In a perfect world, everyone would keep their elderly parents at home with them. But space and time constraints don’t always allow that, especially for parents with serious medical conditions. That’s where the dreaded nursing home—and its hospital-like atmosphere—comes in. The Green House Project is carving out a different path for old age: one where the elderly live in 6 to 10 person homes, have their own room and bathroom, an open kitchen and communal dining table, a living room with a fireplace, and the same care they would receive in a traditional nursing care setting. In other words, the Green House Project is trying to bring back some of the dignity of aging.
An initiative supported by the Robert Wood Johnson Foundation, the Green House Project sprouted from the foundation’s work on issues related long-term care services and support. When gerontologist Bill Thomas visited the foundation in 2001 to discuss the idea of taking existing nursing home licenses and applying them to smaller homes, employees were intrigued. After all, a number of nursing homes each year need to rebuild and modernize anyway.
"Nursing homes are hierarchical, and patient’s needs are at the bottom of the chain. Bill had an idea that you could create these homes that could provide complete care for the elders in a more high-quality way and a way that really supported their lives," explains Dr. Jane Isaacs Lowe, a senior adviser for program development at the Robert Wood Johnson Foundation. "We were all intrigued, because if you could build these Green House homes so they could be embedded in communities then this would make nursing homes more of a home and community-based service, because in theory someone could move from home to Green House home and still be in that community."
10 years ago, the first Green House pilot homes were launched in Tupelo, Mississippi in partnership with United Methodist Senior Services, which had previously been planning on building a new large nursing home. Today, there are almost 200 Green House homes in 23 states. Sometimes a nursing home will build 10 of the home to cover their entire population; other nursing homes will construct a handful and give residents a choice.
No matter where the Green House homes are located, they all have basic features in common: private rooms, a big common living space, a kitchen, and a private room where family members can sit with the elders. The biggest differences between the homes are in square footage. In urban environments, for example, the homes can be built vertically, so that each floor is its own Green House.
As you might expect, independent research has revealed numerous benefits for seniors living in Green House homes compared to traditional nursing homes. There are fewer problems with things like bedsores and readmission to the hospital, staff turnover is much lower, and there is a dramatic shift in family involvement and number of visitors—it’s much more pleasant to visit a home than a nursing facility.
"If you are a resident of a nursing home you can live in a Green House home just as easily, with a better quality of life," says Lowe. "But I don’t mean to suggest that all nursing homes are terrible and Green Houses are the only appropriate place to live in. Many nursing homes have adopted culture change principles that have very good outcomes."
These days, the Green House model is moving into other areas. In Massachusetts, there is home for people with amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS). The foundation is also starting to work with veteran organizations.
But there are still challenges to building up the Green House homes dedicated to the elderly—for example, how do you help the nursing homes that have 90% of their patient population reimbursed by Medicaid develop Green House homes? "One thing we’re cognizant of is that we don’t want the model to be based in more affluent nursing homes where you have a higher private pay to Medicaid mix. We want this to be accessible across the board," says Lowe. The Robert Wood Johnson Foundation is currently working on solutions to financing issues.
In some countries, elderly parents still tend to live at home—but in rapidly developing places like China, nursing homes are becoming more popular as attitudes evolve. Eventually, perhaps, they too will come around to the Green House model as a compromise. The best endorsement comes from Lowe herself: "If I am frail and old and need nursing home care, I would be quite comfortable going to a Green House home. I would definitely not say that about going to traditional nursing home."