Despite intense regulation and substantial expense, nursing facilities do not consistently provide adequate quality-of-care and quality-of-life. This article examines the “Green House,” an alternative to traditional nursing facilities that fits within the regulatory and reimbursement criteria of nursing facilities, yet represents a radical transformation of the physical environment, culture of the setting and organization of the staff. The Green House concept involves groups of homes for seven to 10 frail older people, linked administratively to form a nursing facility. Within each home emphasis is placed on quality-of-life, social involvement and emotional well-being. Residential life is organized to decrease bureaucracy and maximize personal choices regarding furnishings and involvement in activities. The article evaluates efforts to implement the Green House model by a Mississippi nursing facility operator and finds the project successful. Some positive outcomes have been:

• Satisfaction with the physical space and the privacy afforded by the private rooms;
• lower staff absenteeism and turnover than other nursing facilities operated by the same organization; and
• efficient and collaborative teamwork.

The model presented many challenges during implementation but it could be further refined without doing violence to its major principles. Research currently under way and future research will illuminate how to modify the model; how to integrate new staff or new elders into established Green Houses; how to maximize training; and even how an existing nursing facility might phase in Green Houses.