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PROVIDENCE
Seward
Medical & Care Center
May 28, 2019
Greenhouse 2007 Guide Requirements, and Current Practices- what must be kept at Seward Mountain
Haven(SMH) when Greenhouse designation is removed via Management Contract Amendment#5.
2007 Guide / Current Practice Post GH future state
1. A self-managed work team structure is Drop. Administrator and guide position are not the
used with Shahbazim coached by and same.
answerable to the Guide (a new role Keep-mechanism to coach and develop staff and
typically assumed by the nursing home teams to function collaboratively with the elder and
administrator) and partnered with the entire team.
Clinical Support Team. Page 1, 10
2. Each Green House is supported by a Maintain
Clinical Support Team that includes,
nurses, social workers,activities experts,
therapists,a medical director,nutritionists,
and a pharmacist. Page 1
3. Typical Day and Evening shifts (2 Drop GH 5-8 hr shift requirement and maintain
Sh/house and 1 nurse/2 houses). Typical current practice of 3-12 hour shifts.
Night shift(1 Sh/house and 1 nurse 2-3 Maintain-Keep sufficient staffing to meet elder needs
houses). 5 F.h Sh/house, 1.5 AND allow staff and elders to have time to interact
nurse/house. Page 10 in convivium fashion
4. Green House model eliminates GH did not deliver on this. MDS experts are needed
supervisors,MDS coordinator,infection to manage the electronic record and infection control
control,cuts staff development by 75%, roles are mandated by law.
and cuts administrative support staff by Maintain and resurrect staff development work to
40%vs traditional staffing. Page 13 foster healthy collaborative teams
5. Shahbazim are CNAs who receive Self managed teams need to evolve into collaborative
additional training in the Greenhouse teams. Training will be maintained to form
Curriculum which includes...self-managed collaborative,respectful,teams.
team preparation. Page 11
6. Each team member assumes rotating Team coordinators will continue,but the scope of
coordinator responsibilities (Team,Food, care they coordinate will alter(for instance,laundry
Housekeeping, Scheduling,Care). Page 12 and food do not function now).
7. Care coordinator monitors the team's Drop. Care plans are assigned to RNs by regulation.
compliance with elders'care plans and
their effectiveness at meeting elders'needs.
Page 12
8. Care coordinator insures that care has Drop. Care plan oversight is assigned to RNs by
been provided and that the documentation regulation
has been completed as outlined in the
elders'care plans. Page 12
9. Comparison with traditional nursing Drop. High acute elders require closer nursing and
homes. Organization. Hierarchy-nurses physician supervison. And they require sophisticated
t •
control unit activity vs Flattened observation and care that only high functioning
bureaucracy-empowerment of direct care CNAs can deliver. If anything,more nursing
staff,nurses visit the house to provide presence in the lodges is needed.
skilled services. Page 16.
10. Comparison with traditional nursing Keep-Maintain elder decision making and respect
homes. Decision Making. Decisions input from caregivers closest to the elders.
made by the organization vs Decisions
made by elders or person closest to elders
as often as feasible, House councils plan
menus,activities,and house routines.
Page 16
11. Comparison with traditional nursing Drop-high elder acuity demands more nursing
homes. Nurses Station. In the center of attention and proximity to chart to reduce
most units vs Medication and supply documentation and med errors.
cabinets in each room,nurses visit rooms Keep-Maintain environment where nursing station is
to administer medications and treatments. not the focal point of the lodge which remains a
Page 16 homelike environment.
12. Outside observation. There is no staff Providence needs the flexibility to transform space
lounge or place for staff to take a rest for this function. There are no current plans,but it is
break in the lodges. not possible under GH.
13. Green House Organizational Requirement Drop. When time and money allow,the lodges may
4e,page 21. Maintain the Green House be connected for more and safer movement between
homes as independent units from each lodges in inclement conditions.
other and other facilities (i.e.,no physical
connections between houses except,only
in high rise situations,a shared elevator
lobby corridor)
14. Fenced outdoor space with two door Keep-Maintain
access for wandering. Page 4
15. Paperless medical records are used to Keep-Maintain electronic records
create a simple data entry system. Web-
based records allow easy report sharing
and report generation. Page 15.
