National Media Items
"The authors acknowledge that the advantage of Green House homes comes from more than mere size. They have the advantage of private bedrooms and bathrooms, limited ancillary staff, and fewer admissions. Together these factors point to the need to fundamentally change the physical plant structure of nursing homes as an essential starting point in preventing a long-term care pandemic debacle from ever happening again."
Martin Siefering of Perkins Eastman challenges the misconception that the Green House model can't easily scale for both for-profit and non-profit operators: "There are for-profit models that have adopted the small house model and they find a way to make it work. We find some clients who found that there’s actually a better financial performance in the Green House model than there was in a traditional model."
"McGarry said that nursing homes with less dense units — such as Green House models — make more sense with regard to preventing outbreaks. It’s an intuitive finding that wasn’t really being thought about previously, he added."
Morgan Stanley's "Now, What's Next" podcast profiles Sylvia Mendoza, whose long journey to find a welcoming place for her mother, Lupe, ended at a Green House community in California. "'What I was looking for was: Does the staff treat the people under their care the same way they would treat a family member?"' Sylvia found what she was looking for in a Green House."
"The choice is not binary between home-based care and nursing homes. The Netherlands in particular has experimented with small group homes, with much success. There is a similar model in the US, called Green House, a loose collective of homes with 10 to 12 beds that house seniors and are served by a small team of nurses."
"Susan has masterfully guided the Green House world through major changes and opportunities and can potentially help this movement explode. When industry leaders are focused on the bottom line, she has the business savvy to take on their reservations about small residential communities. "
“The Lord has really blessed me in going to the Green House,” Dorothy Foot, an eighty-three-year-old who’d been living in the cottage for two years, said. “The fact that every one of us has our own room gives us dignity. And I have my own bathroom. In my mind, it’s my apartment. I’m not going through the feelings of the woman that got dropped off in a nursing home. And even though I am a Medicaid patient, I still hold my head high.”
"Because some people do choose to receive long-term care in nursing homes, we must reimagine how we can offer higher quality care in residential settings. That does not mean we need more buildings. It means we need to offer incentives to providers to replace or remodel their facilities, and to introduce new models of staffing ... THE GREEN HOUSE® model is the most widely researched small-house nursing home option."
"A person’s mindset plays a big role in her development as a leader, added Green House Project Senior Director Susan Ryan. 'As a leader myself, I have wanted to extend belief in a person,” she said. “It really is creating the intention, believing that we deserve a seat at the table and that we’re going to do the preparation and the equipping to support each other to be successful.'”
"Nursing homes that were less crowded, such as those built on the Green House model, had better outcomes and lower hospitalization costs, the study noted."
"Clearly, 2Life Communities, Carehaus, and the Green House Project are implementing visionary ideas about how we can live full lives as we age, enriched by neighbors, programs, and activities, and by supportive medical personnel as needed."
"The best-known type of nontraditional, small house nursing home is the Green House model, which operates 300 homes across 32 states, each housing only 10 to 12 residents. In addition to their small size, Green House homes also feature consistent, universal staff assignment (meaning the facilities try to assign the same staff to the same residents and that staff perform a wide range of responsibilities in addition to their nursing role, like cleaning and cooking), private rooms and bathrooms, smaller overall space, and a central entry."
"A recent article in the Journal of American Medical Directors Association found that “non-traditional small house nursing homes” in the U.S. had fewer COVID infections and deaths ... Most small households have 10 or fewer residents, like those in the Green House Project or Sherbrooke Community Centre. There is a kitchen in each household, laundry machines and a living room, with staff who are dedicated to a specific household. It offers a familiarity that is comforting."
"The third session, “Secrets to career success,” will be from 1:30 to 2:30 p.m. ET and will feature six 2021 McKnight’s Women of Distinction speaking about mentoring, networking, developing assertiveness, career advancement, leadership succession planning, and establishing organizational culture, among other topics. Sharing their wisdom will be PruittHealth Chief Strategy Officer Mary Ousley, Allure Group COO Melissa Powell, Green House Project Senior Director Susan Ryan, LeadingAge SVP of Research Robyn Stone, DrPH, Belmont Village Senior Living founder and CEO Patricia Will and Birmingham Green CEO Denise Chadwick Wright."
"Differences were most notable among the outliers, wrote lead author Sheryl Zimmerman, Ph.D., of the University of North Carolina at Chapel Hill. Only one-quarter of Green House/small nursing homes had COVID-19 case rates per 100 resident years higher than 2.92, but the corresponding rates for traditional nursing homes ranged from 5.48 and 27, she and her colleagues found."
"To move forward, besides private rooms and private bathrooms, we need to get to smaller buildings along the lines of the Green House Project, or something that is more individually based — so also the staff then becomes more personally tied, because they’re not taking care of 50 residents. There’s 10 or 12 in a house. We’re going to see more consistency of care, which is going to bring more quality of care. And in the end, that’s what we need for our loved ones: quality of care."
"The Green House model involves setting up small houses to house 6-12 residents. The focus is on providing home care as well as treatment through a consistent, well trained team which takes care of all the work. The team may include some nurses besides staff which is trained to cook, assist the patients in their daily activities and engaging them in social activities. The nursing and the clinical care team takes care of medical needs of the patients via use of home nursing products and other medical supplies."
"To hear John Ponthie tell it, you have to visit a Green House Project nursing home to truly know what they’re like ... 'This doesn't look like a nursing home. This doesn't smell like a nursing home. This doesn't feel like a nursing home,' he said. 'This looks like a big home — a 7,500-square-foot home where these 12 elders live this rich life together, as rich as it can be given their functional decline.'"
