Green House Research Collaborative

Evaluation conducted 2011 through 2014

    • October 19, 2012

The Program Being Evaluated

The Green House initiative is a key part of the nursing home “culture change” movement, and aims to provide an alternative to institutionalized nursing home care by developing a model that is holistic, and elder-centered. The goal is to provide a more homelike environment than traditional nursing homes to maintain the dignity and independence of residents while providing a comparable or improved level of care. Frontline care workers, called Shahbazim, expand upon the role of certified nursing assistant (CNA) to include assistance with activities of daily living and additional responsibilities managing the home.

With a target of 15 percent of new long-term care facilities implementing the Green House model by 2013, evidence of the impact on cost and quality compared to other models of long-term care is essential. To support this goal, The Green House initiative has funded The Research Initiative Valuing Eldercare (THRIVE) to evaluate the model in relation to other culture change models of eldercare, as well as traditional nursing homes.

About the Evaluations

The THRIVE collaborative is learning more about the practices and processes that contribute to better quality of care in nursing homes, by working in a variety of long-term care facilities, including Green House homes, culture change homes, and more traditional nursing homes. From 2011 through 2014, leading researchers from Harvard Medical School, The University of North Carolina at Chapel Hill, Pennsylvania State University, The University of Wisconsin-Madison, and the Institute for Clinical Outcomes Management, and Health Management Strategies will conduct research on models of eldercare, and evaluate the Green House model of care.

While early findings are promising, questions that people want answers to include: Do these changes lead to better resident outcomes? If so, which ones? How are different models of culture change implemented? What is the environment of culture change homes really like?

Results from Early Studies

Three pilot studies conducted in 2009 and 2010 use a variety of different methods to assess the effectiveness of the Green House model. Important takeaways gained from these early studies include:

  • Sheryl Zimmerman and Lauren W. Cohen conducted a comprehensive literature review of evidence behind the most essential components of the Green House model. The researchers conclude that components of the model, such as private rooms, private bathrooms, and communal dining are related to positive patient outcomes. 
  • Siobhan Sharkey, Sandy Hudak and Susan Horn used an observational study to measure overall staffing and CNA time spent in skilled nursing facilities. Green House elders receive more direct care time per day than do similar residents in traditional nursing homes. CNA staffing is greater in the Green House model, while overall staffing is slightly less. The model also results in less job stress for front-line care givers.
  • Barbara Bowers and Kimberly Nolet combined in-depth interviews and field work in a study to examine how nurses and Shahbazim work together under various implementations of the Green House model. The resulting white paper measures the impact of various Green House settings on residents’ quality of care. Care quality increased with the high level of familiarity that Shahbazim have with residents. This can be maximized by a good working relationship between nurses and Shahbazim, and can be squandered if they work separately.

Results from the THRIVE Collaborative

Results from the THRIVE collaborative will be provided at the time of publication, in 2013 and 2014.


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The Green House Project

The Green House Project represents a revolution in long-term care, creating small homes that return control, dignity, and a sense of well-being to elders, while providing high-quality, personalized care.

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