A Skilled Nursing Model That Seems Like Home

skilled nursing model that feels like homeWhat if your parent’s nursing home didn’t look like a nursing home at all?

What if it looked like a nicely furnished residential home with an open floor plan consisting of a living room, dining room, kitchen, and several bedroom/bathroom suites? What if your parent lived with a small group of elders who enjoyed conversing with each other, eating together at one dining table, and playing card games?

What if the residents could wake up in the morning whenever they like and enjoy such amenities as a made-to-order breakfast, in-home spa, personalized laundry service, and secure patio with adjoining garden?

These are among the features that make The GREEN HOUSE® Project such a unique and innovative model in the skilled nursing space.

What is a Green House Home?

The Green House model originated with Dr. Bill Thomas, an authority on eldercare who developed The Eden Alternative as an approach to de-institutionalizing nursing homes.

The first Green House home opened in Tupelo, Mississippi, in 2003. Fifteen years later, there are Green House homes in more than 30 states. Each Green House home accommodates between 10 and 12 elders, with homes blending into the communities, along a typical  residential street or neighborhood.

“The Green House model has been created from the ground up to foster the same kind of feelings that you would experience if you were still living in your own home,” says Deborah Wiegand, director of operations for The GREEN HOUSE® Project. “It’s a flexible home setting that is warm and personal. Everything from the residential furnishings to the private rooms and bathrooms to the public and semi-private spaces has had a lot of thought and intention put into it.”

Three Core Values

The Green House model is built around three core values:

1.  A real home, characterized by a physical environment that looks residential rather than institutional. The homes—which meet all state and federal requirements applicable to skilled nursing facilities—feature private, semi-private, and public spaces. Averaging less than 9,000 square feet, a Green House home facilitates mobility. “When you open your bedroom door, you can see where you want to go and get from your room to the dining room table in probably less than 50 feet,” Wiegand says. That’s a definite advantage over the long corridors and maze-like layouts of many traditional nursing homes.

2. An empowered staff. The innovative staffing model emphasizes consistency of caregiving. There are direct caregivers, who are in the same home each day, as well as a clinic support staff who provide additional care. “The direct care staff is charged with three things,” says Wiegand. “One is to sustain, two is to protect, and three is to nurture the elders in that home.”

3. A meaningful life for residents rooted in a philosophy that is person-directed and takes a relationship-rich-based approach. “The model embraces elderhood and looks at elderhood as an opportunity for continued growth and development,” Wiegand says.

To enhance the elder experience, The Green House model puts the emphasis on autonomous decision-making. For instance, residents are able to determine when they get up in the morning and what they will have for breakfast. Putting such decisions in the hands of elders is a departure from what many people experience in a traditional nursing home.

“We have institutionalized our elders’ thinking, and it takes a while to undo that when you move from a traditional setting into a Green House home,” Wiegand says. “Involving elders in making their own decisions lends itself to their emotional wellbeing.”

An Elevated Level of Care

The Cottages of Lake St. Louis, one of the country’s newest Green House communities, embodies all of the model’s core values. Located in the St. Louis suburbs, this skilled care community is built as a neighborhood of six 10-resident homes, each with approximately 7,200 square feet.

Al Beamer, CEO of the Lake St. Louis community, has received positive feedback from residents and their families. For those who previously lived in traditional nursing settings, Beamer describes the transition to a Green House model community as a “reawakening.”

“To have a family come up to you and say, ‘I got my mom back’ or ‘This has literally saved my dad’s life’—what could possibly be better than that?” Beamer says.

While the homes are beautiful, Beamer adds that it’s the engagement between staff and elders—both the quality and quantity—that elevates the level of care.

“There are staff members in the home who know how 10 different people like their toast,” he observes. “We have double the care staffing of many nursing homes. That, along with consistency of staffing, makes our community a happier place.”

A Highly Adaptive Model

One of the advantages of The Green House Model is that it’s highly adaptive. While 80% of Green House homes operate under a skilled nursing license, there are assisted living communities as well.

“Under the skilled nursing license, we have seen people create individual homes that are specific for people who are living with ALS or MS,” Wiegand says. “We have Green House homes that specifically serve a rehab population, and others that serve a long-term care population.  Over time, we’ve seen a maturation of the model, where people have developed niches within the market based on the needs in their community. Looking ahead to where this model will be in five years, it’s exciting to imagine the possibilities.”

While the model is innovative, the costs are in line with traditional nursing homes. “We’re able to be at the same cost as a traditional nursing home, and less than many other culture-change models,” Wiegand says.

Positive outcomes for seniors affirm the advantages of the Green House model. “We’re finding in rehab homes, for instance, that we’re seeing fewer re-hospitalizations with this model,” Wiegand says. “Based on the quality of care, we also see less depression. People are more active. They may come to us walking, and they are able to continue walking for longer periods of time.”

As a result of being more active, residents also have better appetites, experience less weight loss, and experience higher satisfaction rates.

Leading a Wave of Innovation

The Green House model is leading a wave of innovative long-term care solutions, driven by rapidly changing demographics. “There is a looming long-term care crisis that is almost upon us,” says Wiegand. “One in five people are going to be 65 or older by 2030, and these seniors are going to need skilled care. Consumers are expressing a desire for something different. For those who don’t want to go into a traditional nursing home, this model represents an attractive option.”

Wiegand observes that the Green House model was considered a radical departure when it was introduced 15 years ago. Today, it has become more widely accepted and has opened up the market to new approaches.

“The model has become a catalyst for change and a real disrupter in the field of long-term care,” Wiegand says. “It’s exciting, because it’s helped create more innovation—where we continue to think about what’s next and how we can have an even bigger impact on transforming long-term care for elders of today and elders of tomorrow.”

CHIME IN: What type of innovations would you like to see in skilled nursing and long-term care?

 Photos courtesy of Cottages of Lake St. Louis | Al Beamer
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