As OIG Calls for ‘Significant Changes’ to Nursing Homes, Small Homes Are the Answer

Providers, policymakers can take concrete steps today to improve system

Linthicum, Md., January 20, 2023 – After a federal report this week recommended “significant changes” to the nursing home system after the failures of the COVID-19 pandemic, the Center for Innovation (CFI) calls on both policymakers and providers to clear the path for the development of small-home alternatives backed by decades of research.

The HHS Office of the Inspector General found more than 1,300 nursing homes with COVID infection rates of 75% or more during the severe outbreaks of 2020, with mortality rates reaching 20%.

The January 19 report marks the latest in a string of analyses showing the deep systemic problems that put residents of nursing homes at risk during the pandemic.

But policymakers and providers have a host of evidence-based answers to the call for change. As early as July 2020 – months before mass vaccination helped to curb the spread of the virus in communal care settings – researchers from the University of North Carolina found substantially lower COVID-19 infections and deaths in Green House homes than in traditional facilities.

Since 2003, Green House homes have provided vital alternatives to hospital-style nursing homes, with all private rooms and bathrooms, dedicated outdoor space, and an elder-directed care philosophy that puts residents’ needs, wants, and abilities at the center of every decision.

“Green House/small nursing homes are a promising model of care as nursing homes are reinvented post-COVID,” the UNC researchers concluded.

Internal data compiled by the Center for Innovation, the non-profit parent of The Green House Project, reinforced those early findings: In 2020, Green House homes recorded half of the COVID-19 infections of traditional homes, with even fewer cases than the national average in 2021.

“The time for reports and recommendations is long over,” CFI CEO Susan Ryan said. “We know what works: Small homes with private bedrooms and bathrooms aren’t just good for infection control, but they also provide superior dignity and quality of life than outdated, institutional-style nursing homes.”

Policymakers can encourage the development of Green House homes through a range of levers, including:

  • Targeted state-level Medicaid rate increases to encourage new development
  • Lending incentives from HUD, which already backs billions in loans for traditional nursing homes
  • Capital grants, such as those proposed in the federal IMPROVE Nursing Homes Act
  • The gradual phase-out of shared rooms and bathrooms through changes to the federal Requirements of Participation for Medicare and Medicaid
  • Finally implementing Section 6114 of the Affordable Care Act, which requires the development of a national demonstration project on culture change in nursing homes
  • Operationalizing the recommendations from the 2022 NASEM report on nursing home improvement

“Transforming our broken eldercare system may seem daunting, but we have the tools to create real change at our fingertips,” Ryan said. “Elders and caregivers can’t wait for more retrospective reports and suggestions. We must take action, and we’re ready to help policymakers and providers every step of the way.”

About the Center for Innovation
CFI is the new home for both The Green House Project and Pioneer Network, two leading organizations dedicated to changing the design and culture of eldercare in the U.S. and around the world. Learn more at https://thegreenhouseproject.org/pioneer-alliance/.

Media Contact
Alex Spanko, Director of Communications
aspanko@thegreenhouseproject.org
516-587-2097

Press Releases

  • Providers, policymakers can take concrete steps today to improve system Linthicum, Md., January 20, 2023 – After a federal report this week recommended “significant changes” to the nursing home system after the failures of the COVID-19 pandemic, the Center for Innovation (CFI) calls on both policymakers and providers to clear the path for the development of small-home alternatives backed by decades of research. The HHS Office of the Inspector General found more than 1,300 nursing homes with COVID infection rates of 75% or more during the severe outbreaks of 2020, with mortality rates reaching 20%. The January 19 report marks the latest in a string of analyses showing the deep systemic problems that put residents of nursing homes at risk during the pandemic. But policymakers and providers have a host of evidence-based answers to the call for change. As early as July 2020 – months before mass vaccination helped to curb the spread of the virus in communal care settings – researchers from the University of North Carolina found substantially lower COVID-19 infections and deaths in Green House homes than in traditional facilities. Since 2003, Green House homes have provided vital alternatives to hospital-style nursing homes, with all private rooms and bathrooms, dedicated outdoor space, and an elder-directed care philosophy that puts residents’ needs, wants, and abilities at the center of every decision. “Green House/small nursing homes are a promising model of care as nursing homes are reinvented post-COVID,” the UNC researchers concluded. Internal data compiled by the Center for Innovation, the non-profit parent of The Green House Project, reinforced those early findings: In 2020, Green House homes recorded half of the COVID-19 infections of traditional homes, with even fewer cases than the national average in 2021. “The time for reports and recommendations is long over,” CFI CEO Susan Ryan said. “We know what works: Small homes with private bedrooms and bathrooms aren’t just good for infection control, but they also provide superior dignity and quality of life than outdated, institutional-style nursing homes.” Policymakers can encourage the development of Green House homes through a range of levers, including: Targeted state-level Medicaid rate increases to encourage new development Lending incentives from HUD, which already backs billions in loans for traditional nursing homes Capital grants, such as those proposed in the federal IMPROVE Nursing Homes Act The gradual phase-out of shared rooms and bathrooms through changes to the federal Requirements of Participation for Medicare and Medicaid Finally implementing Section 6114 of the Affordable Care Act, which requires the development of a national demonstration project on culture change in nursing homes Operationalizing the recommendations from the 2022 NASEM report on nursing home improvement “Transforming our broken eldercare system may seem daunting, but we have the tools to create real change at our fingertips,” Ryan said. “Elders and caregivers can’t wait for more retrospective reports and suggestions. We must take action, and we’re ready to help policymakers and providers every step of the way.” About the Center for Innovation CFI is the new home for both The Green House Project and Pioneer Network, two leading organizations dedicated to changing the design and culture of eldercare in the U.S. and around the world. Learn more at https://thegreenhouseproject.org/pioneer-alliance/. Media Contact Alex Spanko, Director of Communications aspanko@thegreenhouseproject.org 516-587-2097

