Visitors ring the doorbell to be invited into the Watt cottage.
A shahbaz greets them at the door and welcomes them into the home of 12 elders.
Shahbaz is a Persian word meaning the “king’s falcon,” according to staff members. It means the employees, all certified nursing assistants, are the protectors, and the 12 senior citizens, the elders, are the people they serve. The terms are part of a mental shift, one that starts at the door of the Green House Living nursing home community in Sheridan and carries through to every aspect of life for the 48 senior citizens who call the place home.
“It’s pretty radically different,” said Chris Szymanski, administrator of Green House Living. “We work from a social model rather than a medical model.”
The philosophy and approach to nursing home care is the first of its kind in Wyoming, and the model has caught the attention of both state and local senior care officials who want to emulate its early success.
Davy Baum and his band used to play for packed houses in the Big Horn Basin.
Despite years spent entertaining crowds with late night performances, the five-string electric bassist is an early riser. He and a few other early -bird elders eat breakfast before the rest of the house stirs. The food is cooked in-house by one of the shahbaz and served at a long, wooden dining table lit by chandeliers.
Misty Glassinger, one of Watt’s trained shahbazzim, or certified nursing assistants, said giving senior citizens control over when they eat, sleep or participate is the point of the Green House concept.
“It’s finding what works for them,” Glassinger said. “They can eat when they want, it’s not about getting them up at the same time and shuffling them to the next activity.”
Glassinger worked two years at another Sheridan nursing home before starting at the Green House in 2012. Glassinger said she had to be reconditioned to let the senior citizens make their own decisions and to work with her fellow CNAs as a self-contained team, rather than taking direction from superiors on every decision.
She said the change in philosophy has worked. Glassinger talked about two women she cared for both at her old job and at the Watt cottage. One suffered dementia and frequently wandered off the premises. Another started walking again after she moved onto the Green House campus.
“I think the fact that it’s home-like, and the one-on-one, that helped them change their behavior,” Glassinger said.
The success in Sheridan prompted a recommendation from the Wyoming Department of Health’s facilities task force to build a facility based on the Green House concept at the Wyoming State Veterans Home in Buffalo.
In Casper, a group tried to raise the money for an Alzheimer’s nursing home that would emulate Sheridan’s model.
Szymanski has also heard from people in Riverton and Jackson, and from communities as far away as Indiana and Colorado.
Building a campus from scratch is an arduous task, though.
“The startup costs are prohibitive,” Szymanski said. “You have to have the community committed to doing this.”
A Los Angeles filmmaker with Wyoming connections first introduced Sheridan elderly care workers to the Green House concept in 2005. He shared a short video on other communities converting nursing homes based on the new philosophy.
Senior Center Executive Director Carmen Rideout began passing the video around, and the idea took hold. Rideout said the local nursing homes didn’t express interest in the plan, so community members decided to try and build their own.
The Sheridan campus cost $8.26 million to build. Private foundations and donors contributed $2.58 million. The bulk of the remainder came from a U.S. Department of Agriculture loan.
The campus opened in January 2012 with four cottages meant to hold 12 people each. To make it work, the organization determined half of its elders needed to be private pay and they could accept Medicaid from the other half.
“We didn’t want this to just be the house on the hill that only serves private pay,” Szymanski said.
Making a difference
The Watt cottage opens into a living room with a huge stone fireplace flanked by stocked bookcases, a dining room with big windows looking out onto a deck and open fields, and a large kitchen.
One room holds a jet bath and a hair salon station.
“It’s important for them,” said Marsha Fort, a certified nursing assistant with 20 years of experience. “It gives them dignity … it helps boost their self-esteem.”
Despite the décor and amenities, Szymanski said the costs are similar to other nursing home options.
Typical nursing home cues are also hidden. Medicine is in a locked cabinet in each person’s private room, eliminating the need for the rolling steel cart. Staff members are alerted by pager when there are problems, instead of a facility-wide alarm.
And both staff members and senior citizens socialize more.
Fort credits that to both the environment, the team approach and smaller groups.
Elder Ann Greeley said the whole campus sometimes goes out to Country Kitchen to eat, or to listen to music in town. At Christmas, they piled into vans and toured the local neighborhoods to see the festive lights. In February, family members were invited to watch the Super Bowl.
Fort said focusing on keeping her elders social and maintaining a homey environment are as important to good health and quality of life as any medicine.
And as important as those factors are for the elderly and their quality of life, it matters for the CNAs, too.
“This place is different,” Fort said. “At the end of the day, I feel like I’ve done something for them.”