You can listen to Episode S5E07 right here!
Lori Pinkerton-Rolet
Lori, Hello, and welcome to the Third Age Design podcast where we do the legwork and you get the edge. I’m Lori Pinkerton Rolet, and this month and next, we’re continuing our green theme from last month, but broadening the topic. Now, we tend to think of the Green movement as being related to sustainability and biophilia, but it can also simply refer to the growth of people. Today in part one of a two part special, I’ll be joined by Susan Ryan, fellow podcaster and CEO of the Centre for Innovation, the non-profit parent company of the game changing The Green House Project, improving elder care across the United States and now internationally. And staying Stateside, in today’s ‘Innovation Spotlight, I’ll be speaking with Anna Mutch of the Massachusetts based Green City growers, who’s going to share the concept of urban farming for food production with Seniors. Idon’t know about you, but I find that very intriguing. If you’re a regular listener, you’ve probably noticed that I’ve referenced poet Mary Oliver on more than one occasion, and today is no different. This one is short and sweet, and for the designers and the architects out there. “Maybe the desire to make something beautiful is the peace of God that is inside each of us.” Personally, I love that. But even if you’re an atheist, those of us working to improve environments for senior living know that we can make a significant difference, and that’s why the Third Age Design podcast exists to provide real world examples of the new global concepts that inspire and improve senior sectors wherever you are. So go to our website at Third Age Dot Design and hit the ‘Join Us’ button, and you will also get a free TAD extra exclusive information for our community members. You will be most welcome. You’ll also find our international calendar of events there and research links for the topics we discuss on each episode. So please check that out. Okay, let’s get started. Susan Ryan serves as CEO of the Centre for Innovation, the non-profit parent of the Green House Project and Pioneer Network, leading the organisation on its mission to fundamentally transform elder care in America and around the world. As a member of the Green House team since 2008 Ryan has become an internationally recognised leader in long term care reform, with a particular focus on the organization’s vision for small home elder care campuses that provide person-directed alternatives to traditional nursing homes. Throughout her 35 year career in elder care, Ryan has been active in a variety of other culture change movements, including efforts to eliminate the use of inhumane physical restraints in nursing homes and the expansion of home and community-based services. At CFI, she works to create a future where every elder receives high quality person- directed care in the setting of their choice, while also ensuring the ongoing viability of the non-profit organisation and its multiple business lines. Susan Ryan, thank you so much for being on the podcast.
Susan Ryan
Well, thank you, Lori, this is an honour for me as well.
Lori Pinkerton-Rolet
I’d like to really start at the beginning, and before we started recording, I did mention that the Third Age Design podcast has discussed this project previously, because we think that it’s actually the future of care design, and you’ve already made it what’s happening now, and that’s what’s very, very interesting. So the concept is person-directed care in a non-institutional setting for elders, which gives them privacy, as we say here, or privacy, as you say in the States, and autonomy, and that’s really what seems to be missing from the hospital model of old. Where did the inspiration for this come from?
Susan Ryan
You know, I give full credit to, certainly, Dr Bill Thomas, a geriatrician who really he saw the plagues that were impacting those living in traditional institutional environments when he created the Eden Alternative, and he said, We’ve got to de- institutionalise those environments. And he philosophically came up with these 10 principles that would really be designed to reshape those environments into more humane, dignified approaches, where you really saw the the elder who was living within those environments, and really saw them as a person, and I think you know from there, as he was kind of spreading the message of what can be through the Eden Alternative, he recognised that the ageing infrastructure within those traditional environments was ageing more quickly than those that were living within them. And he said, well, what if we had the ideal environment? What is that ideal environment for these people to be able to live, to grow and to thrive? So kind of building on what Eden Alternative, kind of the Garden of Eden concept. He kind of went in and created that physical environment where these principles would be able to enable the culture there to support people to live, grow, thrive. And so greenhouse, one word is that place we all know to the optimal environment to produce optimal growth in plants. He created green house two words to produce growth in people. And he recognised, certainly, the elders that live there, they had opportunity to continue to grow as humans. But he also recognised that the people that supported them, the staff, that they too, had opportunities for growth, and that often times they were devalued and marginalised as well. So he really wanted to think not just about that philosophical culture, but really the human architecture, and that is people and the organisational design, and those working most closely with the elder…they were the ones that really needed to be empowered to be part of decision making, so that they could be able to deliver on the autonomy and the dignified approaches in person-directed living.
