Robert Jenkens
Robert Jenkens was at boarding school in Exeter, New Hampshire, when, in order to fulfill community service, he chose to volunteer as a buddy to an elder in a nursing home. He soon discovered he enjoyed listening to the personal stories of those who lived there, and he marveled at their rich, interesting lives.
Still, he remembers, “Every time I walked in, I thought, ‘How can anyone live here?’ It was the last area where I saw society accepting a bad quality of life, where rights were really denied. People didn’t have the ability to make choices or lead lives the way they wanted to. I thought it was a civil rights issue.”
Jenkens determined then and there that people need multiple options in their communities for long-term care. So he became an architect and for eight years tried to change the look and feel of typical nursing homes. Then he realized that nursing homes are actually creatures of finance and policy, so he studied public policy at Harvard’s Kennedy School of Government and worked at AARP as a policy analyst.
Finally, he discovered an affordable alternative to the institutional nursing home model called the THE GREEN HOUSE®. This model, he discovered, made full use of Medicaid dollars, innovative design ideas and the principles of culture change. Individuals living in Green House homes have rights: they maintain independence, direct their own care, and live with dignity.
Originally a volunteer working with Bill Thomas, developer of the project, Jenkens now serves as its director.
A new world for workers
The Green House model departs from traditional nursing home principles at every turn. In addition to replacing the institutional care model with small homes that accommodate no more than 8 to 10 people, the Green House model offers a new role for the direct-care worker. That role is to protect and nurture those living in the Green House. Together with the elders, direct-care workers run the household; they also provide personal care, cook, and clean. Nurses are on-call to provide clinical care, when needed.
Each home has a self-managed work team of CNAs who receive 120 hours of extra training in Green House philosophy and skills, including the principles of culture change. These caregivers are even given a new name, the Persian word Shahbaz (plural, Shahbazim),which originally derives from Hebrew. The Shahbazzim report to the Guide, who provides overall administrative support and coordination for residents and staff. PHI developed a leadership training program for Green House Guides , who having previously directed staff in traditional, hierarchical institutions, needed a different set of skills to support the Shabahzim self-managed work teams.
You can go to Lincoln, Nebraska in the middle of the heartland, says Jenkens, and find that Green House CNAs love the term Shahbazim. “In Tupelo at our first pilot site, you can hear them say ‘Shahbazim’ with a strong southern accent,” he says.
If a CNA “is drawn to that word and cares about the importance of language,” says Jenkens, they are probably open to the Green House philosophy.
Studies are finding that turnover drops when people transition to this new role. Sometimes, it drops dramatically. Before the original Tupelo home transitioned into a Green House, it reported a 70 percent turnover rate for the direct-care workforce. That dropped to 10 percent after the transition.
This may be due in part to the greater depth of personal care and contact in the Green House model. According to Jenkens, workers “have reported better job satisfaction,” saying they get to know residents better in this intimate setting and can better care for them. Just outside Albany, New York, where six new houses have recently opened, despite the rigors of new training and the challenges of getting up and running, 97 percent of staff said they didn’t want to go back to their jobs in the traditional nursing home.
Looking ahead
Since the first pilot project opened in Tupelo, the Green House models have expanded to 18 operating campuses today, containing one to 10 houses each, with another 20 sites in development.
“We hope the Green House model is home as people know it from their experiences, preferences and needs,” Jenkens says. “And that may be different in Alaska than it is in Tupelo, Mississippi.”
The GREEN HOUSE® Project is now a program of NCB Capital Impact, a Washington, D.C., based non-profit that works to bring innovation to low-income communities in order to improve the lives of those living there. Established by an act of Congress in the late ‘70s, the organization works in health care, education, affordable housing, and long-term care. Since its inception, NCB Capital Impact has put nearly $1.2 billion into low and moderate-income communities, supporting health care centers, charter schools and affordable homeownership. In 2005, the Robert Wood Johnson Foundation committed to supporting NCB in implementing 50 Green House projects over a five-year period.
“As we go well beyond the grant, we expect the real benefit will be to grow and evolve from what we learn from each other, from our best practices and collective wisdom,” says Jenkens. “We hope the project looks totally different in ten years because it’s grown and because we’ve gotten much better.”
– Story by Dinah Cardin
