New Research Illustrates Green House Model’s Resilience to COVID-19

As long-term care providers look to reinvent their models in a post-COVID world, Green House and small house nursing homes “are an especially promising model,” according to a study published online on Jan. 25 in JAMDA, the Journal of Post-Acute and Long-Term Care Medicine.

Titled “Nontraditional Small House Nursing Homes Have Fewer COVID-19 Cases and Deaths,” the study found that nursing homes created under Green House and small house models have significantly fewer cases and deaths from COVID-19 than traditional nursing homes do, including those with less than 50 beds and more than 50 beds, especially among the higher and extreme values.

The study analyzed data from Green House/small house homes and compared it to data from the Centers for Medicare & Medicaid Services for traditional nursing homes between Jan. 20, 2020, and July 31, 2020.

Researchers noted that Green House/small house homes “are beneficial above and beyond the mere benefit of size, perhaps due to their private bedrooms and bathrooms, limited ancillary staff, and fewer admissions.” Also noted is the potential advantage that small size homes offer elders with regard to psychosocial well-being. “Families may be more able to have socially distanced outdoor visits, and having consistent, universal staff may allow for the maintenance of social relationships,” the paper states.

“One of the things that most passioned me about studying the Green House model and COVID-19 is that it was a slam dunk to think this is a model of care that probably has fewer infections because they’re smaller, with less chance of people coming in and out with infections, and more ability to control exposure when it occurs,” said Sheryl Zimmerman, PhD, lead researcher on the study. “In addition, the model may be able to help residents avoid some of the negative components of COVID.”

Green House Senior Director Susan Ryan said of the study: “The results of this research are not a surprise to our adopters. We’ve known for some time that Green House offers superior customer satisfaction, better occupancy rates, and higher direct care time. This research takes us to a new level of evidence. We’re proud of this fact and we’re proud of the adopters across the country who believed in the model, dared to be different, and took the leap to revolutionize eldercare.”

The study’s researchers noted that more than half of Americans who survive to age 65 will require long-term care, yet most would rather die than live in a nursing home. “Nontraditional Green House/small nursing homes have better outcomes than traditional nursing homes in numerous areas; evidence now demonstrates they have lower rates of COVID-19 and COVID-19 mortality than other nursing homes as well. As such, they are an especially promising model as nursing homes are reinvented post-COVID.”

The study will be published in the March print issue of JAMDA.

Media Contact:

