Green House Blog

The Green House Project Celebrates 100 Homes

The Green House model, considered a radical innovation in skilled-nursing care only a few years ago, is fast becoming a mainstream alternative to traditional nursing homes. This week, the Robert Wood Johnson Foundation and The Green House Project marked the completion of America’s 100th Green House home and announced a goal of tripling the number of homes in the next three years.

“The Green House movement recognizes that just because someone can no longer live independently doesn’t mean that they must surrender their dignity and quality of life,” said Risa Lavizzo-Mourey, MD, MBA., president and CEO of the Robert Wood Johnson Foundation. “The Green House model represents a disruptive innovation that is transforming an entire field for the better. Our goal is to establish it as the benchmark of quality and patient satisfaction for affordable, community-based skilled-nursing care nationwide.”

The announcement comes amid new research that shows the financial feasibility, significantly improved clinical and satisfaction outcomes and strong demand for new models of long-term care — research that should make the Green House model an even more appealing option to policymakers and long-term care providers.

New polling data from NPR, Robert Wood Johnson Foundation and Harvard School of Public Health reveals that older Americans are deeply concerned about the prospect of residing in a nursing home. In addition, a September 2011 article in Senior Housing & Care Journal concludes that Green House homes provide significantly better care at no greater operating cost than traditional nursing homes. Recent analysis of research data by the same authors also suggests that Green House homes may offer substantial savings to Medicare and Medicaid through avoidable hospitalization and pressure ulcers.

“Every community in America should have Green House homes as an option for elders and people with disabilities,” explained Robert Jenkens, director of the Green House Project. “For the same amount we are already spending to operate nursing homes today, people could be happier and healthier, and the system as a whole could save money each year because of avoided health problems. As a country, we can use some of those savings to fund the replacement of institutional buildings that no longer serve our health and quality goals for Medicaid recipients.”

    Welcome Solution to Concerns About Care, Cost

The model provides an environment in which residents receive nursing support and clinical care without the care becoming the sole focus of their daily lives. By altering the facility size, interior design, staffing patterns and methods of delivering skilled services to residents, the Green House model provides residents greater health and lifestyle benefits compared to residents of traditional nursing facilities.

Because these improvements have been difficult to achieve in traditional nursing homes without significant cost increases, the fact that new, peer-reviewed research finds that Green House projects are essentially cost neutral comes as welcome news to long-term care providers, policymakers and consumer groups alike. In fact, the findings were so significant that the National Investment Center for the Seniors Housing & Care Industry recently acknowledged the research with its prestigious GE Healthcare Award for Best Paper of 2011.

The economic data is especially relevant in light of new nationwide polling data revealing that aging boomers are very anxious about how they will pay for long-term care and ensure a high quality of care for themselves and their spouses. The vast majority (nearly 80 percent) of Americans over 50 expect to have trouble paying for long-term care while three out of four worry about quality of care and quality of life. When it comes to the prospect of living in a nursing home, their biggest fear is that “being in an institutional environment is not as comfortable as home.”

    Plans for the Future

The Green House concept has already spread nationwide, with Green House projects operating or in development in 29 states. In meeting its goal to triple the number of Green House homes in the next three years, both the Robert Wood Johnson Foundation and the Green House Project see major opportunities in states like California and Maryland, both of which have their first homes in development currently, and New York, where two completed projects are far from meeting the state’s mounting need for high quality, skilled-nursing options.

The Green House Project has also taken steps to use the model to meet the needs of two groups with increasing needs for non-institutional models of long-term care. Recently, the Robert Wood Johnson Foundation and NCB Capital Impact announced a new $10 million low-interest loan fund to build Green House homes serving low-income individuals. And later this fall, the Department of Veterans Affairs is to open the first Green House homes for older veterans in Danville, IL.

“If we want all Americans to be healthy in their later years, we cannot just focus on what happens in the doctor’s office,” added Lavizzo-Mourey. “We have to make sure that where they live promotes their health and happiness. The Green House model offers a revolutionary and practical way to do just that.”