"'Through July, the Green House Project reported its homes had just 32.5 positive cases per 1,000 residents, almost five times fewer than the national average for nursing homes. COVID deaths were also low; Green House homes saw just under three deaths per 1,000 residents, about 14 times fewer than the national average. Everything that I know about good infection control, I believe was inherently built within this model,' said Green House Project Senior Director Susan Ryan."
Susan Ryan, Senior Director, The Green House Project, Linthicum, MD
"The Green House Project includes a long-term care facility in Memphis called Ave Maria, which has nine cottages and 100 beds staffed by skilled nurses. In each cottage, the rooms are laid out around a central community living space. 'The priority has to be helping folks age with dignity,' said Frank Gattuso, Ave Maria’s executive director. People 'want to read the paper while they have coffee and do their own laundry,' he added."
"Kaleigh Alkenbrack outlines several innovative approaches in this HealthyDebate article. She points to The Green House Project in the US as a sustainable example. Instead of a large, multi-unit facility, The Green House is a small residence with 10-12 private rooms, each with it’s own bathroom. Each room is centered on a communal open kitchen where residents have the opportunity to socialize and interact."
"Newer models of NH care, such as the Green House model and the Eden Alternative, place increased emphasis on providing person-centered care, encouraging independence in residents, and emphasize principles of enablement. Thus, the provision of independent access to the outdoors within modern NHs is increasingly acknowledged as important in maximizing resident quality of life (QoL) and function."
"Third, we need more community housing options for those who require congregate care. These can be homelike settings where people have choice and connections with family, friends and community. These should be non-profit entities and could be provided by community support organizations or municipalities. The Green House Project in the United States is an example of such a community enterprise, and there are Canadian projects in the development stage."
"Experts say there’s no one single solution but point to innovative models to implement or learn from. One promising alternative that is drawing international attention is The Green House Project in the U.S. This small nursing home model is demonstrating remarkable success in not only limiting infections and deaths from COVID-19 but also in providing improved quality of life for its residents, resulting in better health outcomes and life satisfaction and reduced healthcare spending overall."
"Jamie’s Place is one of 300 homes across the U.S. that are part of the Green House Project, an innovative model for residential care. Green House Project homes house small groups of elders in non-institutional spaces staffed by specially trained “universal workers” known as Shahbazim. Though they aren’t new—GHP and other 'small house' elder homes have existed since 2003—they have garnered attention recently for having deftly weathered the pandemic."
"The authors also encouraged state policymakers to consider updating their CON laws and construction moratoria for nursing homes to allow for greater innovation in the marketplace. They also stressed the need to expedite adoption of key model features associated with quality improvement. For example, the authors noted, policymakers should promote more research and demonstration of how key features of the Green House model, including the “universal worker” staffing model and the use of private rooms, could be adopted by larger facilities."
"As of October 2020, there were 11 long-term care homes in Ontario that had either adopted or were in the process of adopting the Butterfly model of care. These homes along with the Green House Project homes in the U.S. that have embraced transformative culture change have reported better outcomes both pre and during the COVID-19 pandemic and have experienced fewer deaths than the institutional models of care that exist in most of our traditional long-term care homes."
"Most prefer to remain at home, but for those who need more care, the nursing homes of the future that will attract them are much more likely to be small, high quality, single-room facilities that resemble real homes. The so-called “Green House” model is the most appealing setting for older adults of today and tomorrow who might need significant levels of 24/7 care."
"Indeed, the nation has a model, the architects said. It’s called the Green House Project, a 17-year-old non-profit organization with 300 homes in 23 states, including Michigan. It hopes to open another 30 to 40 homes nation-wide next year. Each Green House typically has 10 to 12 residents, who have their own apartment and bathroom, a shared dining area, and gardens or porches. There are usually two nursing assistants and a nurse for every 10 residents, which allows staff to actually get to know their residents. Many Green House programs, including Resthaven in Allegan County, accept Medicaid patients."
"Outside of the Katherine and Charles Hover Green Houses, a retirement community in Longmont, Colo., they have set up a tent with four millimeter plastic and arm holes so families can hug."
"Colorado-based nonprofit healthcare organization TRU Community Care teamed up with Hover Senior Living Community’s [Green House] skilled nursing facility to create a “hug tent” that allows visitors and residents to safely see and touch each other during the pandemic. 'It’s really good for the residents,” said Amanda Meier, a project coordinator for the organization. “I just wish everybody could find a way that they could not be so isolated, whatever it takes.'"
"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."
"When—and if—institutionalized care becomes necessary, there are alternatives to warehousing in large buildings. The innovative Green House Project, for example, provides individual “houses” where small groups of 10 to 12 seniors can support and care for each other, with professional assistance as necessary."
"Well, one idea that's got a lot of currency now has been around for nearly 20 years. It's called the Green House Project. These are nursing homes with an emphasis on the home part of it. They're small, with maybe eight to 12 residents. That cuts down on infection spread. Everyone has a private room, which also helps control infection. And during the pandemic, Green House homes have been one-fifth as likely to have cases of COVID-19 as traditional nursing homes."
"The [Green House] model has been praised by academics and doctors and seems far better suited than traditional facilities to stave off the spread of infection and the isolation that has devastated the elderly in recent months. But it remains on the fringes of a $137 billion industry. As of this year, the 2,500 Green House residents represent just 0.2 percent of the 1.3 million nursing home residents nationwide. Of the 10 largest nursing home chains in the country, which collectively operate 2,000 facilities, none have adopted the Green House model."
