Reimagining Nursing Homes in the U.S.

Last Updated: June 7, 2019

True revolutions don’t happen overnight, they happen slowly. There’s one brewing in the senior care industry right now, based on the unique mindset of groups like The Green House Project ® and others like it, that are focusing on people-centered care at nursing homes.

Referred to as a “catalyst for social change,” by The New York Times, these groups are reimagining nursing homes and long-term care in the United States, placing seniors at the center of care models and giving them back control of how they age.

Reimagining Nursing Homes

The Green House Project is just one of the many person-centered approaches to long-term senior care that are sweeping the nation.

Since 2003, The Green House Project has helped 233 nursing homes provide skilled nursing care for small groups of 10-12 seniors in an environment that feels like a home.

Shahbazim (Shahbaz, is the singular) run Green House homes, and these caregivers are certified nursing assistants and homemakers. Nurses, physicians and therapists come as needed. There are two Shahbazim on site per shift and they run the household on behalf of residents, called elders.

The Hub of a Green House Home

To imagine what a Green House home is like, you’ll need to rid yourself of the outdated stereotypical image of a hospital or a nursing home. Here, in a Green House home, residents have private bedrooms with a bath. The central hub of a Green House home is no different than any other home in America – the kitchen. Elders eat together, like a family, at the kitchen table with their Shahbazim.

According to Susan Ryan, Senior Director of The Green House Project, having one kitchen table is crucial to The Green House model.

“The kitchen table is a symbol of family. It’s so reinforcing to an elder’s identity. For most of our elders, their life has happened around the kitchen table. Here, they sit at the table and it feels like a real home,” she says. “We’ve seen elders who couldn’t feed themselves start eating and feeding themselves again. It’s powerful to see how a real home reinforces a person’s health and identity.”

Ryan says that from the beginning, The Green House Project has necessitated a philosophical shift to make person-centered care a reality. In The Green House model, elders are at the center of everything, but this isn’t possible without an organizational redesign that has flattened the outdated notions many people have of nursing homes and placed elders at the center.

In The Green House model, staff are empowered to direct care to ensure elders live a meaningful life. “If you don’t have empowered staff, it can’t happen,” Ryan says.

The Person-Focused vs. Task-Focused Green House Homes

At Green House homes, Shahbazim are person-focused, not task-focused. There are no schedules or other confines. Instead, Shahbazim can sit around a communal table and have conversations and relationships with the elders they care for. This wouldn’t be possible with too many residents, which is why The Green House model limits the number of elders in each house.

“I can’t begin to tell you about the reciprocity here,” Ryan says. “They have so much wisdom and experience to give. I’ve seen an elder sit with her Shahbaz at lunch, giving advice, saying ‘this is what I think you should do.’ The Shahbaz listened and asked questions. It was remarkable, the elder had a sense of purpose and the two had developed a relationship of trust and advice. These relationships are at the heart of The Green House model,” Ryan says.

The Green House has proven effective for the elders who live there, for their families, and for staff whose engagement and job satisfaction is four times higher than the industry average.

Anne Ellett, a certified Nurse Practitioner (NP) shares the feedback of the elders living with dementia (ELWD) who she works with who are “able to connect with life in new ways,” in Green House homes. “Aside from details such as their favorite foods or activities, [residents] overwhelmingly requested that they be enabled to continue to have fun and laughter, and opportunities to try new things, and also to continue to contribute and give back,” she says. “There is an elder in The Woodlands who plays dominoes every day after lunch and loves to teach anyone else, and an individual who is recovering in short-term rehab and plays his harmonica,” she says, adding that “there is a new garden growing in another one of the homes — it is amazing how nature, growth and learning enhances well-being for everyone.”

Ways to Overcome Change in the U.S.

But there have been challenges along the way, including the fact that many administrators discount the model because they assume that reimagining nursing homes is not financially sustainable. Another challenge is that regulations in some states have been difficult to meet because they were created for a very different type of building, although Ryan says that most regulators are embracing the change to person-centered care.

“Change is hardest when it’s most radical,” Ryan says. The Green House Project requires a drastic change in mindset and thinking about senior care.

Although it’s been slow to take off, the movement is building momentum through word of mouth as industry professionals, but more importantly families and seniors themselves share their personal success with new approaches to person-centered care in a home environment and the difference it’s made in the lives of the seniors who live in Green House homes.

Want to learn more about The Green House revolution? Visit The Green House Project’s website or consider attending a workshop to see a Green House home for yourself.

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