“…to grandmother’s house we go!”

“Over the river and through the woods…” You know the tune. But how often does that conjure a vision of visiting an elderly relative in a large nursing home in room 2312? Not very often I suspect. No, what we imagine and what we probably would want for ourselves is something a lot more like a home.

That’s not to say there aren’t legitimate reasons why a senior would be ill-advised to try and remain in their own home. Questions of health, safety, family, and resources all come into play.

The Green House Project

There is a movement in recent years to provide a more home-like environment for elders while still providing the direct care support that may be required. One organization driving this change is The Green House Project®. The Green House model describes a facility created from the ground up to foster the same feeling and experience you would get from living in a real home. Each home is designed for 10-12 residents, with private rooms and bathrooms and a family-like atmosphere of open common spaces. There is an innovative staff model that provides more contact between staff and residents, which is better both for the residents and for the staff.

How does this compare to a traditional nursing home?

There have been a number of studies that suggest that smaller scale, more homelike skilled nursing settings provide better resident outcomes, enhanced living environments for residents and work environments for staff, more staff cooperation, as well as better bonds between residents and staff.

A recent study funded by the Robert Wood Johnson Foundation found that residents of a Green House home are less likely to require hospitalization than similar patients in a traditional nursing home.

Research findings suggest that, compared to traditional nursing homes, Green House homes have:

  • Improved quality of life in seven areas: privacy, dignity, meaningful activity, relationship, autonomy, food enjoyment, and individuality.
  • Improved quality of care evidenced by maintaining self-care abilities longer and experiencing less depression, being bedfast, or having little or no activity.
  • Improved family satisfaction with general amenities, meals, housekeeping, physical environment, privacy, autonomy and healthcare.
  • Improved staff satisfaction and reduced turnover.
  • Higher direct care time, on average 23-31 minutes more per resident per day in staff time spent on direct care activities.
  • Increased direct engagement with elders, four times more time spent engaging in other than direct care activities.
  • Less stress for direct care staff.
  • Improved care outcome, including fewer in-house acquired pressure ulcers.
  • Cost neutral operations (same median cost as national nursing home median cost).
  • Lower capital costs (generally lower square foot costs to construct).
  • Comparable quality even though formal nurse supervision of direct care workers is not part of them staffing model.
  • Timely intervention when there are changes of condition due to direct care worker familiarity with the elders they serve.

Have you had any experiences with either traditional nursing homes or with this new cottage model? What do you believe the future holds?