The Green House Project Applauds National Academies’ Call for Nursing Home Design, Staffing Changes

LINTHICUM HEIGHTS, MD., April 6, 2022 The Green House Project (GHP) today voices its support and appreciation for the National Academies of Sciences, Engineering, and Medicine’s in-depth recommendations for nursing home improvements – particularly its calls for developing small-home alternatives to traditional nursing facilities and investing heavily in the caregiving workforce.

For nearly two decades, The Green House Project has helped providers build and sustain small-home nursing communities that closely align with NASEM’s vision of real homes with private rooms and bathrooms, open kitchens, and readily accessible outdoor areas.

The NASEM report correctly identifies several barriers to small-home development in the United States, including a lack of incentives for operators to abandon the standard multi-bed model that Medicare and Medicaid continue to subsidize – as well as low per-day Medicaid rates that often discourage lenders from providing vital upfront capital to fund new construction and renovations.

“Elders receive substandard care in outdated, undignified settings because the federal government continues to pay for that care,” GHP senior director Susan Ryan said. “Nursing homes derive the majority of their income from Medicaid and Medicare. Congress and federal agencies have the power to change what these programs will and will not cover – and, in turn, transform nursing home care for the better.”

GHP further appreciates NASEM’s call for greater transparency and accountability for the nursing home industry at large. Such long-overdue measures are powerful tools for rebuilding the broken trust between long-term care providers and the public.

“We are not asking for free money with no strings attached and no record of where it goes,” Ryan said. “We are asking the government to redirect some of the billions it already spends on nursing home care to the improvements that really matter, with robust oversight to ensure the money benefits elders and staff.”

Finally, GHP applauds NASEM for highlighting the desperate need for new workforce development and compensation strategies, as well as their call for investment in novel staffing models that emphasize the vital role of certified nursing assistants (CNAs) within the interdisciplinary care team.

GHP has built its workforce structure around CNAs, giving them the respect and power to run day-to-day operations within each home – a concept that has led to nearly four times lower CNA turnover in Green House homes as compared to the national average in nursing facilities.

“Design alone cannot make a nursing community feel like home,” Ryan said. “It’s the people, properly compensated and empowered to do the job they feel called to perform, that truly make a difference in long-term care.”

About The Green House Project

Since 2003, The Green House Project has led a revolution in the way we provide eldercare services. With private rooms, warm communal areas, empowered care teams, and an emphasis on connecting with nature, Green House homes provide a vital alternative to institutional nursing facilities. GHP believes that elders, no matter their physical or cognitive challenges, deserve to live a meaningful life in a setting that doesn’t just feel like home – because it truly is home.