Lori Pinkerton-Rolet
And the the previous model I believe. I believe it was Dr Thomas that coined the phrase enforced dependency. Is that correct?
Susan Ryan
Yes, yes.
Lori Pinkerton-Rolet
Which is where…which is where that old, that old model was? Thank you for explaining why the greenhouse and right has over time. Of course, that phrase green has taken on another meaning, but you just explained that it’s still relevant to exactly what you’re doing in the growth of humans. My understanding is that each single house is domestic in nature, and that they’re up to 12 residents in each. Can you just give us a basic outline of what a sort of, quote, unquote, standard Green House might be set up?
Susan Ryan
Sure. And so I would say, you know, standard, yes, there are core design elements that would characterise each but as you build in different parts of the country, you want it to be similar to the surrounding community. So it really is important it blends in as a single family home, or like a condo in certain more urban areas where you go vertically, you might have a Green House home that is in a vertical building and not a single family home because you don’t have land to be able to do it. And that’s, you know, people live in condos. But what is important is what happens when you walk inside of a real home. And, you know, I think the open concept, if you watch HGTV, or some of those shows that are all about design, everybody wants that open concept. And I think that’s what struck me when I walked into the first Green House home that I saw, was you have an open kitchen, you have the hearth area, where the heart of the home, it’s kind of where people will gather to really be in community and surrounded by, you know, you’ve got your private bedrooms with their own ensuite shower, so they to the privacy or privacy that they would have been able to have their care needs met. They have their own bathroom and their own shower to be able to have those needs met, and they’re all private rooms. They don’t share a room with somebody else. I think the other thing that is core to the design element, everybody eats around one dining table. So instead of having, you know, the Four Tops or whatever, and you’re sitting in smaller groups, you’re sitting around a family table. And I think what is so important about that, and what I have learned over time, is that it really just fosters that sense of normalcy. It’s kind of how we ate our meals growing up. We did life. It’s real life. It’s real home. And I think, you know, the power of normal and normalising our environments are so critically important to really respecting the dignity autonomy of us as humans and even to the staff. The other thing that is a core design element is easy access to outside. And you know, I think especially during COVID, how deprived people in those traditional environments were, and being able to get outside. And even in a non-COVID situation, I can tell you, I walked into a traditional nursing home in Alaska years ago when we were embarking on some work with them. And there was a elderly gentleman there, and he asked me if I would be willing to take him outside. And I said, well, of course, let’s go outside. And while we were out there looking at the most incredible view of the Alaska countryside, he said, he got tears in his eyes, and he said, This is the first time I’ve been outside for five years, since he was admitted there. And I said, Why? Why haven’t you come out? He says, I didn’t have anybody to take me, and they’re so busy. And I just thought, you know that’s depriving us of our humanity and our I mean, we know through COVID that we needed to get outside.
Lori Pinkerton-Rolet
Of life, of life itself, right, right? And all the wellness that biophilia and everything has been proven to supply to people. May I just clarify one thing? [Sure] So I know you talked about the sort of condo setup that might be more vertical in, say, a more urban environment, but when these are in you mentioned neighbourhoods and they need to fit on architecturally and look like they belong. It’s not just one house. Is it? Is it a collection of houses, or is it sometimes just one house?
