South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

The Washington Post had a great article about the Green House Project..  I think Green House is a great improvement in nursing home quality of life for most residents.  The change has been too slow becuase it costs so much on the front end but it is well worth it. 

"The Green House is a philosophy, and you can change your philosophy of operation in any setting," Tierney said. "I think it's very forward-thinking of the board [of county supervisors] to consider the well being of people who need long-term care services and that they are interested in ways we can better serve people and keep them in community because they are all vital members of the community."

Green House provide living areas for a handful of residents to live, setting their agenda and getting one-on-one attention from staff members.  Conventional senior care is being transformed as a few localities nationwide embrace a new philosophy about long-term care that emphasizes independence and puts control in the hands of the country's aging population.   Green Houses, so named because they are intended to be places of continued growth and life, are built for seven to 10 people. Residents are the primary decision makers and are not subject to the monotonous schedule often found at nursing homes, according to the Green House Project. The houses have kitchens and family rooms where residents can gather as well as individual bedrooms they can decorate. A medical staff is on hand, with nurses providing medicine and care on an individual basis, not at a centralized nursing station

"We used to think of [long-term care] as institutional nursing homes, and that is no longer the case," said Courtney Tierney, director of the Prince William Area Agency on Aging. "It's all about consumer choice now and resident-directed care."

Tierney briefed the Prince William Board of County Supervisors last week on the Green House Project and how it can fit into the county. The project, the brain child of New York geriatrician William Thomas, aims to de-institutionalize care for the elderly and place people who need assistance back in the community in a Green House, where personal care and clinical services are provided in a more relaxed and homelike setting.

"Nursing homes were modeled after hospitals, and no one wants to live in a hospital for potentially years; people want to live in a home," said Ruta Kadonoff, Green House Project deputy director. "There is a growing desire to create an environment that allows people to grow and thrive and live no matter what their medical or cognitive needs may be, and that's where the Green House fits in."

The concept has grown from a single Green House built in Mississippi in 2003 to 73 across the country, Kadonoff said. She said the closest ones nearing the construction phase in the region are in Baltimore and Harrisonburg, Va.

Tierney said one of the reasons for the shift away from traditional care is efficiency. If residents and staff members are happier, the facility will be more efficient with less turnover and medical costs could potentially be lower, she said. People want to age in place, she said, and regulations are mandating that nursing homes become less institutional.

Research shows the cost to operate a Green House is similar to that of a traditional nursing home, Kadonoff said. Medicaid coverage is also the same at both facilities. According to the 2009 MetLife Market Survey, the average cost for a private room in a traditional nursing facility is $219 a day. People might pay a little extra out of pocket, depending on which Green House they choose.

Although the Green House Project is focused on building houses instead of traditional nursing homes, Tierney said the Green House philosophy can be adopted in existing facilities. Prince William County, Manassas and Manassas Park have five nursing homes and 14 assisted-living facilities. Nursing homes, she said, can change their staffing structure to allow for more one-on-one interaction or turn hallways into "neighborhoods" or small communities to make the facility feel more like home.

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Below is an editorial from Syracuse.com about geriatrician Dr. Bill Thomas, a proponent of Green House Project and The Eden Alternative.

Ready for a new idea? Nobody has to live in a nursing home anymore.

"Every person in a nursing home has an exact clinical double living at home," says Dr. Bill Thomas, of Ithaca.

A geriatrician and evangelist for sensible new kinds of "elder care," Thomas created The Eden Alternative to raise awareness and change the culture around aging; and the Green House Project, which seeks to replace big, institutional nursing homes with scattered-site housing.

Thomas was in town earlier this month as keynote speaker at Loretto's Legacy Awards luncheon. Loretto has 17 facilities housing elderly residents in a variety of settings, and also runs PACE, a program that provides home-based care. Loretto CEO Michael Sullivan says PACE already keeps as many as 370 elderly clients out of nursing homes.

Although the numbers of the elderly in nursing homes has dropped in the last several years, beds are still filled in large facilities like Cunningham-Fahey, James Square, Rosewood and Van Duyn. Why are so many still living there, if home-like settings are feasible in every case, as Thomas argues?

"Because their daily needs are greater than family and friends can provide," Thomas explains. Back in the 1960s and 1970s, Syracuse made a major investment in what was then state-of-the-art elder care. "It was far-seeing -- then," says Thomas. But it created what Thomas calls "legacy overhang." He says cities like Seattle, Wash., and Lincoln, Neb., now are ahead of Syracuse, moving to scattered-site elder housing.

