T he Green House ® model brings cultural transformation to skilled nursing care settings with the ultimate goal of creating places where people want to live and work. This model restores individuals to a home in the community with power, autonomy and natural rhythms as the basis of daily life. Dr. William Thomas conceptualized this model based upon the Eden Alternative Principles. A Green House home is a self-contained dwelling for seven to 12 people, designed to look like a private home or apartment in the surrounding community. Green House homes are typically licensed as skilled nursing, or in certain circumstances as assisted living, facilities and meet all applicable federal and state regulatory requirements. Each person who lives in a Green House home has a private bedroom and full bathroom, opening to a central hearth/living area, open kitchen and dining area. Elders share meals at a common table. Family members, friends and staff are welcome to join the community at mealtimes and other activities.
Each home is staffed by a team of universal workers, known as Shahbazim. The staff has core training as Certified Nursing Assistants (CNAs), plus extensive training in The Green House philosophy, the self-managed work team structure of The Green House home, culinary skills, and household management. Shahbazim provide personal care, meal preparation, light housekeeping, and laundry, among other duties.
A clinical support team includes nurses, social workers, therapists, physicians, activities and dietary professionals and pharmacists. Nurses serve each Green House home on a 24-hour basis. One nurse typically covers two homes during the day and evening and up to three homes at night. The other clinical professionals on the team visit the houses regularly and as individual residents require.
The people who live and work in a Green House home collaborate to create a daily routine that meets individual needs. If they wish, elders can help cook, help with housekeeping and laundry. There is no predetermined routine, facilitating independence and the ability to pursue individual interests.
Research
A recently completed study, “Nursing Home Workflow Study: Analysis of Staff Workflow in Traditional Nursing Homes and The Green House Project Sites,” funded by the Robert Wood Johnson Foundation and conducted by the Institute for Clinical Outcomes Research and Health Management Strategies, found that the model’s organizational and staffing redesign delivers more direct care time, a key component of improved quality, without increasing staff hours and by maintaining expenses at levels similar to traditional nursing homes. The study, yet to be published, examines front-line staff daily workflow in skilled nursing settings, including Green House homes, and confirms the model’s design to redeploy, but not increase, staff time. Thirteen organizations, including 27 sites, participated in the study.
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The initial Green House pilot project, located in Tupelo, MS, was the subject of a two-year study funded by the Commonwealth Fund and conducted by Dr. Rosalie Kane and a team from the University of Minnesota entitled, “Resident Outcomes in Small-House Nursing Homes: A Longitudinal Evaluation of the Initial Green House Program,” published in the Journal of the American Geriatrics Society in 2007. The research team collected information from residents, primary family caregivers, and staff.
Findings of this study, comparing The Green House homes to traditional nursing care settings include:
- Higher satisfaction levels reported by residents, family and staff
- Less decline in late-loss Activities of Daily Living (ADL) (late-loss ADLs include bed mobility, transfer, eating and toileting)
- Less prevalence of depression
- Increased sense of privacy, dignity and individuality for elders
- More meaningful activity, relationships and food enjoyment
Visit The Green House Project Web site for more information and complete results from research to-date.
About the Replication Grant
The Robert Wood Johnson Foundation awarded a $10 million grant to NCB Capital Impact in November 2005 to help spur replication of THE GREEN HOUSE® concept, an innovative model for residential long-term care. The Green House Project is the vision of Dr. William Thomas, a Harvard-educated geriatrician and is led by Robert Jenkens. The model involves a total rethinking of the philosophy of care, architecture, and organizational structure normally associated with long-term care.
The five-year grant allows The Green House Project team to provide technical assistance and pre-development loans to organizations that want to establish Green House homes. Within the grant period, NCB Capital Impact plans to develop 50 or more Green House projects with organizations throughout the country. Organizations interested in joining the project can find additional information and register for upcoming informational workshops.
Progress To-date
As of February 2010, Green House homes are fully operational in 24 sites in the United States.
• AK (Seward) – Providence Seward Medical and Care Center – Seward Mountain Haven • AL (Birmingham) – St. Martin’s in the Pines • AR (Bentonville) - Northwest Arkansas Senior Services – Legacy Village • AR (Magnolia) – Summit Health Resources – The Green House Cottages of Wentworth Place • AR (Rison) – Summit Health Resources – The Green House Cottages of Southern Hills • AZ (Phoenix) – Arizona Baptist Retirement Centers – Baptist Village – Northeast Phoenix • AZ (Youngtown) – Arizona Baptist Retirement Centers – Baptist Village – Youngtown • GA (Columbus) - Calvary Baptist Church – The Green House at Calvary • KS (Newton) – Asbury Park • KS (South Hutchinson) – Mennonite Manor • MA (Chelsea) – Leonard Florence Center for Living – Chelsea Jewish Nursing Home • MI (Grand Rapids) – Porter Hills Retirement Communities • MI (Holland) - Resthaven Care Community • MI (Powers) – Pinecrest Medical and Care Center • MI (Redford) – Presbyterian Villages of Michigan – The Village of Redford • MS (Raymond) – Mississippi Methodist Senior Services – Riggs Manor Retirement Community • MS (Tupelo) – Mississippi Methodist Senior Services – Traceway Retirement Community • MT (Billings) - St. John's Lutheran Ministries • NE (Lincoln) – Tabitha Health Care Services • NY (Cohoes) – Northeast Health The Eddy – Eddy Village Green • PA (Palmyra) – Lebanon Valley Brethren Home • TX (Longview) – Buckner Retirement Services – Buckner Westminster Place • TX (San Angelo) – Baptist Memorials Ministries – The Green House Homes at Sagecrest • WA (Winthrop) – The Cove – Jaime’s Place
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1. Most home-like settings only accept elders with early or middle stage dementia. Does the Green House project allow seniors to continue living in the home when they reach an advanced stage of dementia? Are you able / willing to provide palliative care and/or hospice type of care?
2. In most cases (except for one in the UK), patients are separated from their spouses when they need to move to a nursing home. As my husband's caregiver, I would want us to stay together. Does the Green House model provide for spouses to stay together?
Thank you.