The Green House Model: COVID-19 OutcomesThe COVID-19 pandemic has, among other things, prompted significant discussion around best-in-class models of care within the skilled nursing, assisted living, memory care and independent living environments. Are there certain design elements that are going to prevent or accelerate the spread of viral contaminants? Have particular staffing patterns and workforce philosophies been shown to be more advantageous during the pandemic? How does culture intersect with the ability to effectively manage through a pandemic of this nature? There have been a number of articles on various topics such as outcomes in not-for-profit versus for-profit nursing homes, a comparison of COVID-19 statistics against Five-Star Quality Ratings, and nursing home density among other items. In this issue of Z-News, we wanted to feature a popular nursing home model that originated nearly 20 years ago, The Green House model, and discuss its standing in the midst of COVID-19 and beyond.
COVID-19 & GREEN HOUSE HOMES
The Green House Project partnered with University of North Carolina researcher Sheryl Zimmerman, PhD, to conduct official data collection on the novel coronavirus after learning of positive anecdotal reports within nursing homes. The study tracks the number of COVID-19 cases and deaths among both staff and elders in Green House homes and compares those statistics with national nursing home data.
Ninety-five percent of Green House homes reported zero cases COVID-19 among residents or staff, according to a study of coronavirus data gathered from February 1, 2020 through May 31, 2020. This information reflects nearly 300 Green House Homes and over 3,200 seniors residing in those homes. The data below provides additional perspective on these findings.
Not only were cases among residents lower, but among staff as well. A similar pattern was found with deaths among residents living in Green House homes, with a lower mortality rate compared to nursing homes as a whole. The organization will continue to collect data from Green House homes each month until at least December 2020. To read the details of the study, click here to access the report.
It is important to affirm that yes, the Green House model is designed for single-occupancy rooms. It has been generally understood that this design element inherently helps mitigate the spread of the virus. What is misunderstood, however, is that not all private Green House homes represent private pay residents. In fact, the original Green House Home in Tupelo, MS, sponsored by Methodist Senior Services, has a payor mix of roughly 65% Medicaid residents. Nationally, roughly 4 out of 10 Green House residents are covered by Medicaid.
Ziegler continues to support the good work of The Green House Project through board representation (Dan Hermann and Lisa McCracken serve as current board members), as well as promotion of their ongoing research, education and outreach efforts. We encourage readers to explore The Green House Project website to learn more about resources and educational opportunities available to providers, many of which are free to interested parties.
Director, Senior Living Research
A couple of things have become clear to JoAnna Trezise in her role as social services designee at Sterling Village, the long-term-care residence at 204 W. Washington, Sterling.
“First, most people don’t even think about Medicaid as a way to cover the cost of long-term care,” she explained. “For some people, it could be the answer they are looking for.”
And second, even when people wonder if they are eligible for Medicaid, oftentimes they don’t pursue it because of the application process.
“We understand this hesitation but local guidance is available,” Trezise said. “For the time being, we encourage families to contact the Rice County Council on Aging in Lyons for quick assistance with Medicaid applications.”
Before the pandemic, families could come into Sterling Village for direct help with the applications. However, there are now a number of long-term-care restrictions in place.
“We are very knowledgeable about the application process and want to help families with education and advice,” Trezise noted. “Our goal is to help them feel less alone and overwhelmed.”
There is no fee for this service.
Sterling Village cannot submit the application until the elder has been admitted to the residence. But once it is submitted to the Kansas Department for Aging and Disability Services (KDADS), Trezise monitors the situation and advocates for the family.
“Sterling Village is often a ‘middle-man’ between elders and Medicaid,” Trezise commented. “When we need extra support, the Rice County Council on Aging is a wonderful resource.”
A meeting with the family to start the application process takes about an hour but data collection can take longer. When the application is approved, the state may start services within a month or two.
“It is important to keep in mind that a resident is not eligible for financial help until the application has been submitted to KDADS,” Trezise emphasized. “The sooner it is submitted, the better.”
Medicaid benefits must be renewed annually to ensure continued eligibility. Sterling Village helps with this too.
“Living in a long-term-care residence can be especially helpful for those who can no longer care for themselves at home,” Trezise said. “Most everything is included in Medicaid coverage.”
In addition to 24-hour nursing supervision and assistance, services include housekeeping, maintenance, three meals a day and snacks, personal hygiene assistance and transportation to medical appointments. After the public-health crisis is over, the hair salon will re-open.
In her multi-faceted role of social services designee, Trezise also coordinates services between Sterling Village and outside businesses, families and residents.
“This includes home-health care and/or meal delivery for residents who are here for short-term services such as rehab,” Trezise said, noting Sterling Village offers physical, occupational and speech therapies on-site. “We can help with the transition back to their own homes. I can also help people with dental and mental-health services.”
Other responsibilities are working with volunteers to offer various activities for residents and collaborating with colleagues to address concerns.
“My goal is to do my best to meet elders’ wants and needs,” Trezise summarized. “All of us want elders to feel at home here.”