Susan Ryan
It’s a great question. We have had an organisation that just built one house, and it was really adjacent to its traditional environment. They have since added more houses around that. And I do think you know, as we look at those that have come this was an earlier adopter of the model, as we’ve seen people come after. We have neighbourhoods. Our largest neighbourhood is 16 single family homes in New York, and this is in kind of a suburban area, and they really do… it just looks like a neighbourhood of of single family homes. And it’s, it’s pretty powerful. I would say most people now are building a compliment of six homes. There are staffing efficiencies that you gain by having semester and efficiencies, right? So that’s typically what we’re seeing.
Lori Pinkerton-Rolet
And you mentioned the design you’re getting, the hub of the home. You’re having the hearth, you’re having the open plan, the kitchens, the private bathrooms and bedrooms. Are there any other specific amenities that are supported by what you’re doing or even encouraged within people that are picking up this model and wanting to run with it?
Susan Ryan
I think the other thing that’s really important is to recognise how important as humans it is to be integrated into the fuller community…
Lori Pinkerton-Rolet
…and that means not separated from everyone else.
Susan Ryan
100% yes. And so I think you know, what is you know, as we work with an organisation, what will it look like to be able to get elders out into the community? What are those things that would be important? And it depends on the community in which these folks have lived and what’s important to them. Certainly, there’s community that happens between the homes and they kind of form their own, you know, let’s do a kind of all of us get out. It’s, well, here it’ll soon be Fourth of July. Let’s get out where Fourth of July barbecue or something. And you kind of share that community within the community of homes. But many times, you know, I’ve got people telling me, Oh, we did this, we did that. And we’ve even had some take some of their residents to Disney World to be able to really get out. And some have gone Massachusetts community of Green House homes. They’ve taken their residence to Cape Cod to really, you know, get to the beach and do something that was really important to them growing up. So I think it really is, again, the power of normal. How do we normalise kind of our approaches to care?
Lori Pinkerton-Rolet
If you’ve got a 66 or 120 bed, traditional care home hospital model and people have personality conflicts, very easy to move them to to move somebody to another wing in a six bedroom or 12 bed property. How? How is that managed from an operational standpoint? Because people are people. Not everyone’s going to love everyone else.
Susan Ryan
So here’s what I’ll say. First of all, I’m one of three children, and growing up, we had conflict in our home as siblings. My dad was one of 11, and I can only imagine the conflict with 11 children. So I think you know, we need to understand that, yes, conflict does happen. How do we work through and resolve conflict? And how do we better understand the nature of the conflict? So in our education and our support with organisations, we do a lot on conflict resolution, and we really try to get to the root of what’s creating the conflict. And how do we do problem solving? And I think the other thing that is part of it is consistent staffing, dedicated teams that are working with the same people each day. [Okay] They have better insights. They have better relationships with families that are supporting so they can really better understand, how do we collectively solve the problem? As opposed to, you know, and I’ve been in those traditional environments you described, and when there’s conflict, it’s very easy, because we’ve got opportunity to quickly move them to another place. And that’s how we solve it, very quickly, quick-fix approaches, and we try to really, kind of explore options and really better understand the problem we’re trying to solve. And who do we need to bring into the problem solving and, and really work to really honour our values in the problem solving as we seek a solution.
Lori Pinkerton-Rolet
In doing so, you’re providing more support for the individuals, because clearly, if there’s conflict, there’s an issue of some kind, and moving and pretending you’re not seeing it, you’re actually having an opportunity again, following the name of what you’re doing for the people to grow, to learn from those experiences. As a result of this setup, as I understand it, you have higher occupancy rates than most other types of elder care. Is that right?
Susan Ryan
That is right, even during COVID.
Lori Pinkerton-Rolet
Wow, if they are in these smaller group, family environments, do they get a say on who moves in? Or is that something that has happened, again, operationally, in a more external way?