"Although the coronavirus has ravaged many long-term care facilities, small group homes are seeing success in minimizing effects of the virus. To date, at the two St. John's Penfield Green House homes in Fairport, New York, where Boland and DiSalvo work, the number of COVID-19 cases among residents is zero."
"Green House homes are perhaps the ideal setting in which Elders live meaningful lives, where staff are empowered to provide high quality care, and given their physical design and focus on quality and data, the ideal setting to reduce the transmission of infectious diseases. Preliminary analyses here indicate that residents fared better in Green House homes, compared to traditional nursing homes (but not staff). Legislation at the federal and state levels could be introduced to incentivize the development of additional Green House homes–even encouraging their construction as the industry standard–including higher Medicare and Medicaid reimbursements and lifting the moratorium on new nursing home construction (in states like Florida, for example) exclusively for Green House home construction."
"Simpson was in particular discussing the development of cottage-style nursing home developments, a model exemplified by the Green House Project — a non-profit that supports the construction of post-acute and long-term care campuses that feature multiple small buildings housing low numbers of residents, each in their own rooms ... The model has gotten increasing attention — and glowing press — during the COVID-19 pandemic, as facilities built on Green House principles experienced substantially fewer COVID-19 infections and deaths than their traditional institutional counterparts."
“And many advocates tout the Green House model, a small-homes approach in which 10 to 12 residents get their own private rooms and bathrooms with access to an open kitchen and common area. ‘It’s much, much more home-like,’ Grant said. A June report showed that 95% of Green House facilities had stayed COVID-19-free between early February and late May, while cases and deaths among residents and staff were lower compared to national nursing-home data.”
"What design/architecture trend in senior living design do you think is right for the sector? Dillard: "'Compartmentalization’” used to be a dirty word in senior living communities. Now, it literally saves lives. The kindest and gentlest template for compartmentalization is the small house or neighborhood concept, where subcommunities of 12-16 residents are gathered into neighborhoods, each with its own kitchen, living spaces, and back-of-house functions. The Green House Project has collected statistics that demonstrate dramatically better results in disease control inside communities built under these guidelines in contrast to the conventional models where more people share more spaces.”
"Over the last decade, the medical practice of elder care has come to recognize the importance of well-designed housing as foundational to the well-being of the elderly. Leading geriatrics doctors such as Dr. Bill Thomas have founded initiatives such as the Eden Alternative and the Green House Project which recognize that “human well-being” encompasses more than what is clinically measurable. These initiatives have brought a semblance of autonomy and a sense of “home” back to these elderly facilities. The concept of de-clinicalizing end-of-life care and understanding the need for elderly residences to have a home have become a driving vision for recent work in geriatrics and hospice care."
"'When I think of good infection control, I think this model was made for this moment,'” said Susan Ryan, senior director of the Green House Project, adding that home design and outdoor access, as well as early adherence to federal and local health guidelines, have aided many of its locations in curbing the spread of the virus. Ryan said that Green House staff members see their role as advocates for residents."
"Alternative designs have been in the works, such as the Green House Project, founded by innovator and anti-ageism advocate Dr. Bill Thomas. The nonprofit organization facilitates development and operation of facilities with small, home-like environments and more stimulating staff and social interaction. There are close to 250 Green House Project locations across 32 states, and only a small fraction have reported positive cases of COVID-19."
“We have ageism and we have racism and that has had a tremendous impact on what we’re seeing. As a society we have accepted what some call warehousing. We have almost dehumanized elders, they have been the Other,” says Ms. Ryan of the Green House Project. She adds: “If we don’t take this pandemic and learn from it, shame on us.”
"As part of the Green House Project, a network of clinicians and caregiving executives who are creating (or restoring) high‐quality environments and services for older adults, Berman understood immediately the importance of the idea. The two worked together to find the philanthropic funding, the architects, and the software engineers to bring Steve’s vision to life. Those years of planning were difficult; “smart” home appliances had yet to come to the mainstream market. But Saling House opened its doors in 2010; in 2016, a second residence followed."
"The advantages of thinking smaller can be illustrated by the Green House Project, a national organization founded in 2003 that has created a network of 300 intimately scaled residential alternatives to nursing homes. Every Green House home has 10 to 12 residents, with each resident having a private room and bathroom."
"We can also embrace an alternative model, called the Green House Model, where instead of housing, say, 240 people in a big tower, you have individual homes with about 12 people per home. Each person has their own bedroom and bathroom, and the group shares a kitchen and a living area."
Ryan recently joined SNN’s “Rethink” podcast to discuss the challenges of turning Green House dreams into reality, as well as to issue a warning that the nursing home industry at large cannot waste the opportunity to permanently reshape the landscape for a post-COVID world “If we can’t get honest about why we’re here, and what we need to do to impact the next generation that you’re talking about, shame on us,” Ryan said.
"Replace aging and outdated facilities, particularly in low-income communities. Moving forward, nursing homes and other institutional settings should be smaller, with single-occupancy rooms and low staff-to-resident ratios (see, for example, the Green House Project). Environments that offer a more homelike setting can help with infection control and can lead to better health outcomes for residents with Alzheimer’s disease and other dementias. These efforts can be accelerated by strengthening federal and state standards on nursing home size, room occupancy, and minimum staffing ratios."
"Researchers gathered coronavirus data from more than 3,200 seniors residing in 300 Green House homes between Feb. 1 and May 31. They found that COVID-19 cases remained low among both residents and staff and that the homes had a lower mortality rate from the virus compared to nursing homes overall."
