Frontline Caregiver Daily Practices

Compared with traditional skilled nursing homes, the Green House model allows for more time to be spent caring for and engaging residents.

The Green House model of care for skilled nursing aims to deinstitutionalize long-term care and provide a supportive, home-like environment for nine to 12 older adults. Green Houses have built upon the role of certified nursing assistants (CNA); these empowered front-line care workers are known as Shahbazim. In addition to assisting elders with their daily medical needs, Shahbazim assume more duties managing the home such as meal time, social activities and assisting with activities of daily living (ADL).

Given the growing interest and recognition of Green Houses, researchers compared the staffing hours of CNAs in six traditional skilled nursing facilities (SNF) with that of Shahbazim in seven Green Houses, measuring direct and indirect care. Direct care activities included helping residents with ADLs, meal time, social activities, communication and time transporting residents and equipment. Indirect care activities included meal preparation, housekeeping, laundry and administrative duties.

Overall staffing was slightly less in Green Houses than SNFs; however, average total nursing hours per resident per day was 5.3 in Green Houses and 3.6 in SNFs, mostly attributable to more time spent by the Shahbazim. Shahbazim directly engaged residents outside of ADL activities 23.5 minutes on average, significantly more than the 5.2 minutes of CNAs, mostly while doing other work such as preparing meals or folding laundry.

The results challenge the assumption that small environments like those in the Green House model cannot achieve staff efficiencies.