Media Contact

Alex Spanko, Director of Communications
aspanko@thegreenhouseproject.org

Press Releases

  • 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

  • LINTHICUM, Md. and ROCHESTER, N.Y., April 27, 2022 – The Green House Project (GHP) and Pioneer Network, two leading organizations in the movement to transform eldercare in America and around the world, today announced their intention to enter a formal alliance. Center for Innovation, Inc., the organization that owns the Green House trademark, is committed to maintaining and expanding both the Pioneer and Green House brands in the years to come, with plans to build a shared executive leadership team currently under active discussion. “For years, GHP and Pioneer have collaborated on a variety of eldercare reform initiatives, driven by our shared history and mission to improve the lives of nursing home residents today and in the future,” Pioneer Network CEO Penny Cook said. “Together, we will go farther than we could as parallel travelers on the same path.” The recent devastating report from National Academies of Science, Engineering, and Medicine on the state of nursing home care in the United States – which described the current system as “ineffective” and “unsustainable” – underscores the dire need for real change driven by increased partnership among changemakers. “In the wake of the COVID-19 disaster in nursing homes and other eldercare settings, reform-minded organizations must band together to amplify their voices and cut through the ineffective rhetoric that has held back true change for decades,” GHP senior director Susan Ryan said. “A Green House-Pioneer alliance is a vital step toward real systemic transformation.” The alliance will be formally structured as a contribution of assets, with the transaction expected to close in early fall. Once the combination is formally completed, the joint entity will serve as a full-continuum consulting, advisory, and education partner for eldercare organizations looking to spark cultural and physical change. Pioneer Network and Green House have an intertwined history. Founded in 1997 by a group of forward-thinking long-term care professionals, Pioneer Network has worked to foster elder-directed operational culture in nursing homes and other congregate settings across the country. Geriatrician and Pioneer Network co-founder Dr. Bill Thomas then launched The Green House Project in 2003 to dramatically reimagine the physical structure of the nursing home itself, abandoning institutional mini-hospitals in favor of small homes with private rooms and warm communal areas that don’t just feel like home – but truly are home. If there’s one overarching lesson from the COVID-19 pandemic, it’s that no one solution can fix the deep fractures in our eldercare landscape. Elders in the United States and around the world deserve to receive high-quality, dignified care and supports in the setting of their choice – whether that’s at home or in a congregate setting. By combining forces, GHP and Pioneer Network can draw on their decades of shared experience to improve the lives of people living in nursing homes today, while also building a better eldercare infrastructure for future generations. To publicly celebrate the combination, Pioneer and GHP are inviting the entire eldercare community to attend Pioneer Network’s annual conference in Denver from July 27-30. More information about the combined event is available at: https://www.pioneernetwork.net/pioneering-a-new-culture-of-aging-2022-conference. “Moving forward, organizations looking to break from the past and implement elder-directed care will have a single address for cultural and physical transformation,” Cook and Ryan said. “No matter where you may be on your journey to improve your eldercare offerings, Green House and Pioneer will be here to help.” Media Contact Alex Spanko Director of Communications aspanko@thegreenhouseproject.org

  • LINTHICUM HEIGHTS, MD., April 6, 2022 – The Green House Project (GHP) today voices its support and appreciation for the National Academies of Sciences, Engineering, and Medicine’s in-depth recommendations for nursing home improvements – particularly its calls for developing small-home alternatives to traditional nursing facilities and investing heavily in the caregiving workforce. For nearly two decades, The Green House Project has helped providers build and sustain small-home nursing communities that closely align with NASEM’s vision of real homes with private rooms and bathrooms, open kitchens, and readily accessible outdoor areas. The NASEM report correctly identifies several barriers to small-home development in the United States, including a lack of incentives for operators to abandon the standard multi-bed model that Medicare and Medicaid continue to subsidize – as well as low per-day Medicaid rates that often discourage lenders from providing vital upfront capital to fund new construction and renovations. “Elders receive substandard care in outdated, undignified settings because the federal government continues to pay for that care,” GHP senior director Susan Ryan said. “Nursing homes derive the majority of their income from Medicaid and Medicare. Congress and federal agencies have the power to change what these programs will and will not cover – and, in turn, transform nursing home care for the better.” GHP further appreciates NASEM’s call for greater transparency and accountability for the nursing home industry at large. Such long-overdue measures are powerful tools for rebuilding the broken trust between long-term care providers and the public. “We are not asking for free money with no strings attached and no record of where it goes,” Ryan said. “We are asking the government to redirect some of the billions it already spends on nursing home care to the improvements that really matter, with robust oversight to ensure the money benefits elders and staff.” Finally, GHP applauds NASEM for highlighting the desperate need for new workforce development and compensation strategies, as well as their call for investment in novel staffing models that emphasize the vital role of certified nursing assistants (CNAs) within the interdisciplinary care team. GHP has built its workforce structure around CNAs, giving them the respect and power to run day-to-day operations within each home – a concept that has led to nearly four times lower CNA turnover in Green House homes as compared to the national average in nursing facilities. “Design alone cannot make a nursing community feel like home,” Ryan said. “It’s the people, properly compensated and empowered to do the job they feel called to perform, that truly make a difference in long-term care.” About The Green House Project Since 2003, The Green House Project has led a revolution in the way we provide eldercare services. With private rooms, warm communal areas, empowered care teams, and an emphasis on connecting with nature, Green House homes provide a vital alternative to institutional nursing facilities. GHP believes that elders, no matter their physical or cognitive challenges, deserve to live a meaningful life in a setting that doesn’t just feel like home – because it truly is home. Media Contact Alex Spanko, Director of Communications aspanko@thegreenhouseproject.org