"Ninety-five percent of Green House homes reported zero cases COVID-19 among residents or staff, according to a study of coronavirus data gathered from February 1, 2020 through May 31, 2020. This information reflects nearly 300 Green House Homes and over 3,200 seniors residing in those homes. The data below provides additional perspective on these findings."
"My hope would be that this is a profound wake-up call and an opportunity for policy makers, regulators and society at large to take a look and see that we’ve been warehousing [the elderly] for a long time. This pandemic has shone a light that we never had before. We need to establish a coalition of stakeholders – policy makers, regulators, providers -- and tap into their expertise for what could work. We need to ensure we are looking at this systemically and that we don’t endeavor to apply quick fixes to make it better. We need to think about how did we get here and why did we think warehousing was OK?"
"Here’s what we know: We know that the model is exceptionally attractive to consumers. Occupancy at Green House is essentially 100%. We know that academicians have studied the model and [found] much lower percentages of antipsychotics and unexplained weight loss and wounds and hospitalizations — and oh, by the way, infections."
“‘I’ve seen people come from traditional nursing homes and they start eating again, they start walking again and they start talking again,’ says Steve McAlilly, one of the founders. The Green House consists of ten homes, each with 10-12 housemates. There are no vinyl floors, no dinners on trays and no bingo. ‘Do you have planned activities in your home?’ asks Mr McAlilly. ‘If it isn’t in a home it isn’t in a Green House.’ Bill Thomas, an American geriatrician who founded the Green House movement in 2003, calls himself a ‘nursing home abolitionist’ and says he is guided by two principles: ‘It is better to live in a house than a warehouse,’ and ‘People should be the boss of their own lives.’ Care homes that follow the Green House model now exist in more than 30 American states.”
"Repeatedly, in discussions about what went terribly wrong, experts have pointed to the need for a continuum of care and for new models of nursing home care to be introduced in Ireland, such as the Eden Alternative or the [G]reen [H]ouse model. There is nothing that new about these models or indeed recommendations for their introduction. Several have been in existence across Europe since the late 1980s."
“Once the smoke clears from all this, we may see that the Green House community and small house models were more effective in preventing COVID than traditional large-scale nursing homes that were built in the 1960s and ’70s,” said Mr. Heffner. Design issues, he said, could well become part of the larger conversation."
"Now is the time to change facility requirements to gradually limit participation in the program only to facilities that provide the following: Small home-like facilities Single rooms and bathrooms A flattened, more flexible staff hierarchy with cross-trained staff A culture focused first on residents’ goals, interests and preferences Fortunately, there is already a model for this kind of facility: the nonprofit Green House Project created by Next Avenue Influencer in Aging Dr. Bill Thomas in 2003."
This piece was originally published in Undark and appears here as part of our Climate Desk Partnership. "One national organization, the Green House Project, aims to replace large institutions with clusters of small homes, each housing around 10 to 12 residents, with private rooms and bathrooms and a shared, central kitchen and dining area. Susan Ryan, senior director at the Green House Project, told Undark that the organization has seen a surge in interest since the pandemic began."
The company, a nonprofit that supports a non-traditional eldercare facility model, will convene long-term care experts to share “proven protocols and lessons learned,” according to the organization. Nursing facilities can utilize the information in preparedness, management, and treatment of COVID-19 cases, it said.
"Fortunately, the country has a growing network of miniature nursing homes, certified by the Maryland organization the Green House Project. Typically, this is a cross between a graduate student house-share and a suburban development. Ten or 12 residents, each with a private room, share a sprawling ranch house. They take their meals together, at a long communal table, sharing their lives with a handful of staffers. 'The kitchen is open, so you can see the food being prepared and smell it as it’s cooking,' says Green House’s senior director Susan Ryan."
One national organization, the Green House Project, aims to replace large institutions with clusters of small homes, each housing around 10 to 12 residents, with private rooms and bathrooms and a shared, central kitchen and dining area. Susan Ryan, senior director at the Green House Project, told Undark that the organization has seen a surge in interest since the pandemic began.
“I think a smaller, self-contained, autonomously functioning residence is far better than [one with] long hallways, semi-private rooms or even three- and four-person rooms,” Ryan told SHN. “How much easier is it to contain a virus, and everybody’s got their own room, breathing their own air?”
Better options can help ensure that the tragedy currently unfolding in nursing homes never happens again. Smaller-scale, high-quality group models, such as the Green House Project, provide care in small, self-contained, family-style houses with a small number of residents. Such models could offer one community-based alternative to nursing homes.
“Two years ago, I said: I want to be part of the change, and I want to see more Green Houses,” she said. But in the wake of COVID-19, with grim data showing just how easily the virus and other diseases can spread through a traditional nursing facility, the project has taken on a new significance for Navigator Elder Homes.
"It’s time to really focus on private rooms in nursing homes,” said Karl Pillemer, a gerontologist and researcher at Cornell University. In the Green House model, for example, a dozen residents live in private rooms with homelike common spaces and assigned staff who know them well. This approach has gained ground very slowly, with 268 homes, of more than 15,000 nursing homes nationwide.
But anecdotal reports suggest that private rooms may be having more success at keeping the coronavirus at bay. That is the conviction of the Green House Project, a nonprofit organization that oversees 266 small-house nursing homes. Of the 243 projects that supplied data in early May, eight reported having cases of Covid-19, the disease caused by the coronavirus, and there were no deaths, said Susan Ryan, the organization’s senior director. ‘From a design perspective, this has only reinforced what we thought was a good idea,’ she added.
