va lues.

Cul tura l Tra n s fo rm ati o n g ui d es o rg a n i zatio n s th rough sus ta in a b le

Eq uip: Eq uip l ea ders an d staf f w ith to ol s ,

a n d co m preh en si ve c h a n ge, w i th a fo c us on a c h ievi n g co m pl ete

e d u c at i o n , a n d m ate r i a l s to s u cce s s f u l l y i m p l e m e nt

tra n s fo rm atio n th at a d d res s es n ot on l y th e phys ic a l e nv i ro n m ent,

th e v isio n c reated in the a l ign ing ph as e.

b ut a l so th e ph i l os o phy of c a re an d org a n iz ati on a l d es i g n .

Su s t a i n : Em b e d t h e p ro ce s s i nto t h e o rg a n i z at i o n a l

Gre en Ho us e proj e c t m an age m e nt suppo rt l ea d s o rg a n iz atio n s

system s a nd prac tices to c reate end ur ing c h a n ge .

th ro ug h th ei r tra n s fo rm ati on j o ur n ey w ith a ta il o red a ppro a c h th at is l ed by Proj e c t Gui d es , w h o prov i d e c riti c a l co a c h i n g a n d s uppo rt every ste p of th e way.

G H P ’s ed uc ati on pa c ka ge of to ol s a n d re so urce s go we l l b eyo n d a c h e c k- th e- b ox a ppro a c h to eq uip i n d i vi d ua l s w ith th e a b il i ty to a ppl y th e Gree n House core val ues i n th e ir d a il y wor k a n d b e a v ita l par t of th e tra n s fo r m atio n pro ces s . Inform e d by res ea rc h , ex per ien ce , an d l es s o n s l ea rn ed f ro m 300 Gree n Ho use h o m es a c ro s s th e co untr y, ed uc atio n a n d tra i n in g m ax im ize s s o c i al l ea rn i n g , w h il e m eeti n g th e n e ed s of b usy l ea d e rs a n d o rg a n iz atio n s .

organizations and their design professionals to reimagine both the environment and the service delivery to improve the lives of elders and staff who live and work in them.

Transformation Requires Sustainable Change Reinventing ex is tin g h ea l thc are b uil d ing stoc k is the f i rst s tep

F or forward-thinking providers who truly want to make a deep impact on the lives of elders and staff, the Green House 2.0 Cultural Transformation initiative transforms the way traditional providers think about and deliver care, with proven tools to create truly person-directed, relationship-rich living environments that also give organizations a competitive advantage.

in tr ul y s us ta ina b l e c ha n ge. Witho ut proven processe s i n pl a ce,

The Green House

m a ny prov id ers fa l l b ac k into in stitutio na l m o d e l s of c a re.

Cul tural Tra nsfo r m atio n fo c uses o n three co m po nents es se ntia l

2.0 Cultural

to a c h ievin g d eep, a b id in g c ulture c ha nge: b el ief s , b eh av io rs , a n d sys te m s . As sessin g und er l ying bel ief s a nd b ehav io rs i nfo rm s th e

Transformation

c reation of a pl a n that o ptim izes ex isting s treng ths a n d res ul ts

initiative is

in “sl ip- res ista nt” c ha nge v ia fo ur pha ses that b uil d upo n o n e a nother : 1.

designed to

A s s e s s : Id e nt i f y key f i n a n c i a l , o rg a n i z at i o n a l , a n d c l inic al ind ic ators n ecess ar y fo r tr ue trans fo rm atio n .

2.

3.

4.

work alongside

Al i g n : Deve l o p a n d co m m u n i c ate a u n i f i e d v i s i o n of c u l t u ra l t ra n s fo r m at i o n ro ote d i n Gre e n Ho u s e co re

Wo rk in g i n conj un c ti o n w ith d e si g n a n d d eve l o pm ent tea m s ,

va lues.

Cul tura l Tra n s fo rm ati o n g ui d es o rg a n i zatio n s th rough sus ta in a b le

Eq uip: Eq uip l ea ders an d staf f w ith to ol s ,

a n d co m preh en si ve c h a n ge, w i th a fo c us on a c h ievi n g co m pl ete

e d u c at i o n , a n d m ate r i a l s to s u cce s s f u l l y i m p l e m e nt

tra n s fo rm atio n th at a d d res s es n ot on l y th e phys ic a l e nv i ro n m ent,

th e v isio n c reated in the a l ign ing ph as e.

b ut a l so th e ph i l os o phy of c a re an d org a n iz ati on a l d es i g n .

Su s t a i n : Em b e d t h e p ro ce s s i nto t h e o rg a n i z at i o n a l

Gre en Ho us e proj e c t m an age m e nt suppo rt l ea d s o rg a n iz atio n s

system s a nd prac tices to c reate end ur ing c h a n ge .

th ro ug h th ei r tra n s fo rm ati on j o ur n ey w ith a ta il o red a ppro a c h th at is l ed by Proj e c t Gui d es , w h o prov i d e c riti c a l co a c h i n g a n d s uppo rt every ste p of th e way.

G H P ’s ed uc ati on pa c ka ge of to ol s a n d re so urce s go we l l b eyo n d a c h e c k- th e- b ox a ppro a c h to eq uip i n d i vi d ua l s w ith th e a b il i ty to a ppl y th e Gree n House core val ues i n th e ir d a il y wor k a n d b e a v ita l par t of th e tra n s fo r m atio n pro ces s . Inform e d by res ea rc h , ex per ien ce , an d l es s o n s l ea rn ed f ro m 300 Gree n Ho use h o m es a c ro s s th e co untr y, ed uc atio n a n d tra i n in g m ax im ize s s o c i al l ea rn i n g , w h il e m eeti n g th e n e ed s of b usy l ea d e rs a n d o rg a n iz atio n s .

organizations and their design professionals to reimagine both the environment and the service delivery to improve the lives of elders and staff who live and work in them.

information

For more information contact: thegreenhouseprojectinquires@thegreenhouseproject.org

WEBSITE www.thegreenhouseproject.org

PHONE

The Green House Project 2.0 a cultural transformation guide

410.246.3806

ADDRESS

The GREEN HOUSE Project 849 International Drive, Suite 100 Linthicum, MD 21090

In collaboration with:

In collaboration with:

NOVEMBER 2020