Susan Ryan
It’s a good question, and it’s one that again, part of the work that we do with organisations is to really help them develop their move-in policies and procedures. And what do we need to think about as we are moving somebody new into a home that has established kind of some norms and such, and it may be a home where the acuity levels, where, you know, people have lived there for a while, so their needs are pretty strong. You know, when you think about cognitive abilities, you know, what can we do to really ensure that we are setting that move-in up for greatest success? What does it look like for the team to be able to meet the person? What does it mean? You know, I think the team that will be providing their care needs and such, I think, you know, they need to be involved in the decision. I think the elders in the home should kind of be involved in the decision that having been said. You know, obviously, if there’s many times Green House homes have waiting lists. If there’s a waiting list and there’s only one room that has become available, then that’s likely where it’s going to go. But again, we have to think about the process and what it looks like to really set the team up for success, the home up for success, and the person moving in a greater success.
Lori Pinkerton-Rolet
So they’re the new kid in school, basically, exactly everybody’s experienced at one point in their life.
Susan Ryan
Absolutely. [But again], exactly.
Lori Pinkerton-Rolet
And there’s learning there as well, isn’t there?
Susan Ryan
100% and you know, I can remember, you bring up school, and it makes me think about in third grade, um, I remember my teacher said, there’s a there’s a new girl coming, and I’d like for you to kind of make her feel welcome. Well, I felt I had a role to play in making this new kid feel welcome. And as it turns out, this person, I mean, she and I are still the best of friends to this day, but I think that the role and the purpose that I had, and certainly it had impact on her, because, you know, I was able to help her integrate into kind of the friends that I had. So, yes, similarly, you know, I think typically, you’ve got an elder in the house that really kind of takes on the role of being the person that welcomes one in You think about the staff and what the staff will do, and you know what they will do around the dinner table to make the person feel welcome, and how they kind of got to know the person a bit before, sometimes the people will come for lunch before they’ve moved in to just kind of meet everybody there. [And that’s lovely]. Get a flavour.
Lori Pinkerton-Rolet
Quite exciting, actually. It sounds like an exciting overlap from where they were before to where they’re going. You mentioned cognitive ability, what happens within a Green House project, if or when Memory Care becomes an issue.
Susan Ryan
We really, I think, ge being the greatest risk factor advancing age for developing cognitive impairment. Obviously, as people grow older, the likelihood that they will experience some cognitive impairment increases as they grow older. So as they’re living in the homes and they become– they’re living with some cognitive impairment, then, rather than move them and really make it very complicated, we have a best life memory care approach all of our folks that work with us. You know, that’s part of our education and training is to make sure everybody is equipped with the skills and the abilities to really support those that have cognitive impairment, and it’s really amazing. We believe that, you know, we don’t see the diagnosis, we see the person first, and we really want to better understand who that person is, and as their cognition is changing, what do we need to do to really focus on their retained abilities. What do we need to do to really advocate for them? What do we need to do to even think about their dignity from a risk perspective, and some things that they might want to do, like go outside and they’ve got some cognitive impairment, how do we reframe that? Think about it, so that we can support them through the end of their life, even as they develop those changes.
Lori Pinkerton-Rolet
I am really touched by that approach, because I have, over the five years we’ve been doing the podcast, spoken to people who have other types of models, and no, we don’t do memory care is the answer [right] You know, then they need to move out. And that doesn’t seem like a way of growing people or understanding or anything. And exactly, quite, quite touched by that. There was one thing about your model, which, in my research came up, which I have to say, frankly, surprised me. So I’m going to give you a little challenge here. You offer a large amount of autonomy for every resident. But what I read was that each private bedroom is fully-furnished, rather than anybody bringing in any of their own furniture. So the question is, was that an easy or difficult decision, and how did you arrive at that decision in the end?
Susan Ryan
So most of the homes are licenced. 80% are licenced as skilled nursing. And in the US, an organisation must provide the bed and all the things that you described. However, we work with our organisations to be able to work with their State Department of Health to enable people to bring in, if they want to bring in their own furniture, or certainly pieces of their furniture, they’re able to do that.
