The Green House Project®: Reimagining Old Age

    • December 13, 2012

“My mother is 100% different at Green House. When I visit, she’s happier. She hasn’t been this relaxed in years. I’ll come in and find her playing cards with the staff, or they are sitting around the fire together. It’s more social.”

Family member of a Green House home elder, Green Hill, West Orange, N.J.

The simple joys of everyday life are often the most meaningful: puttering around in the garden on a beautiful spring morning, diving into a good book in the privacy of your own room, sharing a home-cooked meal with people you enjoy.

These little things make life worth living, and they make a house a home. 

Everyone wants to live in a home, and every elder should have the option of living in a home that provides dignity, happiness, companionship, and the best care. 

Yet finding the right long-term nursing care option can be difficult. We all want the best care, a high quality of life, and, most of all, a place that feels like home. Traditional nursing facilities feel more like hospitals than homes – which is why most elders do not want to live in them.

The Harvard School of Public Health recently conducted a survey for the Robert Wood Johnson Foundation (RWJF) and National Public Radio to assess the health and health care attitudes of Americans who are in or nearing retirement. The study found that Americans over 50 experience deep anxiety about what will happen when they can no longer live independently.

Among the most pressing findings were that eight out of 10 respondents said they worried about living in an institutional environment that isn’t like home. And roughly three-quarters worried about having too few nurses to provide the care they needed or losing their privacy in a traditional nursing home facility.

 Green House Offers Elders a Real Home

Green House homes may just change people’s perceptions of what long-term care holds. Supported by RWJF, The Green House Project® has pioneered a radically different approach to long-term care that returns control, dignity, and a sense of well-being to elders, their families, and nursing care staff. At the same time, research shows that Green House homes cost the same or less to operate than traditional nursing homes, and may even save the health care system money by providing better care and keeping elders healthier.

What makes Green House homes so different from traditional nursing care facilities?

In these small, elder-centered homes, residents have more autonomy over how they want to live, receive more personal attention from direct care staff, and share a full and engaging day-to-day social life. Here, individuality and choice are honored, excellent care is a priority, and people have more satisfying and meaningful lives, work, and relationships.

As a result, Green House elders are happier and healthier than elders who live in traditional nursing facilities. They take more enjoyment in life, remain independent longer, and get more direct-care time daily. Their families are happier too. 

Life in a Green House Home

Each Green House home is a self-contained residence for six to 12 people, designed to look like the homes or apartment buildings in the surrounding community. Every elder has his or her own private room and bathroom. Meals are prepared in an open kitchen and served at a communal dining table so that people can share not only their meals, but their lives. A living room with a fireplace, together with the dining room and open kitchen, is the center of life in the Green House home.  

In these warm, home-like environments, elders receive the personal assistance and care that they need – without that assistance and care taking precedence over the natural rhythms of daily life. Nursing care staff are all on hand but not interfering, and medical equipment is tucked away but easily accessible. This ensures good quality of care while keeping good quality of everyday life squarely as the core focus of a Green House home.

Elders decide what they want to do every day – when they want to get up, when they want to have lunch, whether they want to read or play cards. Not only are their families welcome to visit at all times, but a Green House home is a place where families want to spend time.

In a Green House home, the organizational structure is radically different from that of a traditional facility. The elders are at the center, surrounded by a self-managed team of direct-care workers called shahbazim, who sustain and nurture the elders while managing the house. A shahbaz is a certified care partner who is specially trained in CPR, first aid, culinary arts, and communication. The shahbazim provide a wide range of services, including personal care, meal planning and preparation, laundry, and other light housekeeping duties. They work in partnership with nurses and other members of the clinical support team to provide excellent care for elders.

Evidence on the Benefits of Green House

This blended, self-managed team approach results in less time spent on administrative and housekeeping tasks and more time spent interacting with and caring for elders. Research shows that, compared to traditional nursing homes, Green House homes produce improvements in:

  • Quality of life: Including privacy, dignity, autonomy, and emotional well-being.
  • Quality of care: Elders have less depression, are less likely to be bed-ridden, are more active physically, develop far fewer pressure ulcers, and are hospitalized less frequently.
  • Meaningful engagement: In a Green House home, there is typically four times more meaningful one-on-one engagement time between elders and direct care workers each day.
  • Family satisfaction: Green House families are more satisfied with where their loved ones are living. They are willing to travel further and pay more to obtain Green House services and surroundings for their loved ones. 
  • Job satisfaction:  Green House workers are more satisfied with their jobs and are more likely to stay longer at those jobs. This means that residents get more consistent and more personalized care.

In short, elders in Green House homes have the freedom to live their lives at their own pace and in accordance with what works best for them. They are treated with respect and compassion, and they receive excellent care. This is what people want – for themselves and for their loved ones. Provider Magazine called Green House homes the “pinnacle of culture change” in long-term care.

The Green House model can also be adapted to meet the needs of special populations. For example, a Green House home in Chelsea, Mass., has been specially designed to meet the needs of younger patients with amyotrophic lateral sclerosis (ALS). And, in October 2012, the first Green House home for military veterans opened in Danville, Ill.

Since 2002, the Foundation has awarded $12 million, primarily to NCB Capital Impact, to develop, test and evaluate the Green House model. In 2011, the Foundation decided to expand its support, with the goal of helping the Green House model achieve greater reach and impact. With NCB Capital Impact, RWJF announced a 10-year, $10 million low-interest credit line to finance the building of Green House homes. Specifically, this investment reduces the cost of financing Green House projects to serve low-income elders.

RWJF support is helping to spread the Green House model across the United States. Today, hundreds of Green House homes are open or under development in many states.