CARE: Dedicated to Improving How We Age

By / Posted on May 7th, 2015

The University of Wisconsin-Madison School of Nursing created the Center for Aging Research and Education (CARE) in response to the rapidly expanding care needs of our aging population. The center works toward transformation by using “…nursing leadership, discovery, education, and practice…” to support happiness, health and security for all older adults.

In a recent online post by the CARE team entitled, “What Makes a Green House Home? How You Decide Matters,” the author considers the persistence and commitment necessary to take the philosophical tenets of culture change and put them into practice.

The post describes how UW-Madison School of Nursing Associate Dean Barb Bowers, PhD, RN, FAAN and research manager Kim Nolet, MS have conducted research that analyzes the “lived experience” that the Green House model now has after more than 10 years as the pinnacle of culture change.

“By interviewing 166 staff members at 11 Green House homes, Bowers and Nolet identified patterns of problem solving as important to the erosion or reinforcement of the Green House model over time.”

The researchers found that along with the architecture of the Green House home, it is collaboration across the organization and between nurses and Shahbazim that allows the significant benefits of this model to be realized.

Both Bowers and Nolet are a part of The Research Initiative Valuing Eldercare (THRIVE). Interested in learning more about the THRIVE initiative? Take a look at this recent blog post which discusses the importance of the soon to be published THRIVE research results.

 

 

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Robert Wood Johnson Foundation's Abstract, Green House Nursing Homes: Impact and Outcomes, Honored as the 2014 Ollie Randall Symposium

By / Posted on November 7th, 2014

The Gerontological Society of America’s 67th Annual Scientific Meeting is going on now, from November 5 to November 9. “GSA’s Annual Scientific Meeting brings together more than 4,000 of the brightest minds in the field of aging,” and recognized the Robert Wood Johnson Foundation’s session entitled Green House Nursing Homes: Impact and Outcomes as the 2014 Ollie Randall Symposium. Every year, the Gerontological Society of America‘s Social Research Policy and Practice (SRPP) “recognizes a symposium that examines cutting edge issues with broad implications for policy or practice.”

Ollie Randall was influential in the field of aging.  “She was the driving force behind the first housing for older people in New York City” and was President of The Gerontological Society. She was known as being outspoken on the issues of “sustaining and enhancing individuality in the later years.” The GREEN HOUSE® Project represents what Ms. Randall stood for by offering “services that were individualized and tailored to meet the diverse needs of elders.”

This year’s meeting theme “challenges researchers to present their best evidence on aging-related connections they investigate, ranging from the smallest particles examined in the lab to the most macro-level issues examined globally.”  The GREEN HOUSE® Project embodies this mission by offering an evidence based model as an alternative to institutional nursing homes.


Early Research Findings from THRIVE

By / Posted on March 26th, 2014

The Green House Project has partnered with the Robert Wood Johnson Foundation’s THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care. Supported by the Robert Wood Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes. Each quarter, a member of the THRIVE team will contribute a blog post to the Green House Project website.

Early findings from the THRIVE research collaborative were published in The February 2014 Gerontologist supplement, Transforming Nursing Home Culture: Evidence for Practice and Policy, a themed issue providing evidence to inform practice and policy related to culture change.  The full articles can be accessed at http://gerontologist.oxfordjournals.org/content/54/Suppl_1.toc and are summarized here.

A paper entitled “A “Recipe” for Culture Change? Findings from the THRIVE Survey of culture change Adopters” provided information from a survey that assessed which components of culture change – and in what combinations – have been adopted by nursing homes.  The survey was completed by 164 nursing homes that had already adopted culture change.  Results showed that adopted components of culture change varied across the type of nursing home model (i.e., small house, household, traditional unit).  As one example, respondents from small houses reported a significantly higher rate of direct care workers preparing meals (79%), but these were some of the least adopted practices for other adopters (22% of households and 13% of traditional units).  Results also showed that some traditional environments have been able to implement certain culture change components without large capital investments.  For instance, respondents reported similar rates of practices related to educational support and quality improvement regardless the nursing home model.  Taken together, these findings suggest that although practices do vary by model, some components of culture change are attainable for homes that have fewer resources to invest in large-scale renovations or reorganization.