"Use economies of scale for billing, records," says Thomas. "Get to the small scale for care." Smaller can be economical, he adds. "It's a costly ballet to deliver 500 meals simultaneously," he says. "In Green Houses, food costs are way down. They cook what they want, when they want it."

Years ago, people with mental and developmental disabilities moved from institutions to community housing. Likewise today, there are alternatives to prison for nonviolent inmates.

In the case of the elderly, the transition to scattered sites could be easier, because community resistance -- "not in my backyard" -- is less of a factor. Thomas says there are 100 Green Houses in 12 states and more on the way.

He found a willing audience among Loretto's leaders. CEO Sullivan said Loretto has two scattered sites, on Highland Street and Fayette Street, and he wants more. "We would like to do away with nursing homes, floor by floor, house by house," he said.

Getting there won't be easy -- particularly with state government cutting back aid. Thomas hopes to amplify his message of "culture change" via the Oprah Winfrey show. "The media still treat old people like a plague of locusts," he says. "I think aging is a good thing, though bad may come with it. It's a kind of human development. What's missing in the media is how age makes you better."
 

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The Dallas News had an article about the new "Green" nursing homes that have been built.   The article explains how these new homes have changed the resident's attitudes about being placed in a nursing home.  Residents and family members report other "miracles" at Holly House and its sister nursing home, Hawthorne House, which Dallas-based Buckner Retirement Services Inc. opened amid considerable public attention one year ago.

Holly House and Hawthorne House were Texas' first Green Houses – small homelike facilities where 10 residents, or elders, receive the full range of personal care and clinical services found in a conventional nursing home.  The two Green Houses in Longview are at the vanguard of a national movement to reinvent the traditional nursing home so that it looks and feels less like a hospital and more like a home where the frail and elderly can live and thrive.

Fifty homes have opened in 12 states, and 130 are under development. Forty-two senior-care organizations are building the houses with technical assistance from NCB Capital Impact, a nonprofit group.

"Our Green Houses are the best thing we've ever done," said Pearl Merritt, president of Buckner Retirement Services, a nonprofit agency that traces its roots to the mid-19th century. "They have exceeded our expectations in every respect."

Merritt says Buckner plans to build similar homes elsewhere in Texas and is studying the feasibility of operating several Green Houses as part of a larger retirement development in North Dallas.  Most of the elders at Buckner's two ranch-style homes in Longview had lived elsewhere on the agency's Westminster Place retirement campus there, and the rest had moved from their homes or other nursing facilities in the area.

Since settling in at the Holly House and Hawthorne House, the elders have slept in their own bedrooms, eaten home-cooked meals and enjoyed each other's company, much as the members of any family would.

At the same time, the Green Houses are licensed skilled-nursing care facilities. Residents remain under the watchful eye of a care team that includes a physician, registered nurse, licensed vocational nurse and nurses' aides.Many families say they've seen improvement in their parents' physical health and mental alertness over the last year.

The elders' improved health isn't so much a miracle as the result of a close-knit team of caregivers who know their seniors better than they could in a conventional nursing home, said Green House administrator Debby Burgett.  I wonder why all nursing homes are not required to give this level of care.

Some nursing professionals have questioned whether the Green House movement, with its emphasis on a home atmosphere, compromises the quality of the residents' health care.  Barbara Bowers, a nursing professor at the University of Wisconsin-Madison, visited Buckner's homes in Longview and concluded that, if anything, the nursing care is better than in a conventional nursing facility.

"Things don't get overlooked at a Green House, as they might be in a nursing home, where caregivers don't work so closely with each other. If an elder stumbles at a Green House, every caregiver knows it and starts watching that person," she said.   Shouldn't this be the standard and not the exception?

Bowers' research has been underwritten by the Robert Wood Johnson Foundation, which is encouraging the development of Green Houses and studying their viability.  Of all the challenges facing Green Houses, the toughest is to become financially viable, experts say. For the homes to become a practical alternative, they can't cost too much to build and operate and can't charge more than many older adults can afford. Otherwise, they'll occupy just a small niche of the nursing home industry.  Buckner spent $3 million to construct its two Green Houses, about what it would have spent on a conventional nursing home with private rooms.   During the first year, the Longview houses charged $165 per day, comparable with what most nursing homes with private rooms cost.

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