Beyond Goal Driven Care: Autonomy, Meaning, and Belonging in Nursing Home Care

There have been many attempts to apply a more human lens to nursing home care. There is a 20-year history of a culture change movement in nursing homes directed at this very issue … The Green House model of long-term care has created small homes, more intimate and caring spaces for older adults to age. Anne Basting has led a fabulously creative approach to using art and theater to integrate residents of nursing homes into their local communities. Consumer groups have pushed to include wellbeing, dignity, people’s stories in care.

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  • “A small but growing group of nursing homes are already implementing these changes. Collectively called ‘household models,’ these nursing homes have generated enthusiasm among diverse stakeholders and long-term care experts. Because of its scale and consistency across homes, the Green House approach has been the most frequently studied household model.”

  • “Alternatives to traditional nursing homes for older adults who cannot remain in their own homes has prompted interest in smaller, community-style facilities such as the Green House model. Staff are used more flexibly in the Green House model, and work with small clusters of residents; the model’s success, especially during the COVID-19 pandemic, has attracted interest as an alternative to traditional nursing homes.

  • “The Center for Innovation and its Green House Project is promoting government incentives that support construction of modern, person-directed facilities through targeted grants or Medicaid rate increases. Providers in Arkansas and soon Ohio, for instance, receive Medicaid rate add-ons for private room nursing care.”

  • “Some suggestions included increasing state investment in home care, incentivizing a transition toward fewer-occupant rooms and Green House-style facilities, standardizing the Medicaid reimbursement system with data-based adjustments over time, increasing audits and financial transparency requirements for nursing homes, and building workforce pipelines into the sector through scholarships and more flexible training programs.”