Lori Pinkerton-Rolet
Yes, I feel better now. I was just like, I don’t understand how that could be personalised, if you don’t…
Susan Ryan
Aabsolutely. [Yeah] Right. And in fact, you know, in some of our communities, they’ve said that a double bed is something that they should provide instead of the hospital type bed, and so they have provided a double bed, and it what it is done to mitigate the falls that occurs in that little hospital bed. What it is done to normalise again the environment and make it look more home like, so we strongly encourage our organisations to do that. They need to have, you know, according to the State regs, they typically need to have to provide that. But if somebody wants to bring it in, then we just need to get clarification. Sometimes States are worried about, you know, what, if they bring bugs in and different things, you know? So does it need to be fumigated? Doesn’t need to be this, that or the other, but it’s so important, you know, I want my stuff in my room.
Lori Pinkerton-Rolet
You’ve spent the whole your whole life, and you’re downsizing to go there. You should be able to take something one would imagine that’s very meaningful. Yeah, okay, I feel much better about that.
Susan Ryan
Good. Yeah, we’re on the same page.
Lori Pinkerton-Rolet
Susan, thank you so much for joining me on the Third Age design podcast, and please join us listeners next month for part two of our interview with Susan Ryan as we discuss staffing, how to adapt senior housing models to different cultural norms. And we’ll also, of course, have links to the Centre for Innovation and the Green House project on the podcast page for this episode and again next month at Third Age Dot Design. We’re staying green in today’s Innovation Spotlight. Today joining me is Anna, much of the Massachusetts based firm Green City growers. Thank you for joining me on the podcast Anna.
Anna Mutch
Thank you for having me. Lori.
Lori Pinkerton-Rolet
So Anna, I understand you’ve been running since 2008 and specialising in what you’re calling urban agriculture, with a focus on educating people on how to grow food sustainably. Now, how did that come about? What was the vision?
Anna Mutch
That is correct. It began with an observation that residents in Boston did not have many opportunities to connect with growing food. Boston is a concrete jungle of sorts, especially in certain areas. So when the company first began, it was actually geared towards residential homeowners, giving them opportunities to both build gardens and then have us help teach the homeowners how they can grow food in their own backyard. From there, it’s evolved into more commercial markets, so we have started relationships with some corporate campuses, which then turned into some senior living communities, apartment buildings, and now we work with all kinds of customers, because we’re finding that all sorts of people enjoy the experience of growing food.
Lori Pinkerton-Rolet
Absolutely. And I would be amongst those people. Can I just say I’m not going to tell you how old I am, but I am growing my first kitchen garden this year, and I’m getting mange tout, and strawberries and herbs and raspberries and all kinds of things. And it’s that sounds delicious, and I’m, in fact, it’s so easy to do this, if you you know, I’m learning so I’m not not so good on some of the things, but I’m learning as you go, and you end up sharing it with your neighbours, and it becomes a community thing as well. You mentioned about Senior Living, and I want to really pick up on that, which is you’ve got specific offers for memory care and assisted living and independent senior communities. And you work with many providers. I can see that on your website. Why did you feel that senior living was a good fit for your organisation?
Anna Mutch
Yeah, there are many reasons why we think senior living communities are a good fit for vegetable gardening programmes. First off, gardening vegetables…growing vegetables is a low impact exercise that offers opportunities for seniors to go outside and connect with nature. If you’ve gardened before, which I know, you’re, you’re growing a great garden over there, you’re, you’re probably then familiar with the joy that comes from taking care of the plants and watching them grow every week. Gardening is offering opportunity for for seniors to take care of something, for nurturing something. It provides a sense of accomplishment. And you know, not only is it an impactful activity, but it’s also something that many seniors grew up doing in their own homes.
Lori Pinkerton-Rolet
That’s an interesting point.
Anna Mutch
Yeah, so it’s something that’s often bringing back memories for them, and can hopefully and often reconnect things that they were passionate about in their past.
Lori Pinkerton-Rolet
So what do you do differently if somebody has memory care needs and you’re trying to help them and instruct them in in growing food?
