HaroldUrman
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Feb 5, 2010, 8:48 AM
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Green House® Project Challenges the Traditional Medical Model of Nursing Home Care
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By Harold Urman Ph.D.
In order to appreciate the reasons for the development of the Green House® model, it important to first have a brief understanding of the history of nursing homes in the United States.
During the first part of the 20th century there was no federal assistance to help pay for the care of the elderly. Most states sent people who could not pay for care to “poor farms” or “almshouses” where conditions were very poor. It wasn’t until the 1930’s when President Roosevelt signed the Social Security Act that funding was made available to support services for the elderly.
Private nursing homes grew in the 1940’s but were basically unregulated and many had reputations for very poor living conditions. Significant amendments to the Social Security Act in the 1950’s required states to establish licensing bureaus and standards for all nursing homes in order to receive federal funds.
In 1965, President Johnson pushed through the 1965 Medicare amendment to the Social Security Act to guarantee a livable future for aging citizens. In 1972, Public Law 92-603 contained a number of reforms for nursing homes, including a new policy of reimbursing nursing homes for reasonable cost of care, in the hope that facilities would provide better care.
Finally, reforms enacted in the late 1980’s helped to improve the health care received by many nursing home residents, but for the most part most of the changes that have been enacted to reform nursing homes have focused on the medical care of residents and have done little to address the very large problem of quality of life.
Since then the “Culture Change” movement has gained strength and changed the focus of nursing home care from a “medical model” to a “person-centered model” of care that places primary focus on quality of life while also meeting medical needs.
One of the most innovative projects in the culture change movement has been the development of the Green House®. Green House® homes are residences for 8 to 12 elders who require skilled nursing care. They are a major departure from the traditional nursing home, offering seniors privacy, community, and an environment designed to look and feel like a real home.
One of the leaders in developing these home-like nursing homes is Dr. William Thomas, who believes that older people will thrive in a nursing home if it’s built to look like one’s own home.
The first Green House® was built in Tupelo, Mississippi by Mississippi Methodist Senior Services. These nursing homes look like any home in a community with driveways, BBQ’s and green lawns. Residents sleep in private bedrooms, share family-style meals in an open kitchen and have more freedom of movement than traditional nursing homes. There are no nurses’ station, medication carts, treatment carts, and no chart racks, since such items would not appear in a private home and so have no place in the Green House® .
Each Green House® has two nurse’s aides or Shahbazim (elder assistant) that are on duty in each home most of the day. These Shahbazim have specialized training and are responsible for running the home, including cooking meals and doing house chores. The Shahbazim are a self-managed work team that are coached by an administrator or guide. Registered nurses, doctors, and other medical staff serve a number of Green House® and are available when needed.
Research on the effects of Green Houses® compared to traditional nursing homes has shown the following:
• Green House® residents reported significantly higher scores on happiness, contentedness, and looking forward to the future.
• Residents also had greater satisfaction with their home as a place to live compared to residents in a traditional nursing home.
• Residents had lower rates of depression, bed rest, reduced activity, and decline in functional abilities.
• Family members of Green House® residents were more satisfied than family members of traditional nursing home residents.
• Job satisfaction was higher in Green House® nursing homes and turnover rates where significantly lower than the national average for nursing home staff.
In 2005, the Robert Wood Johnson Foundation began a replication project to open 50 Green Houses® within five years. Today there are 50 Green House® homes operating on 17 campuses in 12 states.
In summary, the Green House® concept is clearly challenging traditional views of nursing homes. Green House® homes provide an environment where residents receive the medical care and support they need without it becoming the focus on their existence. By emphasizing resident quality of life and altering the size, interior design, staffing patterns, and methods of delivering skilled nursing services to residents, a Green House® home is creating a much needed revolution in the nursing home field.
For more information on the Green House® project visit www.greenhouseproject.org.
Harold N. Urman, Ph.D. is an educational psychologist and co-founder of Vital Research, a consulting firm specializing in research and evaluation. Established in 1982 and based in Los Angeles, Vital Research is a national research and consulting firm with expertise in senior living services satisfaction measurement.
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(This post was edited by HaroldUrman on Feb 5, 2010, 1:28 PM)
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