The Green House Project

One of my current quests is to get a better handle on the looming senior housing crisis and, in particular, whether there is a better way to address the needs of elders who are currently housed in traditional nursing homes. During the course of my research I came across the Green House Project. Dr. William Thomas founded the movement which espouses a philosophy of providing small homes (no more than 12 residents), providing privacy with single rooms each with their own bath, and offering care that recognizes the individuality, autonomy and dignity of each resident.

I had the opportunity this past week to attend a two day workshop offered by NCB Capital Impact, which manages the Green House Project nationally. The workshop was held at the Lebanon Valley Brethren Home in Palmyra, Pennsylvania, where there are four operating Green Houses.

Green Houses, Palmyra, PA

The strategy is to combine an authentically residential rather than institutional design approach along with a fundamental refocusing of care from one in which the provider is at the center to one in which the elders are center stage. Designs must include a great room incorporating a communal dining table, a working fireplace, and an open kitchen where all meals are prepared.

Green House great room

Individual bedrooms each with their own bath are clustered around this great room.

Floor plan for Sheridan, WY, Green House

Perhaps even more striking is the way in which staffing is organized. Certified nursing assistants are called Shahbazim and are responsible not only for primary care of the residents but also perform all housekeeping and cooking duties. The combination of the small scale and these “jack of all trade” caregivers lead to extremely close relationships being developed between the elders and Shahbazim.

I have to admit that I was skeptical most nursing home patients would benefit from the Green House setting but based on the research done to date and the time I spent in an operating Green House visiting with residents and staff left me convinced that even the most compromised elder does indeed experience a significant improvement in his or her quality of life in this kind of home setting.

From a developer’s or operator’s standpoint, it is heartening to learn that operating costs for a Green House are almost identical to those for a traditional nursing home.

After a serious stroke, my mother spent the last several years of her life in a traditional nursing home. While it was a well run facility, my mother never felt comfortable there often complaining about the lack of privacy. Throughout the two day workshop, I kept wishing that Green Houses had appeared in time for my mother.

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The Green House movement

Despite the name, the Green House movement isn’t about the kind of environment you would think. It’s about the environment our rapidly growing population of infirm elders will spend their final years. It aims to reinvent the nursing home by making it smaller and more patient centered. Speaking from the personal experience of selecting and then regularly visiting a nursing home for my mother after she suffered a serious stroke and was left incapacitated, I have long been a firm believer that nursing homes needed to look and feel and operate less like hospitals and more like extended stay hotels. If the people running these institutions (and those regulating them) would ask patients or their families, I am certain the vast majority would opt for more privacy and independence and dignity over the most aggressive and sometimes suffocating medical care. In fact, a 2011 poll┬áconducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health showed that among the top concerns of both pre-retirees and retirees expressed about nursing homes was having to spend time in an institutional environment and the loss of privacy. The aim should be to make the remaining time of the residents as enjoyable as possible not to prolong it for a few days or weeks.

This past week saw the opening of a Green House project in Baltimore serving an inner city population with modest financial resources. The 48-unit project is organized on four separately functioning floors each with 12 private bedrooms, a communal living and dining room and kitchen as well as dens, spa and porch. An individual caregiver may administer medicine, give a bath, or cook a meal thereby engendering a close, personal relationship with the residents.

Residents at Green House in West Orange, NJ

Green House project at Green Hill, West Orange, NJ

 

There are currently 124 Green House projects operating with 30 more under construction and another 78 in various stages of pre-construction development in locations throughout the United States.

Location of Green House projects

With the population of those aged 65+ forecast to increase from 40 million to 88.5 million over the next forty years, we are going to be faced with the challenge of not only meeting their specialized housing needs but doing so in a way that meets their human needs and honors the lifetimes of service and accomplishment.

 

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