"It’s not just an exercise in kindness. Independent research shows that the residents living in the U.S.-based Green House Project homes (small households) have deeper relationships with staff, fewer trips to the hospital emergency department and fewer pressure ulcers or urinary-tract infections — conditions that can be serious for older adults and costly to the health-care system."

“A lesson from the Green House movement and from other countries’ experience is that training and permitting nurses and other care staff to deliver a range of services improves quality and job satisfaction as well as patient satisfaction.”

That's why there's a growing call for smaller households, like the Green House model, that can be created within larger care homes but also in residential communities.

The Green House Project and Pioneer Network hope to draw on their decades of shared experience to improve the lives of people living in nursing homes, while also building a better eldercare infrastructure for future generations.

By coming together, we can create a consolidated source of knowledge and best practices based on experience gained through both organizations’ years of work on the ground

Communities that have adopted the universal worker model, espoused by the Green House Project, are seeing much higher levels of engagement than those with traditional workforce models.

Companies like Navigator Elder Homes of New England are teaming up with workforce housing developers to build apartment complexes for nursing home staff.

Removing financial barriers like access to capital and Medicaid underfunding would be a step toward nursing home innovation, Ryan said, like the shift to private rooms and the small home model.

“People vote with their feet,” Ponthie said, adding that traditional rural providers are facing unprecedented closures. “During COVID, we grew our census. Everyone else had huge declines. Drop the mic. We’re done. The demand is there.” 

Residents can continue to live in a Green House home as their care needs progress, without having to undergo transfers to different facilities, which can be more traumatic as people age. Deinstitutionalization is a core value.