A new philosophy for elder care
Jamie’s Place homes operate based on The Green House Model’s philosophy of care, which aims to “de-institutionalize” and enliven the long-term care environment by creating specially designed homes in which elders can live with dignity, comfort and companionship. The Green House model creates an intentional community to support the most positive elderhood and work life possible. Studies show that occupants of smaller assisted living facilities tend to be happier than residents of nursing home facilities. The Green House fundamental core values embody The Eden Alternative: Meaningful Life, Empowered Staff and Real Home.
Jamie's Place was the first Green House Adult Family Home in Washington State, today we are one of three Green House homes in Washington State.
The Green House Project was founded in 2003 with a radically common-sense idea: eliminate the traditional institutional nursing home by creating actual homes where elders live autonomous lives and receive dignified personalized, and high-quality care.
Since then, we’ve helped providers build over 371 Green House homes across the country. The model gained unprecedented publicity during the COVID-19 pandemic, when Green House living showed its powerful ability to curb infections and retain quality staff, but we’ve known for almost two decades that smaller is better- whether it’s the physical buildings or the tight-knit, empowered care teams that staff them.
We’ve taken this information on this page from the 2023 Green House guidebook, which provides an overview of the Green House way, from architecture to staffing to the elder-directed culture that sets our vision apart from other small nursing care alternatives.
We hope this information inspires you to contact our team about bringing a Green House campus to your community.
Together, we can live the Green House core values- Meaningful life, Empowered Staff, and Real Home- while truly transforming eldercare in the United States and around the world.
Vision
The Green House Project has bold vision for reshaping eldercare: By 2030, every elder in the United States is able to access quality, person-directed living in setting of their choice. For elders who by choice or necessity seek out communal living options, we believe that The Green House Project’s combination of small-home design and elder- driven culture represents the new baseline standard for elder services and supports - and it should replace the institutional, medical nursing home that currently dominates the care landscape. This level of care must be available to all elders regardless of their race, income, savings, hometown, or type of insurance coverage.
Overview
Green House Homes are best known for offering private rooms and bathrooms - basic necessities for all people that are rare in current long-term care settings - but the model encompasses far more than just privacy.
Green House homes are built on the foundation of three unshakable core values: Meaningful Life, Empowered Staff, and Real Home.
A Green House campus features small homes, consisting of 10 to 12 elders. Each home’s design includes a spacious living area and an open kitchen, along with easy access to secure outdoor spaces. The goal is going beyond adding “home-like” touches to existing nursing homes and creating a true home design where elders direct the rhythms of daily life - with the support of care partners who have the time, skills, and autonomy to provide the direct attention that leads to better outcomes and satisfaction.
Core features
The exact design can vary substantially depending on each community’s needs; while most Green House homes are licensed as skilled care nursing homes, about 15% operate as assisted living or other communal homes based on local and state regulations. But all Green House campuses must include several vital features that define the model:
A self-managed work team consisting of universal care partners call Shahbazim (singular: Shahbaz), a certified nursing assistant who also cooks meals in the communal open kitchen, performs light housekeeping tasks, and supports meaningful engagement within the home. In direct and continued consultation with the elders, the Shahbazim are responsible for managing day-to-day life in each home.
A Guide. the formal supervisor of the self-managed work team, coaches and empowers Shahbazim to provide the very best elder-directed care.
A clinical team consisting of a medical director, registered nurses, therapists, pharmacists, activities professionals, social workers, and other specialists.
The self-managed work team creates an environment where frontline care partners - the people who spend the most time with elders - are empowered to make decisions and create meaningful experiences for the residents. Shahbazim aren’t at the bottom of a top-down hierarchy; rather, they are at the center of day- to-day operations and integral leaders whose opinions and experience matter.
Taken together, Green House homes are true communities of people with one goal in mind: fostering and maintaining an empowering, fulfilling life for elders regardless of their physical and cognitive abilities. In Green House homes, elders aren’t a collection of medical problems to be managed and minimized - they’re humans with as much value and worth as people at all stages of life.
Architecture & design
Because each Green House community is meant to be a true home to elders - and because each city and town has different housing and land-use patterns - the model offers significant flexibility around the precise definition of home.
For urban dwellers, a multi-story apartment building or townhome might be most comfortable and familiar; but for suburban and rural residents, home probably looks like a single-family house with ample surrounding land.