(Article is a reference to April 30th, 2020 HuffPost article) The article noted that one potential solution may be building smaller facilities, as the spread of infection is greater in bigger ones. These may include more facilities following the Green House Project, a long-term care concept originally developed in 2003. Each Green House has no more than 10 to 12 residents, each of whom has an apartment and bathroom while sharing a common dining area. With two nursing assistants and a nurse for every 10 residents, the Green House concept allows the staff to develop more lasting relationships with residents.
Downsizing current facilities is not as realistic as building smaller new ones. This was one driving force for Steve McAlilly, chief executive office of Methodist Senior Services in Tupelo, Mississippi, who launched the first of what would become a national movement called The Green House Project in 2003.
(Featured: SunPorch of Smith County) Many senior living activities programs ground to a halt when the Covid-19 pandemic forced residents to self-isolate in their rooms starting in March. But in the time since, providers across the country have come up with a range of ways to keep residents entertained and engaged — an effort that becomes increasingly important as the pandemic drags on.
I can't think of a resident who wouldn't prefer living in a small home or a family member who wouldn't choose it over a traditional nursing home.
Lots of things look different when you step into a small Green House nursing home. The bright living and dining space, filled with holiday baubles at this season. The adjacent open kitchen, where the staff is making lunch. The private bedrooms and baths. The lack of long stark corridors, medication carts and other reminders of hospital wards.
When thinking about how we would move forward with our goal of redefining home and revolutionizing long-term care on our campus, we considered several alternative approaches to senior living. We selected the Green House Project as our model since its mission and ideals aligned well with our values of working to ensure that our residents and families thrive in an atmosphere of respect, compassion, and individuality.
By joining forces, community development and health professionals can have a more powerful impact.
Resident choice and autonomy, a homey environment, and well-trained and invested staff are hallmarks of the Green House and similar models that are slowly and fundamentally changing long-term care for Americans who otherwise could be forced into traditional nursing homes.
In today’s skilled nursing environment, diversification of payment sources is critical to success. Organizations catering exclusively to long-term care find themselves grappling with high Medicaid occupancy and the shortfalls it creates. This means that it’s important to add other services to the mix, the most important being short-term rehabilitation that’s paid largely through Medicare.
Green House “has three core values,” says senior director Susan Frazier Ryan, “real homes, meaningful life (culture) and empowered staff (organizational change/human architecture, all of which help an elder live the best life.”
It's a common refrain that adult children hear from their parents: "No matter what, promise that you'll never put me in a nursing home." These seniors obviously have not visited a Green House, a unique alternative to the traditional nursing facility.
Founder of The Green House model, Bill Thomas, believes we are lucky if we get to grow old. That there is a “third” phase of life beyond adulthood that can be as rich as either of the phases that came before.
For greater warmth and nurturing, seniors are turning to small residences like Green House, which is part of a complex of senior housing and care options, and privately owned care homes that are often unmarked in residential neighborhoods. They are usually newer, sometimes cheaper, and generally offer more customized care than most nursing homes.
Leading the way for small-house senior care is the Green House Project, a concept that involves updating traditional nursing care by grouping skilled nursing residents into smaller dwellings of 10 to 12 individuals within cottage-like residences, each with assigned staff that specifically cares for the residents within that particular Green House.
If you haven’t yet heard of the Green House Project, chances are you will soon. Thanks to funding from the Robert Wood Johnson Foundation, there are already more than 170 Green House Project homes in 32 states, with more than 100 more in the works...21st-century Green House Project has been creating specially-designed homes in which elders can live with dignity, comfort and companionship.
Blog summarizes recent feature in The Atlantic that goes into Green House Project, Leonard Florence Center for Living, and demonstrates how long term care can be difference and better.
Susan Frazier, Senior Director of The Green House Project joins other innovators in the field to discuss how changing the way we view aging, and implementing programs to support meaningful lives can impact the world.
Maria is 105 years of age. In her bedroom, the centenarian sits comfortably in a high-back chair with a view of Boston Harbour. Within an arm’s reach is a remote control designed for her with large numbers to enhance independent TV watching. Next to her wall-mounted flatscreen TV is a chalk board with the activities of the week: hairdo every Tuesday, bingo at 2 p.m. every Tuesday and Thursday, communion at 10 a.m. on Sundays, and the times and channels for her favourite TV shows.
Nobody gets excited at the idea of moving to a nursing home. The typical image most of us have of homes for elder care is cold and institutional. That hospital-like environment with long hallways, shared rooms, and seniors dependent on overworked nurses who can only give them a few minutes at a time – that doesn’t have to be the way it works.
The previous column detailed some of the difficulties and failings of traditional skilled nursing institutions and introduced the innovative approach of Bill Thomas’s Eden Alternative and its offshoot, the Green House homes. This column will give more details about the Green House Movement.
Bowers and Nolet previously studied how the Green House model’s unique staff structure affects nursing practice and Elders’ care. More recently, they and other UW–Madison colleagues looked at how Green House Homes maintain culture change practices over time. They also asked how different care practices affect Elders’ clinical outcomes.
"household models do not have to cost more than traditional operations. But to keep the bottom line stable — or even to boost profits — a provider must plan carefully, finance and build smartly, and commit not only to providing care in a new type of environment but in new ways."
“So the question at this point,” Alana Semuels of The Atlantic, writes, “isn’t so much what do good nursing homes look like, but how do you transform the existing institutions into places that look like them?” With one-third of the U.S. population likely to be over 65 by 2050, it’s a question that needs some consideration.
In “A Better Nursing Home Exists,” writer Alana Semuels explores the history of The Green House Project and Leonard Florence Center for Living, their unique ALS/MS residences, and CEO Barry Berman’s vision for his legacy nursing home. “This is not a nursing home with residential trappings,” Steve Saling, a resident living at LFCL with ALS, says. “It is my home that happens to provide skilled nursing services.”