16. Green House Organizational Requirement Drop-little evidence that this has occurred in last 10
10,page 22. Provide operational and years.
outcome data to the GHRI Team
including Minimum Data Set,quality of
life measures,employee satisfaction
measures,and other data as requested.
17. Communication Systems: Elder to Keep-Maintain electronic call system,use of pagers
Shahbazim: Pendant/bracelet call system and cell phones
18. Communication Systems: Shahbazim to Keep-Maintain communication via cell phone
Clinical Support nurse: emergency
pendant to pager and two-way radio. Page
15
19. Lift-free environment. Page 15. Only Drop. We will continue use of Sara Steady lift in
ceiling lifts in rooms and spa. common areas for elders as needed
20. Green House Organizational Requirement Keep the general theory,but allow locked areas:
4g,page 21. Maintain all spaces in the Winter necessitates locking access to the enclosed
Green House homes,including secured patio. Other areas locked so elders do not enter
exterior space,accessible and open to all include: library (nurse's station and med storage),
elders and residents during waking hours. laundry, both entries,service hallway,spa,and some
bathrooms depending on the situation. We cannot
lock access to enclosed areas as this poses a safety
hazad for those without badges per regulation (i.e.,
active shooter)
21. Green House Organizational Requirement Keep-Maintain
4h,page 21. Replace the nurses'station
with an office in the Green House home.
22. Green House Organizational Requirement Keep-maintain a team approach
4q,page 22. Implement the self-managed
work team approach to managing
Shahbazim and the Clinical Support Team.
23. Green House Organizational Requirement Keep in general theory,but also change to allow
4r,page 22. Maintain separate Shahbazim enough flexibility and standardization so that staff
for each Green House residence. can move over to help at other lodges and not feel
like outsiders.
24. Elder centered environment Keep-Maintain
25. Bring hospice to SMH rather than move Keep-Maintain
elders from SMH for care.
26. PSMH is a"special place" ,more Keep-Maintain
dedicated to be a Home Like environment
27. Operate like a home with a fireplace,living Keep-Maintain
room/seating area,kitchen,and a single
table large enough to sit all elders plus a
couple visitors
28. Windows in each room and the living Keep-Maintain
areas
29. Pain identification and pain management Keep-Maintain
program
30. Maintain elders who deplete their ability to Keep-Maintain
pay privately while they transition to
Medicaid
31. Positive peer to peer mentoring Keep-Maintain
32. Loving companionship with pet therapy Keep-Maintain
animals brought in to interact with the
elders. This helps to de-escalate our elders
when they are having a rough day,
especially dementia elders.
33. Focusing on convivium. Elders and staff Keep-Maintain
eating at the common dining room table to
discuss events of the day, engage elders in
conversation and share stories. (A great
deal like home)
34. Involvement with the schools:Job Keep-Maintain
shadowing,kids coming through
presenting programs,doing crafts with the
elders,learning about elder's history,
anticipating working with the school
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system to develop partnership for further
educational training opportunities).
35. Outings: Several elders participate in Keep-Maintain
scenic drives,shopping at local stores,boat
trips,Transportation to medical
appointments in Anchorage or Soldotna
(means dining out, shopping and different
change of pace).
36. Elders in lodges become a part of an Keep-Maintain
extended family.They begin to know the
elder's family and some families actual
become involved with other elders in the
lodge too.
37. Opportunity for development of Keep-Maintain
partnerships with other organizations:
AVTEC,Dietary positions,
High school students: English class
for capturing elder's stories,
High school students: CNA class
for further job opportunities and career
development
38. Creation of being a Special Place: Keep-Maintain
spiritually,mentally,physically and
activities (current events)
39. Have a certified dementia specialist on Keep-Maintain
campus that has created a support group
for local community members to ask
questions and to give caregivers further
information on dementia and challenges
that come with this disease process.
40. Working with hospital to eventually Keep-Maintain
provide more intense clinical hands on
skills and training to accommodate a
higher acuity elder in the future.
41. Have increased elder visits through use of Keep-Maintain
nurse practitioners,wound care specialist
and several doctors to address regulatory
visits and elder specialty needs.
42. Use of telemedicine and telepsychiatric Keep-Maintain
services to meet elder needs.
43. Have gardens that elders can enjoy and Keep-Maintain
participate in