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A Green House and its residents

Green House residents get to select, and even help cook or bake, their own meals. family members are welcome to join them at the table.

Looks like a home, feels like a home

Green Houses model a new approach to long-term care

By Pauline Oo

From M, spring 2006

On a recent episode of the TV series, "Grey's Anatomy," a gregarious 79-year-old patient named Sophie refuses to move into a nursing home. Her reason: "If I have to go to that place, I'm afraid I'll become old."

Nursing homes strike fear in the hearts of many because they're viewed as "bad places to live and bad places to get care," says Rosalie Kane, a University professor and long-term care expert in the School of Public Health. "Most were modeled after hospitals--in terms of long corridors, linoleum floors, rooms doubled loaded with beds, shared spaces, and meals squeezed in between 8 and 5. You wouldn't choose a hotel like that, let alone a permanent living space."

But, adds Kane, the quality of care has improved a great deal in nursing homes in the last decade. "Many of them have made enormous efforts," she says.

Green Houses have sunny private bedrooms and private bathrooms, vibrant outdoor spaces, and a community life centered around the "hearth," an open kitchen and dining area.

Cedars Health Center in Tupelo, Mississippi, is one example. Instead of upgrading its worn-out 140-bed facility, administrators decided to build four single-story houses. The 6,000-square-foot houses opened in 2003 and were the nation's first Green Houses--homes for eight to ten elders with sunny private bedrooms and private bathrooms, vibrant outdoor spaces, and a community life centered around the "hearth," an open kitchen and dining area. While adhering to all codes required by licensure, Green Houses look and feel like a home. The idea is the brainchild of William Thomas, a Harvard-educated geriatrician.

Today, that cluster of houses in Tupelo has grown to 10, and dozens of other Green Houses--from New York to Hawaii--are in the planning stages or have recently broken ground.

Participants--as residents are called--in the Green House project are more satisfied and in better physical shape than those in traditional nursing homes, says Kane, who received a grant from the Commonwealth Fund in New York City to conduct a two and a half year study comparing groups from a Cedars' Green House, the original Cedars Health Center, and a nearby nursing home.

Nursing aides who work at a Green House have also reported greater satisfaction, and were more likely to stay on the job. They manage the household, receive an extra 200 hours training, and report to an administrator called a "guide." Nurses and therapists support them with regular house visits. As does a sage--someone from the community, such as a retired minister or psychologist, who helps them solve problems.

Although Kane's findings favor the Green House over the other two locations, there's still more to learn. The Commonwealth Fund has awarded Kane and her research team another grant to examine what will happen when the Cedars Health Center closes its traditional care facility and only offers a Green House option.

"Essentially, we're interested in how the Green House model is sustained, and how it functions when no traditional nursing home is there to fall back on," says Kane.