The Robert Wood Johnson Foundation (RWJF) has awarded a $10 million grant to help spur the widespread adoption of the "Green House," an innovative model for skilled nursing care. The Green House is a total rethinking of the architecture, organization, staffing and philosophy of care normally associated with nursing homes.

The five-year grant to the NCB Development Corp. will allow NCBDC staff to provide technical assistance and pre-development loans to support organizations that want to establish a Green House. Within the next five years, NCBDC hopes to establish at least one Green House in every state, making it convenient for stakeholders across the country to visit one and consider adopting the model for their own operations. Organizations interested in participating in the project can find additional information and register for upcoming workshops on the project at the NCBDC's Web site.

"Through our partnership, we intend to propel the Green House into the mainstream of long-term care," said RWJF President and CEO Risa Lavizzo-Mourey, M.D., M.B.A. "By doing so, we will help provide frail and disabled individuals who otherwise would live in a traditional nursing home with the option of community-based housing where they have autonomy, dignity, and choice, while remaining part of a community and receiving the full range of clinical services."

The Green House is the vision of William H. Thomas, M.D., a Harvard-educated geriatrician from upstate New York. Jude Rabig, who has been the leader of the Green House Project, and Robert Jenkens, the deputy director of NCBDC's Coming Home program for affordable assisted living, will serve as co-directors of the Green House Replication Initiative.

About the Green House

A Green House is a self-contained dwelling for seven to 10 people that is designed to look like a private home or apartment in the surrounding community. Each person who lives in a Green House has their own bedroom and full bathroom. Each Green House must have a central hearth with an adjacent open kitchen and dining area, and short halls with access to the hearth. There is a common eating area and living room area (both easily accessible from the private bedrooms), and residents can share meals together around a common table. Family members, friends and workers are welcome to join residents at mealtimes and during other activities.

A separate clinical support team includes nurses, social workers, therapists, medical directors, nutritionists and pharmacists. One nurse from the clinical team serves the residents in two Green Houses, and the other clinical professionals visit the houses regularly and as individual residents require.

The people who work and live in a Green House collaborate to create a daily routine that meets individual needs, much as they did in their own homes. If they wish, people who live there can cook meals, prepare snacks and help with light housekeeping and laundry. There is no institutional routine in terms of medical care, allowing residents to be more independent.

"For decades, we have organized the life of the elder or disabled individual in a skilled nursing facility around the needs of the institution," said Rabig. "But in a Green House, clinical care and activities are organized around the needs of the individuals who live there." She noted that a Green House is designed to be a person's home for life, and their ability to remain in a Green House is not dependent upon their medical condition.

Pilot Project Results

The first Green Houses were established in Tupelo, Miss., by Methodist Senior Services of Mississippi. They have run the new houses on a cost-neutral basis, and have seen occupancy rates increase from 85-92 percent before Green House to 95-100 percent with a waiting list. That Tupelo operation has been the subject of a two-year study funded by the Commonwealth Fund and conducted by Rosalie Kane, D.S.W., and a team from the University of Minnesota. Outcomes to date include:

• High satisfaction levels from residents, family and staff.
• Fewer complaints at state level.
• No unexplained weight loss, and almost no nutritional supplement use.
• Less decline in Activities of Daily Living (ADL).
• Staff turnover of less than 10 percent.
• No transfer-related back injuries in elders or staff.
• Less prevalence of depression.
• Less incontinence without a toileting plan.
• Less use of anti-psychotics without a relevant diagnosis.

"We are committed to making the Green House model available to people at all socioeconomic levels," said Jenkens. "Initially, we will selectively recruit Green House sponsors from the ranks of non-profit institutions, local government agencies and existing long-term care providers. We will insist upon a rigorous commitment to Green House principles from sponsors and we will provide them with training, technical support and accreditation review."

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The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 30 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime.