Caregiver's Careers Will Change

A nursing home industry pioneer, physician Bill Thomas, developed an elder care model called Green Houses. Step into a Green House and you step into a small, tight knit community of 10 to 12 residents and their caregivers, where people live together in a ranch-style home in an atmosphere that's more like a family than a facility. Cautious but intrigued, the Robert Wood Johnson Foundation handed Dr. Thomas a modest $300,000 grant. Now the country's fourth-largest philanthropy is throwing its considerable weight behind the vision of "Green Houses," an eight-year-old movement to replace large nursing homes with small, homelike facilities for 10 to 12 residents.

The Green Houses face several obstacles, including regulatory issues. But some say they also face resistance from existing nursing homes, which are based on an economies-of-scale model - the larger the home, the cheaper it is to care for each individual resident.

While some nursing-home operators welcome the idea of Green Houses, others are reluctant to help pay for them, says Susan Reinhard, who heads the AARP's Public Policy Institute. "You have owners who have their personal wealth invested in a model that was requested by society way back," she says. A significant challenge is convincing the nursing-home operators that Green Houses aren't too expensive. "The biggest criticism I hear is, 'How do you make it work financially?'" adds Larry Minnix, CEO of the American Association of Homes and Services for the Aging, which represents not-for-profits nursing homes as well as assisted-living and retirement communities. The foundation says it's studying the financial sustainability, but early indications do show it's financially doable.

Not mention was that not only are Green Houses improving the lives of the elderly who live there, but they also are transforming the workplace of the aides who care for the residents. For the workforce management perspective on nursing homes, I turned to Beth Baker's Old Age in a New Age: The Promise of Transformative Nursing Homes.

Baker's book includes a chapter on the dire workforce shortages, high turnover and poor working conditions of nursing homes, all of which have contributed to their reputation as destinations of last resort. Most HR executives know well enough our nation's shortage of nurses. And many know of a similarly looming shortage of nursing home aides, a crisis that is expected to grow as baby boomers age. Turnover among aides-the people who are the homes' frontline workers-is 70 percent nationally and 100 percent in 10 states. Annually, staff turnover costs the average nursing home $150,000, while absenteeism adds another $75,000, Baker writes. Nationally this waste in the system totals an estimated $4.1 billion, of which $2.5 billion is paid by taxpayers through Medicare and Medicaid.

Nursing home aides have said in previous studies that the working conditions that are most important to them are having enough staff to care for residents, being treated with respect, working as a team and having a good relationship with supervisors. For reasons that have to do with regulation, economics and entrenched interests, nursing homes have been slow to change, let alone transform themselves. But, as Baker writes, it is transformation that is necessary if nursing homes are to attract and retain workers who, in turn, feel empowered to care for and contribute to the lives of residents.

Enter the Green House. In 2004, Baker visited a transformational nursing home, one of Bill Thomas' Green Houses, in Tupelo, Mississippi. Here nursing aides are called shahbazim. Thomas borrowed the word from the Farsi word shahbaz, meaning "royal falcon," an image that evokes courage, loyalty and strength. He likens them to "midwives of elderhood."

Interestingly, the word shahbaz, however foreign, has helped give new life to the job. Baker wrote to me in an e-mail: "When the first Green House opened in Tupelo, they ran an ad for a CNA [aide] to work in an innovative setting. They got 2 responses. When they ran an ad for a Shahbaz they got 70 responses. Such is the power of language!"

Rather than being the bottom rung in a hierarchy, shahbazim are in put in charge to "protect, sustain and nurture" the elders for whom they care. They are the head of a household of 10 to 12 residents, far fewer than the 20 or more residents nursing aides normally care for. They are trained to be both caregivers who help residents dress and wash and homemakers. The shahbazim cook three meals a day for the residents and deal with their everyday needs, desires and problems. For their domestic efforts, the aides are paid more.

They have more responsibility and feel better about themselves and their employer, Baker writes. Nurses, doctors, therapists and social workers make house calls, and in doing so, they become members of a team who bring their services to people, rather than being the top of a social hierarchy in which nursing aides are at the bottom.

Baker shows other examples of nursing homes combating turnover by giving workers career advancement opportunities. But the transformation of work and place is most evident in Thomas' Green Houses. The power to make decisions and to care for residents is in the hands of aides who no longer feel mistreated, disrespected or unable to do their job.

HR executives and other business-minded readers, of course, want to know the return on such an investment. Does it reduce turnover and eliminate wasteful costs? Baker reports that turnover at the Green House in Tupelo dropped by 10 percent. Another nursing home in Rochester, New York, saved $4 million a year in temporary worker costs by including certain principles advocated by Thomas. A shortage of extensive data on Green Houses should change. Thomas recently received a $15 million investment from the Robert Wood Johnson Foundation to build Green Houses throughout the country and study their impact. Perhaps only then will we know whether these nursing homes are as transformational as they seem.

Source: Workforce Management, 6/24/8