Zero deficiencies found during Sterling Village virus survey
The staff at Sterling Village believed they were meeting and even exceeding protocols that prevent the spread of COVID-19. Now they have confirmation their beliefs were justified.
Zero deficiencies were found during a recent on-site survey at the short-term rehab and long-term-care residence, 204 W. Washington. The Kansas Department for Aging and Disability Services conducted the survey, which focused on targeted infection control/COVID-19.
“We have worked so hard to keep on top of the ever-changing rules and regulations,” said Lauren Saenz, director of nursing. “Our team is amazing in its determination to keep our elders healthy and safe.
“Everyone in every department has been great about going with the flow with each new regulation. They love our elders and are able and willing to do whatever needs to be done. They have shown their true colors.”
The state surveyors reviewed all policies and procedures related to COVID-19. “In the process,” Saenz noted, “they monitored our practices to ensure we are doing everything in our power to prevent the spread of the virus.”
For example, surveyors observed Sterling Village’s: screening process; personal-protective-equipment procedures; hand-hygiene practices; all processes pertaining to dining and other activities; and basic care services.
“During this global pandemic, Sterling Village staff members screen everyone at the entrance on the west side of the building and masks are required for everybody,” Saenz said. “If anyone exhibits respiratory symptoms, they are automatically isolated until COVID-19 test results are available.
“These are just a couple of examples of our stringent protocols during this trying time. I love this team.”
But it is not just Sterling Village employees who deserve credit for the zero-deficiencies survey results, the director of nursing emphasized.
“Our whole community has our heartfelt appreciation for everything they have done to support Sterling Village,” Saenz said. “Recent months have been tough for elders and their families. We hope for continued progress and look forward to eventually opening our doors.”
Facetime, Skype and other services are helpful for visits, while telemedicine is available for some doctors’ appointments, Saenz noted, adding she appreciates everyone’s cooperation.
Karen Smith, Sterling Village administrator, said she is proud of the role each person played in achieving the survey results.
“Everyone has been diligent in keeping our elders safe and healthy,” Smith said. “We have offered a lot of advanced education with staff and elders regarding infection prevention and safety measures.
“Thankfully, we have not had a positive COVID case in our community,” she added. “However, we cannot let our guard down. We must continue these best practices during our re-opening phases.”
Smith noted she will share more information about these phases in the near future.
When Mary Lou Comley learned that Sterling Village could accommodate her short-term rehabilitation needs, she was “thrilled” and didn’t hesitate to take advantage of the on-site therapies.
Comley, 81, wanted to share her family’s experience with the community so that others will consider taking advantage of the short-term rehab services at Sterling Village.
The situation began when Comley suffered a major stroke just a couple of days after moving into a Sterling Village Cottage. She was hospitalized in Wichita before returning to Sterling Village – this time in the skilled-nursing area.
She stayed for about 14 weeks, receiving physical, occupational and speech therapies on-site.
“I am lucky the stroke didn’t affect my mind or my actual speech but I did have to re-learn how to walk, write and swallow,” said Comley, who also needed a feeding tube. “The speech therapy helped with the swallowing problems.
“I am now back to independent living in my wonderful Cottage and feel like myself again.”
Before the Sterling Village therapy regimen began, Comley’s children had to keep the road hot between Sterling and Wichita. The short-term rehab services close to home solved that problem.
Comley praised Kyla Knapp, physical therapy assistant, and the rest of the Sterling Village staff for the successful rehab treatments.
“They are well-educated and very caring, Christian people,” Comley noted. “They also were flexible with their schedules. I appreciate their dedication to daily therapy, even on holidays.
Knapp appreciates Comley’s remarks but said “Mary Lou was determined and disciplined throughout the rehab. She made up her mind early on that she would return home to her former level of functioning. And she did.”
Comley’s experience is a demonstration of what can happen when therapy is available and the patient puts in the effort, Knapp commented.
“Our therapists work directly with each patient to individualize a plan of care,” Knapp said. “This teamwork equals success at Sterling Village where the staff cares about the elders’ success in meeting their goals. It is great to see them improve and heal.”
The Sterling Village team is available for patients such as Comley who suffered a stroke but also for those who have fallen or undergone surgeries such as hip or knee replacement.
“Our patients are usually pleasantly surprised at their good and steady progress,” Knapp commented. “All milestones, big and small, are celebrated.
“The fringe benefit is that families are relieved their loved one is receiving therapy close to home. It gives them hope during a challenging time and takes some of the pressure off. Families know their loved one is receiving high-quality therapy that can lead to a return to their previous lifestyle.”
Lisa Valentine, Sterling Village community liaison, said Knapp and her therapy colleagues have a “can-do attitude that is contagious. This whole team is awesome because we have consistency and professionalism with Aegis Therapies.
“Our working relationship is one of trust and mutual respect,” Valentine continued. “Aegis knows our staff and residents, and we are equipped with therapy resources and equipment on site.”
The entire team is focused on continuing “our 5-star-rated care. Patients are treated like family in our small, intimate setting, which results in a very high success rate,” Valentine said.
Therapy services are available at Sterling Village to out-patients who don’t live there. The staff will help prospective patients determine what services are covered by insurance.