    About the Robert Wood Johnson Foundation

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable and timely change. For nearly 40 years the Foundation has brought experience, commitment and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime.

    About The Greenhouse Project

The Green House Project is a partnership between the Robert Wood Johnson Foundation, NCB Capital Impact and The Center for Growing and Becoming. The Green House Project provides technical assistance, financing and ongoing support to providers and local organizations to support the development and operation of Green House homes across the country. To date, more than 227 Green House homes are open or under development through partnerships with over 50 organizations across 29 states.

First Community Initiated Green House Homes!

In a first for THE GREEN HOUSE ® Project (at least that we know of), resident research contributes to the adoption of The Green House model:

[Excerpts from The Thursday Flyer, a weekly newsletter of the residents of John Knox Village of Florida as published September 22, 2011] “In a landmark move to cement the position of John Knox Village as the premier state-of-the-art nursing home provider in the State of Florida, the JKV Board of Directors…voted to apply for membership in The Green House Project.  That motion, from an Ad-Hoc New Health Center Building Committee including ten members who are JKV residents, came before the Board with the unanimous approval of the Board’s Building Committee and Finance & Audit Committee, and passed the Board by near unanimity.

Board Chair Bill Knibloe pointed out that The Green House Project, with more than 100 homes open and functioning, has gained extensive experience operating in 27 states over the past seven years.  They are the only organization, Knibloe said, to have developed a comprehensive, time-tested model embodying the philosophy of person-directed care, a supportive building plan and a corresponding cost-effective staff reorganization model.  Rather than trying to “reinvent the wheel,” JKV will be better served by adopting the proven Green House model.

Board Member and prominent geriatric neurologist Dr. Murray Todd, who visited an operating Green House home in Birmingham, Alabama, earlier this year with Health Center Administrator Mark Rayner, Director of Nursing Christina Desposito and JKV resident Nancy Matthews, said all four had been impressed with what they saw and that he personally was convinced the Green House model was the way to go.  It is more like a real home than an institution.

Addressing the question of cost, Resident Board Member Norm Rasmussen cited extensive independent scholarly research showing that the costs of Green House construction and operation are on a par with those of other first-class skilled nursing facilities featuring all private rooms, as does the Green House model.  Resident Board Member John Thompson had spoken with the Health Center Administrator and CFO at a 5-star California CCRC operating, as does John Knox Village, with “Type-A” insurance-policy contracts and set to start construction of the first Green House homes  in California in a few months.  Both were enthusiastic about their project.  The Administrator praised in particular the skill of The Green House Project in negotiating their project’s approval through three demanding California state agencies.  The CFO said they would not raise monthly maintenance fees at all due to expected operating costs of Green House homes.”

The Green House Project is thrilled to be working with such a strong partnership of staff and residents.

Exciting Green House Website Updates

The Green House website is a powerful tool for connecting our community of Green House adopters, culture change enthusiasts, policy makers, consumers and other partners. This site must be a dynamic gathering place where information is at our fingertips and supporting our efforts. Beyond that, our website must convey the robust culture of our movement. In order to build and support this community effectively, The Green House project website, continuously strives to be more accessible, user-friendly, and constantly updating!

That is why we are so excited to share the latest website enhancements:

  • WordPress platform enables agile access to photo and news updates
  • Up to date announcements of speaking engagements, workshops, webinars and other ways to connect with The Green House project
  • Interactive commenting opportunities on The Green House blog
  • Links to all of our social media channels, including our facebook page ( that has over 800 fans!
  • User friendly access to Green House Projects in your state, and how to get in touch with them
  • and this is only the beginning…

This new and improved website enables us to be in constant communication with you, and we look forward to hearing your ideas and thoughts.  By building our online community and connecting all those who are interested in changing aging, we are creating a national movement, and a national impact to the lives of elders. 