Already 167 Green House homes in the United States have been built by 39 organizations, and 1,735 people are living in them in cheerful surroundings respectful of their needs and wants. Another 108 similar homes are now in development.
Green House Homes are a new model for caring for the elderly that makes sure they’re integrated into the community and puts their care first.
The Green House concept is the most comprehensive effort to reinvent the nursing home, experts say — including the way medical care is delivered.
The white paper “Financial Implications of THE GREEN HOUSE® Model” was announced by the National Investment Center for the Seniors Housing & Care Industry (NIC) as the winner of the GE Award for Best Research Paper from its annual call for applied research papers. The article appeared in the 2011 Seniors Housing & Care Journal and analyzes several recent studies to determine the Green House model’s initial and long-term financial viability.
In 2011, Green House Project was named as one of the “Top Ten Senior Living Design Innovations”
Say goodbye to long corridors, central nursing stations and multiple roommates. In the Green House model, each of the 10 to 12 residents has a private bedroom and bathroom connected to a common dining room, an open country kitchen where all the meals are prepared, a living room, and an indoor porch or backyard.
A model that breaks the mold of institutional care by creating small homes for six to 10 ‘elders’ who require skilled nursing or assisted living care. The homes, which are designed for the purpose of offering ‘privacy, autonomy, support, enjoyment, and a place to call home,’ are a radical departure from traditional skilled nursing facilities and are considered to be the peak of culture change.
The success of the Green House model lies in trading a typical nursing home’s top-down organizational structure for a self-managed team of workers who share the tasks involved in caring for their residents, including housekeeping and cooking. Most important, Dr. Thomas says he wanted to create residences that avoided the loneliness and expense of at-home care and the coldness of an institution.
The foundation's undertaking represents the most ambitious effort to date to turn a nice idea into a serious challenger to the nation's system of 16,000 nursing homes.
At some point in life, you can't live on your own anymore. We don't like thinking about it, but after retirement age, about half of us eventually move into a nursing home, usually around age 80. It remains your most likely final address outside of a hospital. To the extent that there is much public discussion about this phase of life, it's about getting more control over our deaths (with living wills and the like). But we don't much talk about getting more control over our lives in such places. It's as if we've given up on the idea. And that's a problem.
The nursing home where Reinhard lives is known as a Green House, and it could be a model for the long-term-care institution of the future.
"At the center of the Green House is quality of life — meaning worth and dignity. At the Green House, we put those things at the center of life."
Local News Items
"According to preliminary project plans, the hospital, in partnership with Navigator Elder Homes of New England, wants to build an approximately 70-bed skilled nursing facility using the Green House elder home model. The project, which is expected to cost some $34 million, would also include 60 beds of workforce housing."
"Lutheran received a $5.9 million state grant for the project, with an additional $1.5 million from foundations. Lutheran is expected to invest more than $15 million in the estimated $22 million project ... Each house would be 8,000 square feet, with shared space like a kitchen, dining room and living room. With the additional 48 beds in the new proposed facilities, the main facility on the Lutheran campus would be reduced to 100 beds."
A new nursing home that’s only the sixth of its kind in Arkansas is close to being completed. “No one can plan for a pandemic, but they did a great job of doing that and we’re still right on schedule for a late fall open and we’re proud of that,” vice president of strategic operations John Montgomery said. “We’re ready to offer this to the elders and the community of Northeast Arkansas and Walnut Ridge.”
"In the Green House Cottages, elders live in a home-like environment. In contrast to traditional nursing homes with long hallways lined with rooms, the facility is made up of small cottages with private suites surrounding a common living area. The existing building will be renovated to become exclusively private rooms. With the four new cottages, the facility will total 64 beds; there are 12 rooms for elders in each cottage."
“The elders are happier in this atmosphere,” stated Rhonda Hall, registered nurse at Green House Cottages. 'What you’re doing is observing them on a more personal level and interacting with them more. You can see the changes more readily. This is as much of a home atmosphere as we can attain while being (in) a medical setting.'”
"Unlike a typical nursing home setting, the Leonard Florence Center consists of 10 7,000-square-foot condominium-style “homes” on six floors that care for both short- and long-term care residents. Many previously on ventilators have amyotrophic lateral sclerosis, a progressive neurodegenerative disease. It’s called a “Green House” model of care because each home has 10 private rooms with comfortable furniture and private baths that are grouped around a common living area with a fireplace, open kitchen, and dining room with access to other amenities."
"Staff teams work collaboratively at the Green House Homes to give personalized care to elders while fostering their continual progress. Nursing staff and universal workers have had an additional 120 hours of training to provide total care to elders. The residents work alongside caregivers to develop a routine that suits their individual development. The elders living at Jefferson Place’s legacy building typically move into the Green House Homes as rooms become available."
"TRU Community Care created a “hug tent” on Friday for residents at the Hover Green Houses senior living community so their loved ones could embrace them, in some cases for the first time since the coronavirus pandemic began. The team behind the idea first saw it in Brazil and then in other places across the U.S. before bringing it to Colorado."
“We believe that everyone in Arkansas should have access to the best long-term care that can be designed. That’s why with this announcement in Walnut Ridge we are also declaring our vision that a Green House Cottage facility should be no more than 60 miles from any community and any family in Arkansas.”
"The panelists noted that small home designs are much better equipped to deal with the pandemic than larger environments and have fared much better than their counterparts in the mitigation of COVID."
