Loneliness, helplessness and boredom. These are the three plagues existing in today’s nursing homes according to Dr. Bill Thomas, a geriatrician and founder of the Eden Alternative and THE GREEN HOUSE® Project aimed at changing the culture of long term care.

So what is "culture-change" in long-term care? Simply said, it is putting the elders living in nursing homes first. The system, or culture, in nursing homes today focuses more on efficiency and meeting state and federal regulations rather than focusing on the wants and desires of those living there. The result for the elders is loneliness, helplessness and boredom. The culture-change movement’s intent is to replace this system with one that recognizes and engages elders in all aspects of life, replacing the three plagues with meaning, worth and dignity. Rather than running "institutions" that provide medical care, the intent is to provide a home where elders continue to enjoy a high quality of life and at the same time receive the care they need.

St. Martin’s has adopted The Green House model of care. The Green House model changes the architecture from large institutional design to smaller scale residential design. To change the culture though takes more than new buildings. In the Green House model staff roles change. The most important positions become those working directly with the elders. The Certified Nursing Assistant receive additional culinary and team management training and become what is called a "Shahbaz", a new term used in the Green House model, in order to move away from the old institutional roles and titles. Elders living in a Green House home maintain choice; choices for what they eat, when they get out of bed, what activities they do, what kind of bed they sleep in, etc. Institutions by design are regimented so giving people power of choice doesn’t work so well. But in a Green House home the smaller scale gives the Shahbaz an opportunity to build relationships with the elders under his or her care and the needs of the elders are met individually.

To begin our organizational culture-change, St. Martin’s recently took a group of 35 people, including Certified Nursing Assistants, nurses, administrators, maintenance staff, food service staff, and board members, to visit the first Green House homes built three years ago at Traceway, a Mississippi Senior Services retirement community in Tupelo. The group visited the homes and met elders and staff, including several Shahbazim (plural for Shahbaz). All came away sure that our effort to build and operate the Green House model here must happen, and the sooner the better.

We expect to break ground on the first houses to accommodate 60 elders this summer. We have applied for the required Certificate of Need with the Alabama State Health Planning and Development Agency. Our architectural plans are being finalized and our capital campaign is underway. Our hope is to raise funds over the next 18 months enabling us to replace our entire 138-bed nursing home with the Green House model.

As the culture of long-term care changes, St. Martin’s will be a leader. An article in The Birmingham News, "Putting Life in Nursing Homes", published January 22, 2007 outlined the changes taking place in nursing homes across the nation and shared St. Martin’s plans to build Green House homes. Change is not easy, leading change is even more difficult. St. Martin’s staff and board members are committed to making a difference in the way we care for elders. Our hope is that other organizations will follow with their own plans to de-institutionalize elder care in America. Nursing homes today are places where elders "exist", St. Martin’s is building homes where elders will "live" with control, choice, privacy, and dignity.