Are Green House Project Homes the Next Big Thing in Nursing Home Care?


If you’re looking for a long-term care residence that looks and feels like a home, but offers the same skilled elder care services found at an assisted living facility or nursing home, you may want to consider a Green House home. These facilities follow an elder care model promoted by the Green House Project, a nonprofit based in Maryland.

History of the Green House Project

After working as a ER doctor at an upstate New York hospital, Dr. Bill Thomas became a medical director at a local nursing home in the early 1990s. Although he thought the level of medical care at this facility was very good, he didn’t like the personal care the residents received in such an institutional setting. He thought residents were essentially dying from being lonely, bored, and helpless.

Thomas and his wife, Judith, transformed the nursing home into a more vibrant community by bringing in pets and creating intergenerational activities for the residents. The changes he instituted there turned into a new, long-term elder care philosophy called the Eden Alternative, which is now being promoted through the non-profit group with the same name.

Thomas then launched the Green House Project which helps create (through an accreditation process) long-term skilled elder care homes across the county. The first Green House home was built in Mississippi in 2003; at the end of 2017, there were over 240 homes in 32 states (and more than 100 more in various development phases). Many Green House homes are built and operated by non-profit organizations, although some have been built by state housing agencies. (You can find an accredited home here.)

What is a Green House and how does it work?

A Green House provides elder care in a home-like setting. The plan calls for the structure to have an open layout, where the living and dining rooms are communal, but ten to 12 residents have their own private room and bathroom. Many homes have a fireplace, porch, and garden. The personal care staff, called Shahbazim (from shahbaz, the Persian word for falcon), make home-cooked meals and connect with the residents on a more intimate level than workers at a traditional skilled care facility.

A Shahbaz, a certified nursing assistant who gets extra training under the Green House model of care, is the house den mother/father. Besides taking care of the residents and the house, a Shahbaz can organize activities and outings and talk about the level of care with family members directly. Medical staff, which includes doctors, nurses and other therapists, come to the house as needed.

Residents can set their own schedules, so if they want breakfast at 3 a.m., it is not considered to be a nuisance. Staff turnover is relatively low, since each Shahbaz has more autonomy to adjust the type and level of care that’s needed for the residents in the home—a stark difference to a traditional nursing home where the care (even if its good) is on a strict schedule.

Many surveys, including a recent report by the THRIVE Research Collaborative, found that the residents and their families were very satisfied with the quality of life in a certified Green House residence. The THRIVE report found that while the Green House standards were implemented inconsistently (not all homes allowed residents to set their own schedules, for example), overall the model resulted in lower hospital readmissions, lower Medicare expenditures, and better scores in some key measures of quality, including the percentage of residents who are bedridden.

Cost and how to pay for it

Generally speaking, the cost of a room at a Green House home is comparable to or higher than a traditional nursing home. A 2017 article in Politico cited a Green House residence in Lebanon Valley, PA charging residents $389 a day; the median nursing home cost in Pennsylvania at that time was $320 per day. A 2014 Denver Post article cited a monthly cost of $8,000. (According to Genworth Financial, the median cost of a private room in a nursing home totaled $8,121 per month nationwide.)

Like other long-term nursing facilities, each Green House home must be Medicaid- and Medicare-certified in order for residents to seek reimbursements from those plans. Medicare does not pay for custodial care services, like room and board, but will pay for certain services, like physical and occupational therapy, or prescription drugs.

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