"The number of Green House facilities is small, with just over 300 facilities in several states, but we have enough information about their operations and costs to know that they can provide more effective, human-scale environments to help residents flourish than the traditional large nursing home model, while remaining affordable."
"Despite its size and variety of housing arrangements, Rest Haven of Holland has stayed clear of coronavirus in all three levels of care it provides for 145 seniors in its skilled nursing home; 61 in independent living; 117 in two assisted living buildings; and 20 in two homes built with the philosophies of the Green House Project. Green House is a national nonprofit that encourages small housing units, separate bedrooms, a family-like dining space (replaced during the pandemic by food service in rooms) and a staff well-familiar with residents."
Phillips said the entire staff and residents at the Green House Cottages of Southern Hills were tested in June, which was the second time they have been tested this year. She said all tests came back negative.
There have been a number of innovative models that have embraced this culture change in the U.S., Europe, Australia and recently in Ontario. Examples of these are the Eden Alternative, Green House Project, Butterfly Homes and Hogewey Villages.
The Green House model was first developed by Bill Thomas, a geriatrician who re-envisioned what home care means for elders. Instead of housing elders in a close-quarters space, the Green House model orients home care toward independence and freedom, while providing the optimum level of assistance. Each home has a large living area surrounding a hearth for congregating and activities, and individual residents have access to a large, screened-in porch.
“If I were going to do something different, I would have a nursing home that had enough staff around the clock, all the time,” said Wright, standing next to Dr. Danny Avula, director of the Henrico and Richmond Health Districts. “I would have a nursing home where everyone had private rooms. I would have a nursing home where there was greater access to the outdoors.”
The purpose behind these homes is to cause elders to feel at home through safe and living environment and through the Shahbaz’s care, love and support.
An expansion project will begin this week at Longmont‘s Hover Senior Living Community that aims to add affordable, full-time skilled nursing care in a non-institutional setting.
Most cutting-edge nursing homes belie the stereotypes about them anyway. But now the Jewish Home at Rockleigh, one of those cutting-edge places, plans to change its residents’ lives by creating homes inside the institution, so that residents can have the advantages of both.
Also in April, two Green House Project homes were dedicated — Honor and Valor. That makes four 10-resident homes on the west side of the VA campus. The facilities offer a home-like atmosphere.
“You can wake up when you want to. You can eat breakfast when you want to, you can eat what you want to when you want to and the staff are here to provide that for you and to help you continue to live your life in the last chapters of life," said Tanya Detweiler.
This year, the couple’s most recent tree stands in the entryway at Valor Home, one of four Green House buildings with a home-like atmosphere for veterans. Valor, which can accommodate 10 veterans, is dedicated to short-term rehabilitation.
Mirasol has added six homes to its senior living community based on a new model of skilled nursing. The "Green House" homes are a smaller, more resident-driven and are intended to make residents feel as though they are living in a home, rather than institution. The housing authority is looking at building three more of these types of homes in 2018.
The green house model “brings nursing care into a real home, where 24/7 nursing care is provided employing cross trained certified nursing assistants, nurses and physicians and other specialists including a social worker, dietitian and physical and occupational therapists,” according to a news release.
THE GREEN HOUSE Homes at Saint Elizabeth Home in East Greenwich are open! These are the first new nursing homes to open in RI in over 25 years. The Rhode Show is WPRI 12's daily lifestyle show for having fun, eating well, and living life.
Priest helps seniors contribute to society while working to reduce and eliminate loneliness, boredom and helplessness.
When JGS Lifecare launched the strategic plan five years ago that would become Project Transformation, the goal was to, well, transform the organization’s entire range of senior services to reflect 21st-century ideas about delivering care in a resident-centric way. The Sosin Center for Rehabilitation, the highlight of the project’s first phase, is a good example, employing the burgeoning Green House philosophy, a model aimed at making residents feel at home while achieving the independence they need to return to their own homes.
About 200 people gathered at JGS Lifecare on Thursday morning for a ribbon cutting ceremony for the Sosin Center for Rehabilitation.
The Woodlands at John Knox Village, Florida’s first Life Plan Community Green House Project, opened in May 2016.
The much-anticipated grand opening for the new Washington County Nursing Home was celebrated Tuesday, September 13. A ribbon cutting, held by the Akron Chamber of Commerce in front of the new homes.
The community is located in Chelsea, Massachusetts and run by the Chelsea Jewish Foundation; it currently has 10 Green House-style skilled nursing residences with 10 bedrooms each. Two of the Green Houses are built for people living with amyotrophic lateral sclerosis (ALS), and one is specifically equipped for residents living with multiple sclerosis (MS).
In preparation for the new Green House homes, educators were chosen for both initial and ongoing staff education.
Some three years after first conceiving of a multimillion-dollar project to remake its Brighton campus, Jewish Senior Life is slated this month to break ground on its Green House initiative...the project plans to build nine residences at an $83 million cost.
The Woodlands at John Knox Village, Florida’s first Life Plan Community Green House® Project offering a new model of care for living and healing, celebrated its grand opening
"We’ve always had a great reputation for delivering superior care in our organization,” CEO, Mike King says. “Now we’re really making a major paradigm shift, where we’re saying that we’re going to put the quality of life of our residents up there right alongside the quality of care that we’re delivering.”
Video tour of Green House homes in Kalkaska, MI. 2 Green House homes celebrated their grand opening on January 6
In this case, a trip to Falmouth on the Cape in September of 2009 became the genesis to a new form of nursing home care that is expected to become a reality in 14 months at Saint Elizabeth Community.
