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Nursing in a "Household Model" ??

zenoangel zenoangel (New) New

Hello -- Are folks here familiar with "culture change" in long-term care? Does anyone have experience working in a "household model"?

This YouTube clip shows Steve Shields (of Meadowlark Hills in Kansas) discussing the role of nursing in the household model. I'm curious to know what folks on this forum think about it:

marjoriemac, LPN

Specializes in nursing home care.

Didn't quite comprehend that talk about the 'household model' but cheers because i did find a really good speech by Dr William Thomas beside it!

Great -- the clip about the Household Model is Steve Shields describing the role of nurses in it...."Green Houses," as envisioned by Bill Thomas, is version of a household model (an inspired version!) But there are others out there, with the kind envisioned by Steve Shields (and LaVrene Norton) being the another inspired version. Not sure what clip you saw of Dr. Bill, but there's one on that YouTube channel of him describing the Green House and another of Nora Gibson from ElderHealth Northwest describing a simililar model for the assisted living community.

The challenge that Steve lays out is how to fully develop the role of nurses in the new model -- it's a challenge that they've encountered too in the Green House (I actually wrote the guest editorial for The Gerontologist about this topic in the August 2006 issue).

The role of nurses in LTC organizations undergoing culture change is proving to be a real issue in getting true buy-in throughout the organization, so that's why I've come to this forum to hear from nurses themselves and understand better the barriers...I'm learning a lot reading through all the threads!

A CCRC I work at is considering this. I heard Dr. Bill Thomas speak in person last week and it was very inspirational. I thought he nailed it! However, I can see huge, HUGE issues implementing this. There are definite entrenched turf wars already at work and putting the resident and direct care workers at the center of importance is going to have almost everybody up in a major snit. There is an ongoing snootiness problem at this posh CCRC and whoever attempts culture change is going to come up against massive resistance.

The CNAs, relieved at finally hearing somebody acknowledge that they are indeed taking care of the patients, aren't going to embrace having 10 pts per 2 CNAs PLUS simultaneously being the cook, chef, housekeeper, laundress, janitor, maintenance personnel, etc. It's taking skilled, ALF, residential care, memory impaired care, and foster homes and rolling it all onto the CNA's back.

Acknowledgement accompanied by a major duty dump isn't quite what most CNAs are seeking. I think it would work better as an all-round shift in respect, realizing that all workers are contributing essential benefits to the patient. I don't see it as a power shift but I know that where I work, the whole concept of the Green Houses will elicit a horrendous screaming marathon from all corners. Yikes.

zenoangel, I'd like to read your editorial but it's a paid-subscription read only so would you like to post it here?

Well, we're going boldly where angels fear to tread ;) :lol2:

Our CCRC is going to build 2 Green Houses stacked vertically with a radically gorgeous design. Leading edge innovation, thought and care.

The snots are already having conniptions but don't quite get the concept yet. When they do it will be all-out war. But we have an amazing leader DHS who can pull this off. She's already gone to Tupelo and seen it all.

Wonder why Joe Angelelli never responded to my posts about this? Is he not really interested in this fascinating subject after all?

Congrats on your Green Houses! That's very exciting news.

As for you message above re: my editorial, unfortunately it's copyrighted by the Gerontologist so I can't post it here (even though I'm the author!) But if you e-mail me I will be happy to send you a reprint. My e-mail is: joe.angelelli "at" pioneernetwork.net

thanks and good luck,


Thanks Joe! I know your email because you email my boss all the time :specs:

Thanks for responding! I want to read your editorial and am very interested in hearing any updates you've gleaned regarding resistance from nurses r/t culture change. Actually, after reading Dr Bill Thomas' awesome book What Are Old People For and working in a variety of facility settings, one realizes the resistance is fear-based, and that fear is held by anybody who has a "power" position that feels threatened by the acknowledgment that CNAs are timewise and hands-on the closest members of the healthcare team to the residents. If people would just address their fears rationally, directly and openly they'd learn there really is nothing to fear; everybody can focus on best patient outcomes happily in their own role and have plenty to do!

It's going to be an interesting journey ...

Currently there are no official Green Houses yet in Oregon.

Praying the snobs don't derail this most promising practical mode of enlightened elderhood

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