The Green House Project has partnered with THRIVE (The Research Initiative Valuing Eldercare) to learn more about the Green House model as well as other models of care. The THRIVE team is launching a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes. This effort is funded by the Robert Wood Johnson Foundation.
The THRIVE researchers represent leading research institutions and long-term care organizations around the country, including Harvard University, the University of Wisconsin-Madison, Health Management Strategies, Institute for Clinical Outcomes Research, Pioneer Network, and the University of North Carolina at Chapel Hill. Many of the THRIVE team members have previously researched the Green House model, and in part, these previous studies – and the questions left unanswered – provided impetus for the current project.
For example, in a comprehensive review of the research literature, THRIVE team members Sheryl Zimmerman and Lauren Cohen found strong support for certain components of the Green House home model, such as that private rooms and bathrooms and communal dining are related to positive outcomes. However, these researchers also found that very little research has been done around the concept of normalized engagement, and therefore there is no evidence to show that this type of engagement relates to better care or outcomes.
Other THRIVE team members, including Siobhan Sharkey, Sandy Hudak, and Susan Horn, found in their earlier studies of work flow that Green House elders receive more direct care time per day than do similar residents in traditional nursing homes. They also found that Shahbaz spend about 20 minutes more per day with elders than do CNAs in traditional homes. In their work on elder outcomes, they also found that elders living in Green House homes maintained their ability to perform activities of daily living such as dressing and eating, to a greater extent than residents living in traditional nursing homes. These findings suggest further exploration into what structures and processes are associated with better outcomes, such as less decline in activities of daily living or fewer falls.
Earlier work by Barbara Bowers and Kimberly Nolet provided important insights into the role of the nurse and how it differs across Green House homes; they found, for example, that there are differences across homes in how the Green House model is implemented. In particular, there are important differences in how Shahbazim and nurses relate to one another and the degree to which they collaborate or work separately. Although this study demonstrated that the choice of model had meaningful consequences for both staff and elders, it did not determine what had led some homes to use one model over another.
It is these unanswered questions – plus many more related to staffing, care provision, clinical outcomes, and costs – that the THRIVE collaborative intends to address. The THRIVE project will be taking place through 2013, and during that time, members of the team will be contacting Green House homes to complete interviews, request records, and schedule visits. In addition to providing homes the opportunity to inform these matters and influence the direction of nursing home care, participating homes will also receive confidential feedback about their organization.
We are excited to be able to learn more about the Green House model, and look forward to working together.
(Questions about THRIVE can be directed to Lauren Cohen, firstname.lastname@example.org, (919) 843-8874).