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The City Council on Tuesday unanimously approved changes to its agreement with Providence Health & Services Alaska, the entity that operates the city-owned hospital and long-term care facility. The changes release Providence from the obligation to run Seward Mountain Haven (SMH) under the so-called Green House Model of elder care.

The Green House model is a philosophy of geriatric care that emphasizes home-like care environments that deviate as little as possible from an ordinary residence.

The City Council originally selected the Green House Model at Mountain Haven’s inception, but developments at the facility – including a higher number of more acutely ill patients – have led to challenges in adhering to the model’s principles, Hanna said in a letter to the council.

The switch reflects recommendations brought forward by Providence staff, including Interim Administrator Donald Hanna, who told the council at a work session earlier this month that many of the Green House requirements made it very difficult to care for patients with more acute medical needs.

For instance, the Green House guidelines prohibit lifts in patient rooms, Hanna said, a stipulation that Providence had already stopped following to ensure that staff could safely move patients with limited mobility.

The model also requires the in-home nursing staff to do laundry on site – another Green House guideline that has gone by the wayside with laundry being done in a central location in the main building.

Participation in the Green House model also requires agreeing to collecting data which is then shared with the Green House national organization, but the Providence team found “little evidence that this has occurred in last 10 years,” according to a summary document Hanna provided the council for Tuesday’s meeting.

“The acuity of elders at Seward Mountain Haven is a different population than the acuity of elders the Greenhouse Project was designed to serve,” Hanna wrote in his letter to the council. 

“This fragile population requires considerably more therapies, medications, and oversight than an assisted living facility. This increased need for care delivery is hampered by Greenhouse rules that restrict lifts in common areas (SMH violates for the sake of staff), restrictions on charting mechanisms (can lead to lower quality charting due to intervening activity between care and documentation), and physical separation of nursing staff work from the elders.”

“Significantly acute patients take more direct care time than the moderately impaired,” Hanna added. “As a result, direct caregivers do not have time to do some homelike activities Greenhouse specifies. Laundry, activities, and housekeeping are outsourced, a deviation from Greenhouse.”

The Alaskan climate presents another challenge, Hanna said, since the Green House Model requires the individual lodges at Mountain Haven to remain physically separate. Moving elders from one lodge to another – if, for instance, an activity happening in one lodge is open to elders from another – is infeasible during winter or inclement weather.

Providence proposes to keep a number of Green House-inspired elements, particularly when it comes to the overall home-like atmosphere of Mountain Haven’s four lodges. The summary document indicates that Providence would like to “keep” or “maintain” provisions such as “operat[ing] like a home,” “elders and staff eating at the common dining room table,” and “having gardens that elders can enjoy and participate in.”