Anna Mutch
Yeah, that is a great question. And you know, we’re always assessing the audience we’re in front of and making sure that we’re meeting people where they’re at. So for a lot of our memory care folks, what’s what’s great about gardening is it’s so tangible, and there’s so many sensory experiences that come along with gardening. So even if you know, maybe an individual is struggling with certain tasks, they can still hold some fresh herbs in their hands and smell the lovely smell of basil or mint. They there are still lots of activities like that that also help bring back memories, sometimes, but also there, you know, can be a familiarity there from having done it in their past. So we always try to adapt activities to be appropriate for, for the audience.
Lori Pinkerton-Rolet
And are you using a lot of raised beds to keep people from having to bend over? Or what are the average engagements with seniors in general, or elders? What do those look like?
Anna Mutch
Yeah, that’s a great question. So typically, actually, I’d say exclusively, we are installing tall raised beds so that seniors don’t have to bend over, because that can sometimes be inaccessible for folks. Yes, and I mean, honestly, I also prefer not having to bend over. It’s nice for people of all ages. And you know, after we figure out what infrastructure makes the most sense for, for the group and for the space, we’re offering a hands-on programme that our urban farmer educators are leading. And you know what it looks like is, is kind of all of the the basic maintenance tests that you do to grow a vegetable garden, but everybody’s doing it together and getting tips from our farmer. But there’s a lot of tips and techniques that are also being shared with our farmer from from these seniors who have a lot of experience growing food.
Lori Pinkerton-Rolet
That’s very interesting. So they’re feeding back as well, and they’re being able to give, give their experience. Do people eat the food? Or what happens to the food that is grown?
Anna Mutch
I mean, that’s the best part of all. Yes, the food is being enjoyed by the seniors, after they spent all this this time and effort, the food is kind of divvied up by participants so that they can choose how they’d like to enjoy it.
Lori Pinkerton-Rolet
That’s fantastic, by way of inspiring others to develop similar practices and specifically links to sustainable food production. What would you say are the very key points to keep front and centre?
Anna Mutch
Yeah, so urban agriculture is very different than traditional agriculture. It both has unique challenges and unique opportunities. So it’s very important to stay creative in coming up with a solution that makes the most sense for for your property or your purpose. You know where your space might not have access outside to have an area available for grounds, level of raised beds. Maybe we have to look at a rooftop instead, or maybe we’re looking at an indoor space and bringing in an indoor hydroponic unit so that you have a year round growing opportunity. We’re really approaching our projects and addressing their their unique opportunities to come up with a custom solution and approach. The other key to keep front and centre is remembering that this is a garden that actually requires quite a bit of maintenance while it is while it is fun, we always recommend having some kind of expert help just to make sure that it’s successful, or to be very serious about what your maintenance plan is. It’s really an investment in in the maintenance that goes behind it.
Lori Pinkerton-Rolet
So it’s a whole commitment to the whole philosophy behind it, and the delivery, [exactly] the delivery of that. Thank you so much.
Anna Mutch
Thank you.
Lori Pinkerton-Rolet
Now a look at our tad international events calendar, starting with the most important event coming up next month in St Louis, Missouri, USA, when you’ll have the opportunity to meet Susan Ryan in person from the 11th to the 14th of August at the Centre for Innovation’s Conference, which is entitled ‘Mobilise the Movement’, and later in the year, the dementia World Conference 2025 is taking place in Boston, Massachusetts, from the 5th to the 7th of September, also obviously in the United States. As always, you’ll find more information and additional events on the events page of our website at Third Age dot Design. Thank you to today’s guest, Susan Ryan of the greenhouse project, Anna Mutch of Green City growers, and to our editor and producer Mike Scales, to Valerie Adler of The Right Website, to Peter Thorne, who composed our theme music and is playing the piano with Mary Blanchard on flute. And of course, to you for listening. I’m Lori Pinkerton Rolet, and next month, my interview on the greenhouse project continues in Part 2 with more insightful information from Susan Ryan. I do hope you’ll join us.