The first Green House homes were in Tupelo, Mississipi, where plentiful land allowed for single-family-sized cottages, but that’s only one type of Green House campus. The Leonard Florence Center in urban Chelsea, Mass. built a vertical Green House with two autonomous Green House homes on each floor seperated by an elevator bank.
Regardless of the macro-level design, each home must be designed to house 10-12 elders mazimum, and must include the following:
A hearth with fireplace that serves as the anchor of the living area, dining area, and open kitchen.
Private bedrooms, each with its own private three-piece bathroom (toilet, sink, shower) and secured medicine cabinet, eliminating the need for institutional medical carts.
A single dining table capable of seating all elders and Shahbazim.
A Safe lifting environment utilising ceiling lifts from bed to toilet.
Open and accessible spaces for elders, including secured outdoor areas.
Open sight lines from the kitchen to the hearth area, bedrooms, and outdoor space.
Plentiful windows to encourage natural light and views.
Just as importnat as what’s included in the design is what’s left out:
Administrative offices are maintained seperately from the homes.
Physical seperation between homes, whether it’s green space or an elevator, reinforces the autonomy of each work team and the individual home.
Institutional design touches such as fluorescent lighting, long hallways and nurses’ stations have no place in a home, and thus they have no place in a Green House home.
Our team works closely with each developers architect, plus local and state regulatory agencies, to ensure that all designs meet model requirements.
Outcomes
The Green House Project’s unique model gained unprecedented attention in the wake of COVID-19, when both the physical design and staffing models helped Green House communities experience 50% fewer infections and a death rate that was 30% of the national total in a long-term care during 2020. Those trends continued into 2021, even as the nation’s long-term care facilities continued to struggle with deadly outbreaks.
But the benefits of the Green House model go far beyond simple infection control, as nearly 20 years of research has demonstrated.
Elders
Compared to elders residing in traditional institutional nursing homes, research has illustrated that those living in Green House communities.
Report improvement in seven key domains that measure quality of life: privacy, dignity, meaningful activity, relationships, autonomy, individuality and food enjoyment, as well as overall wellbeing.
Maintain self-care abilities longer, with fewer experiencing declines in late-loss activities of daily living (ADLs).
Are less likely to experience an inability to get out of bed, depression, or have little to no day-to-day activity.
Have families that are more satisfied with the amenities, housekeeping, physical design, privacy, autonomy, and health care provided.
Acquire fewer pressure ulcers.
Workers
Compared to workers in traditional nursing homes, care partners at Green House communities:
Spend 23 to 31 more minutes providing direct care to each elder every day.
Report four times as much engagement with elders outside of caregiving tasks.
Have less job-related stress.
Provide more timely interventions due to closer relationships with elders.
Feel greater job satisfaction and are less likely to leave their jobs.
Providers
Compared to traditional nursing homes, Green House providers can typically expect:
Greater demand and occupancy.
Comparable operational costs with less overhead, allowing for more spending on direct resident care.
Substantially lower staff turnover.
Financial Viability
Because a Green House community looks so different from the common conception of a nursing home, providers and investors are quick to assume that the model can’t work from a financial or operational standpoint. But nearly 20 years of experience - and 371 homes in operation - prove that assumption wrong.
Because the universal caregiver model significantly reduces administrative overhead, Green House providers can deploy dollars where they matter most - direct care - and less on the things that don’t, such as administrative expenses and third-party agency staffing support.
In addition to being more efficient, the Green House model is simply more desirable for elders and their families, particularly in the wake of COVID-19. Private bedrooms and bathrooms, plentiful outdoor space, and better health and wellness outcomes will attract referrals from health care providers, managed care plans, and the community at large - turning a campus into the provider of choice in any given market.
Leadership Development & Staff education
The Green House Project team provides nearly 200 hours of educational programming to ensure the successful establishment of operation of The Green House homes. Key educational components include:
A leadership team workshop focused on building skills to lead an organization through transformational change, including participatory decision-making.
An education program or individuals preparing to serve as Green House Guides to develop the critical skills and knowledge needed to effectively coach self-managed work teams.
An education program for nurses on their key roles within the Green House model.
A workshop for clinical support team members to build coaching skills.
A 120-hour education curriculum to prepare Shahbazim, nurses, and clinical support team members to work as self-managed work teams, giving them the skills and knowledge to support elders’ self-direction, daily life, and tasks in Green House homes.
A course to prepare on-site educators to teach and mentor new staff.
To learn more about the Green House Project visit www.thegreenhouseproject.org
and https://www.thegreenhouseproject.org/news/Media-Coverage