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What Can We Do About Our Nation's Nursing Homes? The SeniorScape™

Updated: Nov 6, 2022

New York State Governor Hochul took a bold step in her state of the state address earlier this month. She committed to supporting conversions of traditional nursing homes to the Green House Model. This step can not only change how care is delivered, it can change the lives of millions of older adults who are in need of care as they advance in age and for whom the home living environment is not conducive to receiving that care.

The Green House® model reimagines the traditional institutional model to one that resembles a person's home. It was created by Dr. Bill Thomas, a visionary who was able to transform a small nursing home in upstate New York to one that was a true living environment, with hundreds of plants, birds, and animals as well as interactions with children. The environment became known as the Eden Alternative and became the basis of the Green House Project®. The term Green House came to describe these living environments based on the sunlight, plants and access to the outdoors that they offer to residents.

In these homes, each resident has a private room, each with its own bath. The rooms are built around a central family style dining room and living area. Each home has its own kitchen, where the aromas of freshly cooked food waft through the air at mealtime, stimulating the senses and the appetite.

There are none of what we come to know in the traditional institutional style facilities, akin to being a step down of the hospital setting. This, despite the fact that the level of medical issues for residents in Green House Homes® is the same as for traditional institutional style nursing homes.There are none of the overhead pages, central nurses stations overflowing with racks of medical charts, long hallways lined with linen carts, medical personnel scurrying to and fro, traditional looking medical carts from which medications are dispensed, and residents staring blankly into space seated in wheelchairs lining the hallways.

The purpose of the Green House Home ® is to provide a true living environment, where people can continue to find purpose while receiving quality care

In Green House Homes® people are engaged in conversation and activities with "Shahbazim" or elder assistants who are specially trained and are available throughout the day to run the home, cook and perform general household duties. There is also ample time for interactions and opportunities for input from residents. What we know as the traditional Certified Nurse Aide, (Or CNA) is specific for assisting residents with bathing, dressing, feeding and ambulating or transferring as needed.

Medical Personnel, including nurses, doctors and other specialists visit on an as needed basis and are available on call. This is a perfect fit with the advent of telemedicine.

An ongoing study found that the incidence of COVID infections and COVID related deaths among residents and health care workers in Green House Homes® was far less than in the traditional institutional type of nursing home. This is likely related to the fact that residents live in private rooms with private bathrooms as well as the overall foundational philosophy of these homes.

A 2005 report based on a 2 year study headed by Rosalie A. Kane, professor for the Institute of Health Services at the University of Minnesota School of Public Health found residents reported a higher quality of life and there was less decline in their ability to perform activities of daily living, less depression, less use of antipsychotic drugs and less incontinence. reports the results of the 2 year study of Green House Homes® the first of which was built in Tupelo, Mississippi.

Seventeen years later, of the 15,000 + nursing homes in the U.S.there are approximately 300 Green House Homes®. In August 2021, included in the bill for providing nursing homes with more funding, was $1.3 billion for a demonstration program to encourage construction of care facilities for 5-14 residents. While not necessarily the same, these appear to be roughly modeled on Green House Homes®

I applaud Governor Hochul for this initiative. However, it begs this question: since the cost of renovating existing homes to resemble Green House Homes® is both prohibitive and unrealistic, what can be done in the traditional nursing home car model to resemble or incorporate aspects of the Green House philosophy that would provide a higher quality of care and quality of life for nursing home residents?

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