For the first time since Rhode Island imposed a moratorium on additional nursing home beds nearly 20 years ago, a state-approved project is getting under way in East Greenwich to create a cluster of small, communal-style buildings for 48 seniors. On Tuesday, a ground-breaking ceremony will be held for four scaled-down nursing homes to be built by Saint Elizabeth Home on Post Road. Each will have 12 private bedrooms with private bathrooms. They will surround a central living space that includes a kitchen, dining area and hearth.
"Lawrence Township now has the distinction of having the first Green House® homes in central New Jersey," Hanley said to rousing applause.
Clark-Lindsey in Urbana, IL, has partnered with The Green House Project and architecture firm Perkins Eastman to create small homes for specialized dementia care
In a Green House Project home, though, dementia care is designed to look and feel like it's being delivered in a real home, all the way down to the home-cooked meals. Urbana's Clark-Lindsey Village will be the third site in Illinois to add Green House Project homes, with two other Green House locations at VA health centers in Danville and Chicago.
Roughly 60 people attended the groundbreaking. Among these individuals were representatives from GH Phipps, the company building the nursing home; residents and staff from the nursing home; and members of the Washington County Nursing Home Board.
U.S. News & World Report awarded Buckner's two Green House homes with a four-star rating in its annual Best Nursing Homes issue.
“The Homeplace at Midway represents a new beginning for older adults in Kentucky and for communities across the commonwealth to embrace them as living treasures, not a burden or a challenge,” Dr. Keith Knapp, president and chief executive officer of Christian Care Communities, which built the Homeplace and will operate it, said at the ribbon-cutting ceremony.
Texas Dept of Aging and Disability Services highlight Fred Worley and his dedication to good design for Elders and their community. Check out this great article highlighting his career and the Green House Homes he designed at Buckner Senior Living Baptist Memorials in San Angelo, Texas!
“the Green House model provides a natural environment that promotes a meaningful experience with elderhood and the later stages of life. The Green House model is a de-institutionalization effort that restores individuals to a home in the community with the full range of personal care and clinical services expected in high-quality nursing homes.”
, Episcopal Homes of Minnesota has opened the doors of The Gardens, Minnesota’s first nursing home designed around the Green House Model of Care.
The Gardens is the state’s first nursing home to implement the innovative Green House model of skilled nursing care. A Green House home is created to foster the same feeling and experience as living in a real home.
Dubbed “Cottages of Lake St. Louis,” the community will be comprised of six homes, each of which will house 10 residents. Each will be about 7,149 square feet, for a total of 42,894 square feet.
Construction was completed for The Woodlands at John Knox Village and the milestone was celebrated by residents and staff at an April 28 topping-off ceremony—complete with the traditional placing of a tree on top of the structure.
How the Green House model transformed one woman’s life and an overview of how the Green House Project has grown, its model and why its unique, also noting the recognition it received in the “Homes on the Range” film.
The article reports that the Ave Maria Home is tied for first-place health care facility, which is a member of the national Green House Project.
Profiles the work of Noel Auld, an employee of Jewish Home Lifecare, which is partnering with the Green House Project to build The Living Center of Manhattan.
Opportunities for people to hear from experts on aging, including an upcoming presentation by Bill Thomas “ChangingAging: Challenging Conventional Views on Aging.”
An article reports on the new Green House home that will be built in Janesville, Minnesota, and comments on how the new home will impact local residents
An article dedicated to Dr. Bill Thomas chronicles his journey leading up to the inception of Green House, shares his philosophy on aging and positions him as a leader and innovator in the industry.
An opinion article argues for a change in nursing home structure in Chesire County, naming Green House as a successful model that should be implemented.
In his coverage of the Audobon Christmas Bird Count, the author mentions that a bird path was installed behind Green House homes for residents to use
The author describes how he met Dr. Bill Thomas and why Cheshire County should adopt the Green House model to better care for their elderly.
The author provides an overview of the GHP model and how it can improve elder care: “On the other hand, the Green House concept, which started more than a decade ago and now has facilities in 30 states, is transforming the culture of long-term care.”
Details on the opening of a Midway Nursing Home which is based off the Green House Model to create a home-like environment
WRVO Public Media’s recent community forum on the topic of aging, referencing panelist Dr. Bill Thomas’ input, who is described as an “innovator in senior housing.”
The Paralyzed Veterans of America’s experience with GHP and the growing support of its innovative model: “The Department of Veterans Affairs and nursing homes across the country are beginning to embrace the Green House model of care that focuses on the dignity, health and independence of patients as well as the well-being of medical staff and caregivers."
Coverage of the premiere viewing of “Homes on the Range” in Sheridan, a documentary detailing the planning and building of Green House Living homes for elders in Sheridan.
Report on the approved plans for a Green House nursing home in Ozark as “part of the nationwide move designed to make nursing homes less institutional.”
Report on the opening of the second of six Loveland Green House Homes, describing the model and the improvements it makes for residents.
Announcement of Dr. Bill Thomas’ upcoming speaking engagement at the UNR's Division of Health Sciences and details some of his successes.
Review of the documentary “Alive Inside” including quotes from those who attended a Modesto screening and Dr. Bill Thomas on the positive impact music has on nursing home residents.
In his review of Gawande’s book, the author mentions the section on “nursing home pioneer” Bill Thomas and the improvements he made to a New York nursing home.
In 2012, VA Illiana received national recognition for their planning and implementation of the Green House model through a federal award by the Under Secretary of Health for Innovation in Long Term Care.
Buffalo News reprints the New York Times article spotlighting Green House.
Spotlights the Loveland, Colorado, Green House home, highlighting the positive features of the homes and sharing insight into what makes Green House a different, innovative model.

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