A paper entitled “Who are the Innovators? Nursing Homes Implementing Culture Change” focused on the organizational factors associated with culture change implementation.  Using a sophisticated analytic process, information from 16,835 nursing homes was used to determine which resident, facility, and state characteristics related to a nursing home later being identified by experts as having implemented culture change.   These characteristics included being nonprofit, larger in size, and with fewer Medicaid and Medicare residents. Implementers also had better baseline quality with fewer health-related survey deficiencies and greater licensed practical nurse and nurse aide staffing. These findings suggest that nursing homes are in a better position to implement culture change if they start out with more resources and fewer challenges.   In a related article entitled “Culture Change and Nursing Home Quality of Care”, analyses examined how culture change implementation related to later nursing home quality.  This study found that nursing homes identified as culture change adopters later had fewer health-related survey deficiencies, but there was no improvement in the MDS-based metrics of quality.  These finding may suggest that culture change improves nursing home processes of care, and/or that surveyors recognized the homes’ culture change efforts in their ratings.  The lack of impact on MDS outcomes may suggest that either the early focus of such efforts has not been on clinical outcomes, or that because nursing homes adopting culture change already had better outcomes, there was less room for improvement.

Finally, a paper entitled “Developing the Green House Nursing Care Team: Variations on Development and Implementation” explored the roles of the nurse and the Shahbazim in the Green House model, focusing on how variations in the nursing team related to clinical care practices. Data were collected through observations and interviews with nurses, Shahbazim, Guides, and Directors of Nursing, and found that implementation of the nursing role within the Green House model varied both within and across sites.  Four nursing model types were identified: Traditional (nurse manages both care and non-care activities); Parallel (nurse manages care, Shahbaz manage non-care activities); Integrated (nurse and Shahbaz collaboratively manage care and non-care activities); and Visitor (Shahbaz manage care and non-care activities, with input from nurse as requested).  Care processes, Shahbaz skill development, and worker stress varied across each model, and although the Integrated model presents considerable challenges in terms of clarifying boundaries, it seemed to offer the greatest benefits in the areas addressed in this study.  

The THRIVE team will be expanding upon these and other findings in 2014, and will be sharing those with you and others via conference presentations, webinars, blog posts, and more journal articles.  As always, we invite your feedback about the best ways to keep you informed of the latest findings.

Questions about THRIVE can be directed to Lauren Cohen (lauren_cohen@unc.edu or 919-843-8874).

 


THRIVE (The Research Initiative Valuing Eldercare) Update on Green House Homes

By / Posted on January 27th, 2014

The Green House Project has partnered with the Robert Wood Johnson Foundation’s THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care. Supported by the Robert Wood Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes. Each quarter, a member of the THRIVE team will contribute a blog post to the Green House Project website.
The THRIVE research team is committed to the timely dissemination of findings relevant to The Green House Project homes and stakeholders.  Members of the THRIVE team recently presented preliminary research findings at the 2013 Green House meeting and in a January 2014 webinar.  Highlights from these presentations include:

David Grabowski (Harvard Medical School) debunked several common myths about The Green House model.  Using administrative data, David’s presentation showed that although higher resource nursing homes are more likely to adopt the Green House model than are lower resource nursing homes, these lower resource homes can be successful adopters with adequate vision and internal and external support.  His data also looked at culture change more generally, and found that culture change homes perform better on survey inspections — in fact, they lowered their health-related survey deficiencies by almost 15%!  David’s findings appear in the February issue of The Gerontologist journal:

Culture Change and Nursing Home Quality of Care

Who Are the Innovators?  Nursing Homes Implementing Culture Change

Lauren Cohen (University of North Carolina at Chapel Hill) presented data comparing the characteristics of Green House, higher culture change, and lower culture change nursing homes.  Interviews with guides and administrators found that a greater proportion of Green House homes offer resident choice in bedtime and get-up time, but not in bath time.  Lauren noted that previous research has shown that the desire for choice is not universal, and that predictability may be most important.  Her data also showed that Green House homes were less likely than culture change nursing homes to offer prescheduled daily activities, but were more likely to empower caregivers to lead activities.  So, it remains essential that empowered caregivers offer activities and encourage participation.

Kim Nolet (University of Wisconsin – Madison) reviewed the variations in how the Green House model is being implemented across homes, and discussed the implications of this variation.  Kim described variations in several Green House elements, including the role of the Shahbazim and the use of the den.  Her presentation suggested that model variations occur due to the challenges presented by critical events, organizational changes, daily routines, and subtle evolution in how things are done in Green Houses.  These challenges lead to problem-solving that sometimes results in reinforcement of the model and its core values, and other times in practices that are inconsistent with the core values of the model.

