‘The Program of All-Inclusive Care for the Elderly’ and The Green House model: An Innovative and Cost-Effective Partnership for Comprehensive Care

By / Posted on January 23rd, 2017

Lori Gonzalez is a PhD researcher at the Claude Pepper Center of Florida State University who studies alternatives to traditional nursing care and social inequality.

The first Green House homes included in a Program of All-Inclusive Care for the Elderly (PACE) partnership will open in early February, joining together two of the nation’s most promising long-term care models.  The Harry and Jeannette Weinberg Green House homes, located in the Thome Rivertown Neighborhood in Detroit, Michigan will serve approximately 21 lower-income older adults who are otherwise able to live safely in the community, but who are currently residing in skilled nursing facilities.  According to Capital Impact Partners, serving these older adults in Green House homes with the support of PACE, compared to providing care in a traditional nursing facility, is expected to save the state’s Medicaid system about $130,000 per year.

PACE began in California in the 1970s as an alternative to institutional long-term care.  A group of Chinese, Italian, Filipino, and other immigrants held cultural views about caring for their loved ones that departed from the larger culture of aging in nursing homes.  They formed “On Lok” meaning peaceful, happy abode.   By 1986, On Lok developed the nation’s first comprehensive model of coordinated care and by 1997, the program became a permanent provider under Medicare and a state option under Medicaid.  Today, PACE operates 116 programs in 32 states and serves over 30,000 older adults, most of whom are dually eligible for Medicare and Medicaid.  PACE operates with the belief that, “it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible.”  With the assistance of the PACE program, 90% of participants who might otherwise enter a nursing home are able to live in the community.

PACE provides comprehensive care to those who are eligible for the program.  PACE eligibility includes being 55 or older, certified by the state to need a nursing home level of care, residing near a PACE care center, and having the ability to live safely in the community. When an individual enrolls in PACE, they (and their family) meet with a team of care professionals including social workers, nurses, primary care physicians, and nutritionists to help craft a plan to serve an elder in the community.  PACE participants visit a PACE care center routinely where they, depending on their plan of care, might receive a flu shot, dialysis, dental care, respite care, a hot meal, physical therapy, transportation, or participate in social activities.  Family members who visit the center receive counseling or advice on how to care for their loved one.

Green House homes also provide quality care and quality of life, but in a residential setting.  In Green House homes, “elders and others enjoy excellent quality of life and quality of care; where they, their families and the staff engage in meaningful relationships…” and when licensed as ALFs, they provide a community-residential setting for elders that is expected to exceed the quality provided by other ALF models.  Green House homes are not just homelike, they are places where elders call home.

The goals and values supported by PACE and The Green House model are similar and their partnership will honor elders’ preferences to avoid a nursing home and to live in the least restrictive care setting possible. Green House homes provide high quality residential living and PACE provides the physical health, mental health, social health, and family support for both acute care needs and long-term care needs.  Furthermore, PACE and Green House value the belief that all elders should have access to quality care and a good quality of life. PACE serves mostly dual eligible, frail elders and Green House homes are meant to be available to all, regardless of income or wealth.  The Green Houses at Rivertown Neighborhood, along with PACE will support these values by serving 21 low-income elders.

Aging in place is highly desired by older adults, but sometimes financially out of reach.  The Thome Rivertown model demonstrates that creating a Continuing Care Retirement Community for lower income individuals is possible and that when PACE and Green House are integrated into that community, high quality, cost-effective care is achievable.


Researcher Spreads The Green House Message Through Her Work

By / Posted on December 12th, 2016

Lori Gonzalez, Florida State University

Lori Gonzalez, Florida State University

Lori Gonzalez is a PhD researcher at the Claude Pepper Center of Florida State University who studies alternatives to traditional nursing care and social inequality.  She spoke at The 9th Annual Green House meeting about how she discovered The Green House model, and her passion to spread its message.   

“Of those who were surveyed, most frail elders reported that they would choose death over a nursing home.” This was one of the first studies that I came across when I started working as a researcher at the Claude Pepper Center at Florida State University. As I delved deeper into the research literature regarding quality of care and quality of life in long-term care it became clear why the elders in the survey would say such a thing.  Study after study reported resident lack of autonomy, lack of privacy, and lack of dignity.  The physical environment in many nursing homes resembles the hospital instead of home.  Staff and resident schedules are rigid.  Unhappiness and dehumanization abound.  Although the problems are well documented in the literature, few solutions are offered.

Eventually, I came across the early research on The Green House Project.  Not only were Green House homes the comprehensive answer to a complex problem, but the research showed that they were effective in reducing many of the ills facing both elders and staff in the traditional nursing home.  Since then, I have been following The Green House movement and advocating for the model as an independent researcher.  For example, my op-ed that appeared in the Tampa Bay Times earlier this year argues that Florida, during its temporary lift of the moratorium on new nursing home bed construction, has the opportunity to build more livable, human-scale residences like Green House homes instead of the traditional, large-scale institutional model.

I have also been documenting a story of elder empowerment at the Woodlands of John Knox Village (JKV) Green House homes in Pompano Beach, John Knox_Final ExteriorFlorida.  When the community’s rehab facility needed replacing, several elders used their vote on the board to bring The Green House model to JKV.  It took several years, lots of back and forth, but in the end—it was the elders who insisted that The Green House model was what they wanted, that according to their research, it was right for their community. I had the honor of touring the beautiful, bathed in natural light, full of life homes, and the honor of speaking with elders, guides, direct care staff, and the CEO—it is a place where elders truly rule.

I will continue to try to help spread the model because The Green House Project provides the type of long-term care that elders want and deserve.