GE Healthcare Finance Award for The Green House Project

Today, The Green House Project had the honor of accepting the GE Healthcare Award for Best Paper. Over 1,800 leaders, including top lenders in health care finance, assembled at the National Investment Center (NIC) conference in Washington, DC. The National Investment Center for the Seniors Housing & Care Industry (NIC) is committed to advancing the quality of seniors housing and care by facilitating informed investment decisions for investors, lenders, owners, operators and developers through groundbreaking research, actionable data and dealmaking events. NIC is driven to empower the industry with the insight needed to accurately measure performance, drive business decisions and communicate performance to key stakeholders.

Important findings from The Green House journal article were summarized by NIC’s president:

• 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.

The full journal article, Financial Implications of The Green House (r) Model, can be found in the 2011, Volume 19, Number 1 edition of Senior Housing and Care Journal

Presenting Elders Rule! Elders Speak From Experience

St Martins Where Elders RuleElders Rule! Here, you can watch the elder’s from St. Martin’s in the Pines speak on a panel at The Green House Annual Meeting. Learn first hand what it means to live a life worth living in a Green House home.

the panel featuring elders from The Green House Cottages at St. Martins in the Pines in Birmingham, Ala. Now you can watch the whole discussion again and learn first hand what it means to live a life worth living in a Green House home.

From left to right: Ms. Geneva Troxel, Mr. Thomas Harrell, Ms Joann Blake and moderator Anna Ortigara, Green House Project Resource Development Director.

Presenting Elders Rule! Elders Speak From Experience from The Green House Project on Vimeo.

The Green House Project Photo Contest

THE GREEN HOUSE ® Project’s photography contest was a huge success.  From planting flowers in a garden to whipping up something delicious in the kitchen, photographs illustrated how individuals living and working in Green House homes celebrate life.  Over the course of the summer, photographs and stories poured in exemplifying the core principles of the Green House model from meaningful engagement to the art of convivium. 

It was difficult to select just one winner.  However, the submission from THE GREEN HOUSE ® Homes at Green Hill in New Jersey truly captured how lives are not only celebrated, but changed in Green House homes. 

“This photo is of one of our elders that has lived at Green Hill for many years.  The young lady next to her is Maggie Frank.  Maggie has been the Activity Director at Green Hill for many years, leaving briefly to work at another community, then returning “home” to Green Hill.  She has recently stepped into the role of “Guide” for our second Green House Home that just opened a few weeks ago.  You really need to know Liz to fully appreciate this picture and how special it is to see Liz engaged in looking at that book.  Maggie recently went to Ohio to visit family.  Knowing that Liz was a native from Ohio, Maggie went to a local bookstore while out there and purchased a book about Ohio and the specific area that Liz was from.  Upon Maggie’s return,  she sat with Liz and went through the book.  It was so touching to hear that Liz remembered visiting the farms pictured in the book as a child.  Liz shared with Maggie many stories about her childhood and growing up in Ohio that were simply  triggered by familiar pictures in that book.  

I think this photo not only shows our elder during a special moment, but it’s a tribute to all the wonderful, exceptional,  caring people that work at Green Hill.  We ( the staff) at Green Hill are all drawn here out of our love for being part of  an intergenerational setting.  For many of us, it gives us our purpose in life.  What we get in return from being a part of Green Hill and from our elders  – is priceless.”  -Stephanie Roselle, Director of Admissions at Green Hill, Inc.

All the stories and photographs were shared at The 4th Annual Green House Project Meeting on September 8-9th.  Take a moment and explore all the wonderful things happening in Green House homes across the country!

Changes to Life Safety Code

The Green House Project is excited to report that the Pioneer Network/Rothschild Regulatory Task Force’s life safety code revision recommendations submitted to the National Fire Protection Association (NFPA) have been approved and will be incorporated into the 2012 edition of to NFPA 101® Life Safety Code®. These recommendation, which the Green House Project participated in shaping, are a major advance in supporting core culture change practices in nursing homes. They include four proposals that, in the words of the NFPA’s website, will help to”foster a more comfortable, home-like environment.” Per the The Pioneer Network’s press release, these revisions include:

Kitchens serving no more than 30 residents will be permitted to be open to the corridor and other spaces, and either residential or commercial stoves or cooktops may be used provided certain criteria are met.