The THRIVE team will be expanding upon these and other findings in 2014.  We have planned conference presentations, webinars, blog posts, and journal articles to communicate our findings to you and others, and invite your feedback about the best ways to keep you informed of the latest findings.

Questions about THRIVE can be directed to Lauren Cohen (lauren_cohen@unc.edu or 919-843-8874).


THRIVE research: Examining deep culture change adoption in the Green House model

By / Posted on June 26th, 2012

The Green House Project has partnered with the Robert Wood Johnson Foundation’s THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care. Supported by the Robert Wood Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes. Each month, a member of the THRIVE team will contribute a blog post to the Green House Project website.

There’s an old saying, “you can’t know where you’re going until you know where you’ve been.” The culture change movement is a shift in philosophy towards a more person-centered model of nursing home care. Green House specifically, and the nursing home culture change movement more generally, has grown tremendously over the past two decades. If policymakers are to further encourage adoption of this model, they need to better understand the factors that promote adoption of the model. To help, the THRIVE research team examined nursing home adoption and non-adoption of “deep” culture change as well as of the Green House model specifically. 

Where has Green House Been? The results suggest culture change adopters are more likely to be nonprofit, faith-based, independently-owned, located in urban areas, and larger in size. Settings that eventually adopted culture change or the Green House model initially had fewer minority residents, lower Medicaid census, and lower resident acuity.

Those that didn’t adopt had more survey deficiencies, lower registered nurse staffing, and a greater debt relative to assets. Greater culture change adoption occurred when states rewarded adoption in t their pay-for-performance (P4P) system, had a culture change coalition, and paid a higher Medicaid per diem.

The bottom line finding is that, to date, nursing home culture change models such as Green House have been adopted differentially by higher resource organizations, and that nursing homes are responsive to state policy factors when adopting culture change. 

Where is Green House Going? Deep culture change such as the Green House model requires significant investment, vision, and leadership on the part of nursing homes. Not surprisingly, our findings suggest resource-challenged organizations have lagged behind in the adoption of culture change and the Green House model.

Medicaid nursing home payment policies such as P4P can be used as an important first step towards expanding the number of settings adopting Green House. Other policy and related efforts to promote Green House might include regulatory changes, quality reporting, lowering the costs of capital, and workforce enhancements. However, states will need to develop additional policies and incentives to target resource-poor settings that have higher numbers of Medicaid enrollees and minorities.


Thrive Research: Multi-group benefits for an evidence-based model

By / Posted on April 25th, 2012

The Green House Project has partnered with the Robert Wood Johnson Foundation’s THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care.  Supported by the Robert Wood Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will compose the largest research effort undertaken to date in Green House homes.  Each month, a member of the THRIVE team will contribute a blog post to the Green House Project website.

 

Let’s be honest—when someone comes along and says, “Wouldn’t it be great to do a research study to learn about how well Green House Homes function and the impact that they have on residents?” It won’t sound like a good idea to everyone, especially those who are asked to spend time and effort on the study.  The time needed for site visits and data collection will lead some people to ask, “Is it really worth the time and energy?”

We think it is — and let us tell you why.

Many groups of people benefit from studies of the Green House model. The first group is–naturally–the residents of the homes.  Sharing best practices across homes is sure to help care and resident well-being. When researchers look at best practices they don’t just look at one home with a good idea, they look across a number of homes to see if the practice works in various settings or could work in various settings, or instead whether it’s a one home phenomenon.

The second group to benefit is the homes that want to move to the Green House model, or to adopt some of its best ideas. They need evidence that this model will be worth the effort it takes to make change. Within the homes, the staff who make the changes need evidence, and so do their bosses.

The third group is the agencies who foot the bill. Whether it’s a government program or a foundation, “payers” want to know the facts. Stories of success are important, but only information collected in a standardized manner across a number of homes will provide them with the evidence they need.

Participating in research does take some time, but what can be learned by thoughtful, experienced researchers is useful not just to those they study but to the field overall. Participating in research is an act of giving to your residents, their families, and caring staff all over the country. Thank you for all that you do.

 

Questions about THRIVE can be directed to Lauren Cohen (lauren_cohen@unc.edu or 919-843-8874).