  • Former Pioneer board members to bring national, international perspective LINTHICUM, Md., January 19, 2023 – The Center for Innovation, Inc. (CFI) today announces the addition of Jessica Luh Kim and Thomas Gilmartin to the non-profit’s board of directors as the integration of The Green House Project and Pioneer Network teams continues. Kim and Gilmartin had previously served as executive members of Pioneer Network’s board, holding the respective roles of secretary and treasurer. “CFI is the new hub for changemakers and innovators, and we’re both honored and excited for Jessica and Tom to bring their unique experience, expertise, and perspective to our work in the years ahead,” CFI board chair Michele Holleran said. “Pioneer’s legacy of infusing person-directed care practices into all types of communal care settings – particularly through building grassroots coalitions of elders, caregivers, and those who care about them – is a cornerstone of CFI’s mission. Jessica and Tom are vital custodians and champions of that legacy.” Kim currently works as an independent consultant to senior living providers in Canada and the United States, drawing on her extensive experience in the field with the Ontario Retirement Communities Association, Schlegel Villages, and the Murray Alzheimer Research and Education Program at the University of Waterloo. “I’m excited to serve on the CFI board and support the coming together of two amazing organizations,” Kim said. “I look forward to what the future holds and grateful to be part of this new beginning.” Gilmartin is the chief financial officer for National Health Care Associates, Inc., an organization focused on providing short-term rehabilitation, skilled nursing, and post-acute care in six states within the Northeast. He has spent the majority of his career in the senior care sector, including senior housing and home- and community-based services (HCBS). “I am grateful for this tremendous opportunity to work collaboratively with other exceptional leaders from our industry as CFI advocates for systemic change,” Gilmartin said. “I look forward to working with like-minded leaders and organizations as they migrate from an institutional model of care to a more meaningful and rewarding home-based model of care.” The Green House Project and Pioneer Network formally combined under the CFI banner in 2022. “Together we will go farther than we ever could have separately, and the addition of Jessica and Tom to our board is proof of how this combination makes us stronger,” CFI CEO Susan Ryan said. “They bring years of experience in both the theory and practice of elder-directed care to the CFI board, and I’m eager to call on their counsel and vision for the work ahead of us.” About The Center for Innovation To learn more about the Green House-Pioneer alliance under CFI, visit https://thegreenhouseproject.org/pioneer-alliance/. Media Contact Alex Spanko, Director of Communications aspanko@thegreenhouseproject.org 516-587-2097

  • Green House, Pioneer Merge Executive Teams to Oversee Future Growth LINTHICUM, Md., November 28, 2022 – The Center for Innovation, Inc. (CFI) today announced a combined leadership structure for the newly allied Green House Project (GHP) and Pioneer Network, with executives from both organizations taking on new roles to oversee the continued growth of the long-term care reform groups. Susan Ryan will serve as the Center for Innovation’s first CEO, bringing her 35 years of experience in eldercare reform – with more than a decade at The Green House Project – to the top position. Ryan was most recently GHP’s senior director. Penny Cook is now the chief culture officer for CFI, with direct oversight of external relationships – including Pioneer’s nationwide network of state-level leaders and volunteers, as well as the LinkedUp peer network of Green House adopter organizations. Cook had previously served as president and CEO of Pioneer Network. Marla DeVries is the new chief learning officer for CFI, spearheading the non-profit’s internal and external education programming – including workforce development training, person-directed living certification, and leadership coaching classes. DeVries previously held the same position at GHP. Colleen Kammar will serve as the CFI’s chief financial officer, continuing a role she previously held at GHP. “CFI is the new home for eldercare transformation in all settings and for all elders, regardless of where they call home,” CFI board chair Michele Holleran said. “This new leadership structure will strengthen the existing power of the Green House and Pioneer brands while also expanding our reach – and deepening our impact – as we look to create new solutions for the entire continuum. Whether it’s nursing homes, assisted living communities, home- and community-based services, or anything in between, CFI will be at the forefront of person-directed living.” Taken together, the moves kick off a new era in the movement to bring true cultural and physical change to the eldercare system in the United States and around the world. “Seeing GHP grow to include more than 370 homes across 32 states has been a high point of my career, and I can’t wait to see where this team will take our mission into the future,” Ryan said. “This leadership team will honor the legacies of Green House and Pioneer while building on our experience, knowledge, and passion to blaze new trails in eldercare improvement and reform.” “GHP and Pioneer are all about culture – both in terms of transforming the culture of long-term care and harnessing the spirit of the individuals who have come together to demand better services and supports for elders and their families,” Cook said. “It’s my honor to serve as the custodian of that culture. I look forward to strengthening the GHP and Pioneer networks while welcoming new leaders, providers, advocates, and volunteers into our movement.” GHP and Pioneer announced a formal alliance earlier in 2022, with CFI serving as the parent organization of both groups. The new leadership structure was approved by CFI’s board of directors earlier this month and takes effect immediately. To celebrate the alliance and kick off this new era in eldercare transformation, CFI will host its first annual conference in Pittsburgh from July 23-26, 2023. For more information, visit thegreenhouseproject.org/2023-conference. Media ContactAlex SpankoDirector of Communicationsaspanko@thegreenhouseproject.org516-587-2097www.thegreenhouseproject.org