Furniture may be provided in corridors so that residents can sit and rest and then continue to their destination provided certain criteria are met.

Combustible decorations will be permitted in resident rooms, corridors, on doors, and in common space.   There are limitations on the percentage of coverage depending on whether the building is sprinklered and where located. 

Gas or electric fireplaces will be allowed to be used in smoke compartments that contain sleeping rooms, but not within individual sleeping rooms, with some restrictions.  Some of the restrictions are that the controls must be locked and a sealed glass front must be provided to prevent anyone from throwing object into the flames.

The Green House Project is deeply grateful to The Pioneer Network and the Hulda B. and Maurice L. Rothschild Foundation. for their leadership and tireless efforts to accomplish this success.

Dementia Care: Seeing It From the Other Side

Teepa Snow is an occupational therapist working as a dementia care and dementia education specialist. She has over 31 years of clinical experience in the field of geriatrics and dementia care. Currently, she has an independent practice as well as clinical appointments with Duke University’s School of Nursing and UNC-Chapel Hill’s School of Medicine. Teepa’s approach to interacting and communicating with those people living with dementia is currently a part of  The Green House Project’s curriculum.   

American Society on Aging is hosting a three-part webinar series by Teepa Snow that boils down the overwhelming amount of information available about dementia. The webinars will bring you salient, meaningful resources, techniques, and ideas that you can immediately implement with people you meet and work with everyday who are living with Alzheimer’s and dementia

“Moving Forward with Alzheimer’s & Dementia,” a 3-part series* sponsored by Senior Helpers and the Alzheimer’s Foundation of America
Free and Open to Everyone and
Includes Free CEUs!

Part One of September 26, 2011 (Monday)
11:00 AM Pacific / 12:00 PM Mountain
1:00 PM Central / 2:00 PM Eastern
Speaker: Teepa Snow

Click here for more information and to pre-register.
*Each webinar in the series is a stand-alone event. Participate in one webinar or all three!

Compassion — A Key Ingredient To a Vibrant Green House Home

All people are surrounded by a circle of compassion that defines their relationships with those around them, said Green House Project founder Dr. Bill Thomas in opening remarks at the fourth annual Green House Project Meeting and Celebration in Birmingham, Ala.

And the key ingredient to building a happy and vibrant Green House home is the ability of those in it to significantly grow their personal circle of compassion, Dr. Thomas said.

How big is your circle of compassion? In the video below, Dr. Thomas challenges participants in the Green House Project meeting to examine how willing they are to welcome all people into their circles of compassion.

Compassion — A Key Ingredient To a Vibrant Green House Home from The Green House Project on Vimeo.

Principles and Practices of The Green House Model

green house meeting participants
Karen Boland, Denise Carlson and Megan Swartz of VA Illiana Health Care System

On the final day of the fourth annual Green House Project Meeting and Celebration in Birmingham, Ala., participants explored the “sacred truths” at the core of the model and compiled a rich trove of suggestions during a session called “Principles and Practices of The Green House Model.”

Green House Project director Robert Jenkens provided a brief overview of how the model operates today. He singled out the Green House Project’s requirement for a single dining room table as one of the model’s main “core practices” outlined by founder Dr. Bill Thomas. The practice gives every elder “a place at the table,” which contributes to their overall well-being.

Session attendees were then asked to refine the 10 key principles at the core of both The Green House Project and Dr. Thomas’ Eden Alternative philosophy, which include: autonomy and control; A real home; Family involvement; Community integration; Meaningful days, Optimal health and wellness; A habilitative environment; Ability to age in-place; Wise leadership; and Empowered staff.

Each table made up of Green House Guides, Shahbazim and other staff was given one principle and collaborated to define the top three practices that exemplify it.

For example, to achieve the principle “meaningful days” one table of participants suggested learning what each elder’s individual preferences are, receiving clear and instructional training on what the principle means and promoting elders’ choices.

The input on each core principle was recorded and handed over to the Green House Project staff to be documented and disseminated by the Peer Network, which works to facilitate the success of the Green House model.