 

The THRIVE research studies are funded by the Robert Wood Johnson Foundation.


Thrive Research: Culture Change Sustainability in the Green House Model

By / Posted on April 4th, 2012

The Green House Project has partnered with the Robert Wood Johnson Foundation’s THRIVE (The Research Initiative Valuing Eldercare) collaborative to learn more about the Green House model as well as other models of care.  Supported by the Robert Wood Johnson Foundation, the THRIVE team is conducting a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes.  Each month, a member of the THRIVE team will contribute a blog post to the Green House Project website.

 

One of the broad concepts that long term care researchers, practitioners, and consumers are interested in is culture change. It’s hard to find a long-term care setting that doesn’t claim to be engaged in culture change in some way.  Many see it as a shift from the traditional institutional “one-size fits all” model of providing care to one that focuses on “person centered” care.  But are people walking the walk, or just talking the talk?  What extent of change is necessary to really change the culture?

The Green House is one model of culture change that uses a comprehensive approach to culture change, including creation of specific environmental features, alteration of traditional care practices, and re-organization of staff roles.  Alternately, some nursing homes have changed by adopting a single practice, such as consistent assignment of staff, or resident choice about what time to awake  in the morning. Some have changed the environment to offer private rooms, more intimate dining rooms, or more private lounge spaces.  Also, environmental changes using a “hotel amenity” approach are becoming particularly common to attract people who need short-stay rehabilitation.

Does any or all of this equal “culture change”? Can smaller changes achieve the same outcomes as more extensive changes? Are there specific practices or environmental changes that are necessary to achieve certain outcomes?  When are changes sufficient to suggest that culture change has occurred?  Is all culture change equal? 

Research suggests that change in an organization occurs only when a new way of doing things is generally accepted throughout an organization, and when policies, procedures, and routine practices are aligned with the new way of operating.  So, when implementing culture change, it’s important to ask:

1)     Do we generally agree about what is important?

2)     Are we all moving in the same direction, toward what we believe is important?

3)     Do our policies and procedures support this new way of operating or are they at odds with where we say we’re going to do?

The THRIVE research team will be exploring some of these questions with culture change organizations, many of which are Green House homes, and strives to understand how culture change is achieved and sustained within these organizations.

 

Questions about THRIVE can be directed to Lauren Cohen (lauren_cohen@unc.edu or 919-843-8874).


THRIVE Research – What does this mean for Green House Homes?

By / Posted on January 26th, 2012

THRIVE Research – What does this mean for Green House Homes?

 

You’ve probably heard about the THRIVE  research studies aimed at learning more about how the Green House model works and how it differs from other models of care.   You might be curious what this means for the Green House projects over the next few years.

 

Many of the Green House projects will be getting calls over the next year to discuss participation. Research team members from Pioneer Network, University of Wisconsin-Madison, University of North Carolina, and Health Management Strategies will be contacting several projects to ask them to participate in one or more parts of the study.

 

Here are some terms you might hear or see:

 

Questionnaires: These are paper or electronic surveys staff complete on a topic.

 

Site Visit: Several Green House projects will be asked to host a visit by a small team of friendly researchers (usually 2-4 people).  The purpose of the visit is to collect information on what life is like in the Green House homes for shabhazim and elders and how care is provided.

 

Interviews: Interviews are one way researchers get to know details about how things work in the Green House homes. Interviewees will be asked questions that allow them to tell stories and share their experiences.

 

What is a site visit like? 

Enjoyable !  A site visit from the research team is not like a visit from state regulators, in that the intent is to learn and not to evaluate.  It’s a time for researchers to learn about what life and care is like in a Green House, and for Green House staff, shabhazim, and elders to have the opportunity to contribute to what is being learned.  

 

Lori Kinney, Green House Guide at Lebanon Valley Brethren Home, has experienced a few site visits from research teams. “The research team’s communication was great, whether it was through emails or phone conversations. The visits went well… Since we, staff and elders, were prepared for the visits from the research team, things moved along swiftly and elders always appreciate visits from ‘new’ people that enjoy listening and talking with them.”

 

The researchers understand that the Green Houses are the elders’ homes and intend to minimize disruption as much as possible. The researchers are flexible and know things can “pop up” that make it difficult for staff to attend to the research needs during the visit. Elder’s needs are always the top priority.