  • LINTHICUM, Md., October 17, 2022 – The GREEN HOUSE® Project (GHP) and Pioneer Network today announce the expansion of the Green House trademark to bring their flagship model of small-home care to more elders in more communities across the country. GHP granted approval to The New Jewish Home of New York City to use the Green House trademark on a new care community currently under development in Manhattan, becoming the first eldercare operator to undergo the updated trademark approval process. “For many years, providers have expressed a desire to adapt the Green House model to their communities’ unique needs, from land-use challenges to capital constraints to local regulatory issues,” Green House Project senior director Susan Ryan said. “This new approval process is the result of intensive work by our model integrity experts to ensure the correct balance between adaptability and adherence to the principles that set Green House homes apart from traditional hospital-style facilities.” The move comes as Green House and Pioneer officially reorganize under the banner of the Center for Innovation (CFI), a non-profit that will serve as the new central address for eldercare solutions. The Center for Innovation now provides a host of services for eldercare providers of all types, including: Workforce education and development support Green House home development Cultural transformation for traditional nursing homes and assisted living communities Memory care consultation The 174-year-old non-profit The New Jewish Home will use the Green House trademark on a new Rehabilitation and Community Healthcare Center, applying the small-home concept to a unique post-acute care community in Manhattan. Once opened, the community will be the first purpose-built Green House community exclusively designed for post-acute care, providing the latest equipment and technology, advanced infection control, and beautiful outdoor green spaces. “We are excited to partner with The Green House Project to enhance the clinical care we will provide at our state-of-the-art Rehabilitation and Community Healthcare Center,” said Dr. Jeffrey Farber, president and CEO of The New Jewish Home. “As we begin planning for what will be a tremendous resource for older adults looking to get well and go home, this collaboration means a commitment to revolutionizing the standard of care not only for our organization, but for others across the country.” CFI has compiled a list of frequently asked questions on the new trademark process and will be exhibiting at booth 1429 at the LeadingAge Annual Meeting + Expo in Denver from October 17-19. “We’re so pleased to welcome this new addition into Green House network, and we will continue to work with The New Jewish Home to help them provide top-quality care in these innovative Green House homes,” Ryan said. Media ContactAlex SpankoDirector of Communicationsaspanko@thegreenhouseproject.org516-587-2097www.thegreenhouseproject.org

  • LINTHICUM, Md. and ROCHESTER, N.Y., September 6, 2022 – The Green House Project (GHP) and Pioneer Network applaud the introduction of the IMPROVE Nursing Homes Act (H.R. 8677), legislation that would overhaul the nation’s outdated nursing home infrastructure and bring small-home care to 250,000 more Americans before the end of this decade. Introduced last month by Rep. Jan Schakowsky of Illinois, the bill would create a federal grant program to fund the development of small-home nursing communities with private rooms and bathrooms, easily accessible outdoor space, and fully elder-directed programming. “We are humbled and honored to see Green House and Pioneer principles take center stage in this proposed federal grant program,” Green House Project senior director Susan Ryan said. “The future of eldercare is small and elder-directed, and we want to work with advocates, policymakers, and officials across the country to make that a reality.” Crucially, the proposed grant program would also include strong oversight to ensure that operators use the grant funding for its intended purposes and provide elder-directed care services for years to come. “Creating a real home for elders, no matter their abilities, isn’t just about bricks and mortar,” Pioneer Network CEO Penny Cook said. “It’s about responding to their needs and giving them continued autonomy, making elder-directed principles a crucial part of any reform effort.” Research has shown that the Green House model – in which elders live in small homes of no more than 12 residents – provides superior quality of life, health care outcomes, and infection control for elders when compared to traditional nursing facilities. “America’s elders deserve high-quality care in the setting of their choice,” Ryan said. “For those who prefer or require care in a communal setting, the Green House small-home model is the gold standard.” Green House and Pioneer also thank the diverse group of reform and resident advocacy organizations – the Center for Medicare Advocacy, Justice in Aging, the Long-Term Care Community Coalition, and the National Consumer Voice for Quality Long-Term Care – for endorsing the legislation. Media Contact Alex Spanko Director of Communications aspanko@thegreenhouseproject.org 516-587-2097