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

Press Releases

  • 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

  • August 30, 2022 – Nursing homes that embraced culture change principles prior to COVID-19 largely maintained or expanded their efforts to focus on resident quality of life and person-centered care principles, a new study from a group of leading culture-change organizations has found. Nearly three-quarters, or 71%, of key culture-change metrics were maintained or expanded within at least 60% of surveyed nursing homes, the non-profit Altarum found in a recently fielded survey. Other key findings from the group of 62 nursing homes in 30 states include: 77% maintained or expanded efforts to learn and support residents’ interests 87% had no restrictions on visitation as of March 2022, and 81% reconfigured or updated indoor space to better facilitate COVID-safe gatherings 61% expanded support for virtual communication, such as assistance with video calls and e-mail The surveyed homes consisted of communities affiliated with The Green House Project, Pioneer Network, the Eden Alternative, and the Live Oak Project – organizations dedicated to overhauling the institutional nursing home culture that far too often prioritizes operator convenience, efficiency, and profit over resident quality of life. Despite the positive trends, culture change sites still faced challenges during the pandemic, with many reporting having to scale back group outings, intergenerational programming, resident input into mealtimes and menu selection, and other vital principles of nursing home culture change. These results emphasize the real need to incorporate culture-change principles both more widely within nursing homes and more broadly in long-term care policy and regulations, particularly during current and future public health emergencies. Altarum’s report and recommendations also build on other recent work that calls for both physical transformation of nursing homes – including conversions to all private rooms and bathrooms – and comprehensive culture change that puts residents, not finances or efficiency, at the center of all decisions. FIRST REACTIONS “There is no one-size-fits all solution to the challenges facing long-term care in America, but we cannot go wrong when we put elders’ needs and wants ahead of all other considerations,” Green House Project senior director Susan Ryan said. “We must work together to ensure that these vital culture-change principles are incorporated into any and all post-COVID nursing home reforms.” “Altarum is very pleased to learn that the creativity and flexibility inherent in person-centered care enabled these nursing home leaders to continue, and even expand, practices like resident choice in daily routines and supporting visits from people important to residents, during the pandemic,” Sarah Slocum, program director for delivery system transformation at Altarum, said. “We believe that person-centered care is key to resident quality of life and to nursing home quality improvement overall.” “Enough already! The system of services and supports for elders and people with disabilities has failed. The time is NOW to reimagine, redesign, and transform the entire system, including reimbursement, regulation, architecture, staffing, and person-centered care, with a culture that works for the well-being of each person,” Live Oak Project co-founders Barry Barkan, Rose Marie Fagan, and Jeff Jerebker said. “We are pleased to see the results of the Altarum research, and at the same time, not surprised that elder-directed care resulted in such positive outcomes – even in the midst of a pandemic,” Patrick Bultema, president and CEO of the Eden Alternative, said. “After all, it only makes sense that empowering elders to live the lives they want – recognizing changing abilities and circumstances – leads to greater wellbeing.  Furthermore, the research illustrates how this partnering approach to care is also better for staff.” “This report shows us all what’s possible,” Pioneer Network CEO Penny Cook said. “If person-directed practices and principles can survive during a history-making pandemic, they can be implemented and practiced everywhere in the United States. It will take all of us to make that happen.” Media Contact Alex Spanko Director of Communications The Green House Project aspanko@thegreenhouseproject.org 516-587-2097

  • LINTHICUM, Md. and ROCHESTER, N.Y., August 24, 2022 – The Green House Project (GHP) and Pioneer Network today applaud the federal government’s call for states to foster the implementation of private rooms and other improvements in U.S. nursing homes through targeted Medicaid funding increases. For nearly 20 years, The Green House Project has overseen the development of small-home alternatives to traditional institutional nursing homes. Providers across the country now operate more than 370 Green House homes, and while this number represents significant progress, it’s also only a fraction of the more than 15,000 nursing homes nationwide. Medicaid covers the majority of residents in nursing homes, providing generally lower per-day rates than Medicare. Organizations looking to implement the Green House model or other physical upgrades often struggle with finding sufficient financing due to investor and lender concerns about the sufficiency of Medicaid rates for stable long-term operations. Historically, this has led to chronic underinvestment in the long-term care infrastructure, particularly in low-income areas and communities of color. But as the federal government observed in its recent memo encouraging states to align Medicaid rates with nursing home quality, “Medicaid is a key lever for accomplishing the goals of strengthening quality of care, accountability, and transparency.” “Even a small increase in Medicaid rates is a powerful catalyst for innovation and development in long-term care,” Susan Ryan, GHP’s senior director, said. “A few dollars per day can mean the difference between the status quo and a complete transformation of the way we provide care for elders and people with disabilities.” States such as Arkansas and Michigan have already implemented Medicaid rate add-ons for small-home development, helping providers in those states develop and operate Green House homes. GHP and Pioneer wholeheartedly encourage state Medicaid officials across the country to consider similar plans as they work to meet the White House’s set of care improvement goals in nursing homes. These improvements aren’t limited to physical design: GHP and Pioneer call on state Medicaid officials to implement rate add-ons for providers that demonstrate a commitment to person-directed care principles and comprehensive workforce development. “The inputs of quality care – including properly trained and compensated staff and a person-directed culture – have a substantial impact on quality outcomes,” Pioneer Network CEO Penny Cook said. GHP and Pioneer also fully support the federal government’s call for robust accountability and transparency for providers alongside increase funding. “Any increases in Medicaid funding must be coupled with strong benchmarks and oversight to ensure that the money goes directly to improving the lives of residents and caregivers,” Ryan said. Media Contact Alex Spanko, Director of Communications aspanko@thegreenhouseproject.org 516-587-2097