 

The research team looks forward to working with the Green House homes! Questions about THRIVE can be directed to Lauren Cohen (lauren_cohen@unc.edu or 919-843-8874).

 

 The THRIVE research studies are funded by the Robert Wood Johnson Foundation.


The Green House Project research study: “Prove it works.”

By / Posted on January 6th, 2012

You wouldn’t buy an expensive medication without confidence that it works, would you?  Because the Green House model requires an investment, people are asking for evidence that it works and to understand why it works.  In response, the Green House Project has partnered with THRIVE (The Research Initiative Valuing Eldercare), funded by the Robert Wood Johnson Foundation, to learn more about how the Green House model works and how it differs from other models of care.  The THRIVE team is launching a series of projects comprising the largest research effort undertaken in Green House homes.  Many of the THRIVE team members have previously researched the Green House model, and their earlier work in part shaped the questions that THRIVE will be answering.  Here is some of what is known from previous work:

  •  Do specific components of the Green House model relate to better outcomes for elders?   THRIVE members Sheryl Zimmerman and Lauren Cohen (University of North Carolina at Chapel Hill) reviewed research literature and found strong support that certain components of Green House homes seem to relate to better outcomes — such as that private rooms and bathrooms and communal dining relate to less infection and better intake.  However, they also found that little research has been done regarding many other components of Green House homes, so several questions remain as to which components matter in terms of better quality of life for elders. 
  •  How does daily practice of front-line caregivers differ in Green House homes compared to traditional settings?  THRIVE members Siobhan Sharkey, Sandy Hudak, and Susan Horn (Health Management Strategies and the Institute for Clinical Outcomes Research) observed that elders receive more direct care time per day in Green House homes than do similar residents in traditional nursing homes – about 20 additional minutes more per day, in fact.  They also found that elders in Green House homes maintained their ability to perform activities of daily living, such as dressing and eating, to a greater extent than those living in traditional nursing homes.   It is not clear, though, what it is about the Green House model that might relate to better outcomes. 
  • How does the role of the nurse differ in Green House homes?  Work by Barbara Bowers and Kimberly Nolet (University of Wisconsin-Madison) found that Green House homes have used different models for how Shahbazim and nurses work together to provide care for elders.   Each model had meaningful consequences for both staff and elders, but it is not clear why there were such differences across homes. 

These three studies left us asking, “Are Green House homes helping elders more than are traditional nursing homes, and if so, which specific elements and practices are making the difference?”  The THRIVE team will be answering this question, and also looking at other topics including staff turnover, who is adopting the Green House model, and costs.  Participating sites will help answer these questions, and also will receive confidential feedback about their organization.  It’s an exciting opportunity for researchers, Green House homes, and other nursing homes to work together toward improving care.

Questions about THRIVE can be directed to Lauren Cohen (lauren_cohen@unc.edu or 919-843-8874).


A New Research Article by Bowers and Nolet: Empowering Direct Care Workers

By / Posted on November 18th, 2011

A basic tenant of THE GREEN HOUSE model is that an empowered, self-managed team of direct care workers will improve the quality of life and care of elders in long-term care settings, as well as the quality of life and job satisfaction of the people providing that care. While this has been a long-held belief of not only THE GREEN HOUSE model, but also other small-house models and the culture change movement in general, it has been difficult to substantiate in a quantitative fashion. A recent study by Barbara Bowers, PhD, RN and Kim Nolet, MS of the University of Wisconsin-Madison, published in the of Seniors Housing & Care Journal has attempted to do just that.

This study focused exclusively on THE GREEN HOUSE model, examining 14 Green House homes with site visits to 11 of them and in-depth interviews with 68 direct care workers (Shahbazim), 29 licensed nursing staff and 8 directors/assistant directors of nursing.
Here are some of their findings.
Selecting Workers / Implications for Empowerment
• Shahbazim have clear beliefs about the criteria that should be used when selecting new workers and this differs from the criteria most managers used in their selection process.
• Considerable variation exists in how direct care workers were selected to become Shahbazim. Few homes included direct care workers in the selection process. For those that did, the nature of their involvement varied across organizations.
• Management has a generally insufficient appreciation of the impact nurses have on direct care staff empowerment and the difficulty of implementing the model without the support and understanding of the nurses.
Meaning of Empowerment
Shahbazim were clear in how they defined being empowered.
• Not having someone looking over their shoulder, checking up on whether they’ve done what they were already planning to do and what is part of their everyday routine.
• Control over the prioritization of the work day – i.e. not getting pulled from a task underway to attend to some other matter.
• Ability to talk directly to family members about elder care. Being able to initiate such discussions during family visits or by phone is considered to be an important aspect of empowerment by the Shahbazim.