The perspective of those who work day-to-day in a Green House setting, especially the frontline universal workers, or Shahbazim, is invaluable for ensuring that the model continues to thrive and

adheres to its core mission, said Peer Network director Dan Klein.

— By Joseph Popiolkowski, special to the Green House Project Blog

Recognizing Changes in Mental Status: What it means, What to do

Caregivers in Green House Project homes should be aware of changes in elders’ cognition status and act preemptively to address possible underlying causes rather than simply blaming dementia.

That was a lesson delivered at fourth annual Green House Project Meeting and Celebration in Birmingham, Ala., Sept. 8 by Anna Treinkman in an education session called “Recognizing Changes in Mental Status: What it means, What to do!”

Treinkman — a registered nurse and advanced practice nurse at the Rush University Medical Center’s Rush Alzheimer’s Disease Center — urged session attendees to “think like a detective” when an elder’s altered mental status is noted.

“A sudden change in mental status is always a red flag,” she said.

Signs and symptoms such as wandering, apathy and anxiety can indicate an acute illness such as a urinary tract infection or drug side effects rather than dementia, she said.

Finally, Treinkman led the group in a discussion of several case studies to determine how to respond to situations that might arise in a Green House.

— By Joseph Popiolkowski, special to the Green House Project Blog

RWJF Announce $10 Million Program Related Investment (PRI) to Expand Green House Access to Low-Income Elders

The big news at fourth annual Green House Project Meeting and Celebration in Birmingham, Ala., Sept. 8-9 was the announcement that the Green House movement is receiving an additional $10 million investment from the Robert Wood Johnson Foundation to help finance Green House Projects serving low-income communities.

RWJF has partnered with NCB Capital Impact, the nonprofit organization that oversees the Green House Project, to provide the 10-year, $10 million low-interest credit facility. The investment is the first part of a new $100 million “impact capital” campaign launched by RWJF to help the Foundation and its grantees leverage funding from multiple sources.

“Our goal with this initiative is to go beyond traditional grantmaking, to drive social change, achieve measurable impact and collaborate with partners who can help us achieve our mission,” Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation said in a statement. “This commitment allows us to better leverage our funding and spread innovative models, like the Green House Project.”

Bringing a Proven Model of Care to Low-Income Seniors

Since 2002, the Foundation has awarded $12 million, primarily to NCB Capital Impact, to develop, test and evaluate the Green House model. The model provides an environment in which residents receive nursing support and clinical care without the care becoming the focus of their daily lives. By altering the facility size, interior design, staffing patterns and methods of delivering skilled services to residents, the Green House model provides residents greater health and lifestyle benefits compared to residents of traditional nursing facilities.

The Foundation’s new program investment builds on its past support with the goal of helping the model achieve greater reach and impact. Specifically, the new investment will lower the cost of financing Green House projects to serve low-income individuals and low-income areas. NCB Capital Impact will serve as administrator for the loan fund and will seek investors to leverage Foundation funding in any one project by a ratio of 4-to-1.

“This $10 million investment from the Robert Wood Johnson Foundation clearly demonstrates that the Foundation is committed to providing the leadership to replicate the Green House model and increase access for low-income elders,” said Terry Simonette, president and CEO of NCB Capital Impact. “It also highlights the Foundation’s confidence in the Green House model as an economic enterprise that can provide important services while also generating sufficient cash flow to repay investments.”

Earlier this year, AARP called the Green House Project “a model for aging that promotes growth.” Long-Term Living magazine also recently named it one of the decade’s Top 10 Senior Design Innovations. Early results show that Green House residents report higher satisfaction levels, less physical decline and less depression—at a cost that is comparable to traditional nursing facilities. To date there are 100 Green House homes in 27 states.

“Like everyone else, low-income seniors want to live in their own homes. When that becomes impossible, they want to get the care they need in an environment that becomes a new and real home,” explained Robert Jenkens, who directs the Green House Project. “This investment will have a major impact on the number of seniors and families who benefit directly and it will help change the face of long-term care.”