Benefits of an Empowered Worker Model
The benefits of being empowered played out in several ways:
• Learning to work as a team, responsible for all of the house and elders, not just “my elders”.
• Development of new work skills such as budgeting, mentoring and management that they would not have an opportunity to develop and use as CNAs in a traditional nursing home.
• Bringing natural talents and abilities to their work, such as baking, craft-making, music, photography, etc.
Sources of Variation in Empowerment Implementation
• Organizations have approached empowerment in different ways with varying degrees of obstacles and success.
• Variation was greatest in the homes that were among the first to be involved in the Green House culture change. Those that joined after the change in orientation that integrated nurses and included Shahbazim in the selection of new Shahbazim experienced more consistency in implementation strategies and a greater sense of empowerment of the direct care workers.
• As the model matured and the bringing of nurses and Shahbazim together from the beginning to discuss what empowerment means and how it relates to the roles each play resulted in greater comfort and satisfaction of both Shahbazim and nurses.

These findings are important to consider as Shahbazim, nurses and the entire teams in Green House homes and other household models continue to develop and evolve.  Click here to read theNIC_2011_Journal_Bowers


Preliminary Implications from Early Hospitalization and Pressure Ulcer Data

By / Posted on November 1st, 2011

Sharkey, Hudak, Horn, and colleagues (2010) collected data to examine differences in staffing utilization in Green House homes compared to traditional nursing homes. During the study, clinical outcome data were collected and analyzed to help frame future research. Resident acuity data were reviewed to assure comparability among sites. As the researchers analyzed the clinical data, several important trends emerged that provide insight into The Green House model’s impact on hospitalization and pressure ulcer rates as well as costs. The information below reflects the results of additional analysis of these data by Sharkey and Horn and a preliminary cost analysis of these data by The Green House Project. Current research being conducted by a collaborative of research partners under Robert Wood Johnson Foundation funding will examine these areas further.

Preliminary Implications from Early Hospitalization and Pressure Ulcer Data


Financial Implications of The Green House Model: Full NIC Article

By / Posted on October 27th, 2011

Financial Implications of THE GREEN HOUSE® Model Overview

Robert Jenkens, MSRED; Terri Sult, MBA; Newell Lessell, MBA;
David Hammer, MS; Anna Ortigara, RN, MS, FAAN

Existing research establishes that THE GREEN HOUSE® model of nursing home care provides significant and sustained satisfaction and clinical improvements. Because these improvements have been difficult to achieve in traditional nursing homes without significant cost increases, potential adopters, policy makers, and advocates have asked if Green House homes can deliver these results within the cost neutral financials promised by the model’s transformational redesign.

Several recent studies, each limited in scope but with mutually reinforcing findings, provide growing evidence that The Green House model’s operations are comparable in cost to traditional nursing home operations as well as nursing homes implementing other culture change practices. Capital costs for Green House homes are found to be equivalent to or less than similar culture change models. Occupancy and private pay revenues are found to increase.

Major findings include:

• Significantly more direct-care and nursing time is delivered in The Green House home
• Overall staffing needs and costs do not increase compared to traditional settings due to a shift from supervisory and department hours to direct care hours.
• The Green House model uses time more effectively, delivering significantly more direct care and nursing hours within lower total direct service hours.
• Average operating costs for Green House homes are between the 50th to 60th percentile of nursing homes nationally.
• Consistent and financially important differences were found in Green House providers’ overall occupancy (7% higher) and private-pay occupancy (a 24% increase) compared to nursing home averages.
• No hidden or unexpected costs were associated with The Green House model.
• Green House homes’ capital costs, including all private rooms and bathrooms, were found to be at the low end of culture change models.

These research results, coupled with anecdotal experience of early adopters, indicate that The Green House model and implementation process offers a strong and flexible option for organizations seeking proven innovations to address current challenges and future opportunities.

NIC GHP One Page Summary

Click the Below Link to download the full article:

Financial Implications of The Green House Model_Senior Housing &Care Journal

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