Green House Blog

Leading Age names The Green House Project a Leadership Program to Watch in 2013

To expand the world of possibilities for aging, LeadingAge members and affiliates touch the lives of 4 million individuals, families, employees and volunteers every day. The work of LeadingAge is focused on advocacy, education, and applied research. CEO, Larry Minnix, shared an inspiring blog about how far our field of aging has come, and he asks the question, “So, how did dramatic change occur over the generations? Did it happen spontaneously? No, it happened because of the leadership from members, many of whom have served their communities for generations!”

Just as Eden Principle #10 states, “Wise Leadership is the lifeblood of any organization”, Larry Minnix calls out a few programs whose leadership is moving our field forward. The Green House Project, with a commitment to research, including a business case, is honored to be named as a leader. Leonard Florence Center for Living was also named as a leader to watch. As the first urban Green House Project and with incredible use of technology to create meaningful lives for those living with ALS and MS, this project is beyond cutting edge.

Thank you to Leading Age for this honor and for the work that you do to support and advance our field.

Green House homes are a viable lifestyle choice for communities of the future

The National Association of Home Builders (NAHB) sees Green House homes as a model that consumers prefer, and will demand.  A recent piece on this model for skilled nursing care highlights consumer research that found informal caregivers willing to drive further and pay more to have this as an option in their community, ” The enthusiasm among informal caregivers doesn’t just bode well for this market in the immediate future, but also in the longer term, when millions of boomers will need care themselves. Surveys show that as boomers age, they will greatly value — perhaps more than any prior generation — the independence and amenities that a home setting affords.”

The next evolution of The Green House model is to not just build real homes on an existing nursing home campus, but to embed the homes directly in the community.  At St. John’s home in Rochester, they have done just that..

Nestled among the rest of Arbor Ridge’s new homes and residential amenities are two Green House homes, which have been built from the ground up to deliver the highest quality skilled-nursing care in a setting that looks and feels — both inside and out — like a real home. Both homes are operated by St. John’s Home, , and each provides a home for up to 10 elders, each with private rooms and bathrooms. Elders set their own schedules, eat home-cooked meals made in the home’s open kitchen, and share good company by the fire in a real living room.  

This article speaks to builders and devlopers who are hoping to bring this option to their communities and provides information about how to partner with The Green House Project. “As America’s population rapidly ages, communities must increasingly offer a mix of housing options, and that includes long-term care for those who can no longer care for themselves. Like parks and good schools, Green House homes have the potential to not only to improve individual lives, but also to enhance whole neighborhoods. They are a practical way to meet the needs of families today — and in the years to come.”  Click here to read the full article.

Exploring Green House Core Values: Real Home

“I want to tell you a story about the beginning of The Green House model”

“Part of being home is being where you belong,” states Dr.Bill Thomas.  When he envisioned The Green House concept he wanted to create a home rather than a “home-like” environment. He wanted every Green House home to feel warm and inviting and be a place of safety and refuge. Most importantly, he wanted the individuals living and working there to create home together.  

Join Dr. Bill Thomas as he reflects on what it means to create Real Home, and how this value is foundational to The Green House model.  To radically transform long term care, Dr. Thomas had to manage the technical aspects, while bringing the “heart and soul” back into the paradigm.  It is an interesting question, “what is home?”, because it isn’t necessarily a building or an address, but rather a feeling, of safety, refuge, relationship.  Green House homes strive to fit into the culture of the surrounding community through intentional design that looks and feels like a real home. 

It has been 10 years since the first Green House project opened its doors, and we are marking this occasion by highlighting a different aspect of this model each month.  The first three themes are the foundation that ties all Green House homes together: Real Home, Meaningful Life and Empowered Staff.  Each aspect of The Green House model has power on its own, and the real beauty occurs when they all come together to create something new, something special… a synergy that impacts the lives of those who live and work there. 

Enjoy this video, on Real Home and stay tuned for Meaningful Life… 


THE GREEN HOUSE® performance on Quality Measures

Eighty percent of Green House homes serve Elders with skilled care needs. The model strongly supports Elder choice and relationships but Quality of Care is also important to support meaningful lives in real homes. The case needs to be made for quality clinical outcomes from deeply transformative models like The Green House Project.

EQUIP for Quality* is the quality tool used for clinical benchmarking by The Green House Project and all skilled Green House Projects are encouraged to participate in data collection.

This report represents the MDS 3.0 data from 10 skilled Green House Project organizations from third quarter 2012. This is a snapshot in time, but very important in understanding quality of care in Green House homes. Below are Quality Measures where these homes performed significantly better than national benchmarks:

• Percent of Residents Who Self-Report Moderate to Severe Pain (Long Stay)
• Percent of Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine (Long Stay)
• Percent of Residents Assessed and Appropriately Given the Pneumococcal Vaccine (Long Stay)
• Percent of Residents Who Have/Had a Catheter Inserted and Left in Their Bladder (Long Stay)
• Percent of Residents Who Have Depressive Symptoms (Long Stay)
• Percent of Residents Who Received an Antipsychotic Medication (Long Stay)
• Percent of residents who have behavior symptoms affecting others (Long Stay)
• Percent of Residents Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine (Short Stay)
• Percent of Residents Who were Hospitalized in the last 100 days (Long Stay).

Other Quality Measures were similar to national nursing home benchmarks.

Two measures that are particularly targeted in long term care today are re-hospitalizations in the previous 100 days and the use of antipsychotic drugs. These show significantly better performance during this period of time and are considered areas of both high cost and clinical significance in understanding and managing care transitions. All indicators are important to guide the understanding quality of care in Green House homes. Having regular data provides deeper understanding of the model and sharper targeting for education and process redesign within the model. For more information contact

*EQUIP for Quality, Leading Age New York

Pennsylvania Planning Construction of "Real Homes" for Elders

After years of planning, Beaver County, Pennsylvania, is getting ready to build a new senior living community. Comprised of 4 houses with yards and sidewalks, the homes will be part of The Green House Project, a national model that creates caring homes for meaning lives.

The Ellwood City Ledger explains: [Lutheran SeniorLife spokeswoman Mary Lou] Harju said construction is expected to begin this spring on four houses. Each house will be 7,000 square feet and will house 10 residents. Each resident will have his or her own private bedroom and bathroom, and they will share a living room and dining room, she said. The development will look like a residential neighborhood with sidewalks and landscaping.

She said the residents have input in their daily living, such as planning meals. The staff won’t just walk into the homes, but will knock and be admitted by the residents, she said.

“Basically, it’s creating a community of individuals,” Harju said. “It is truly their home.”

As Americans age, they worry about finding a place to live happily and comfortably, that provides the care and services they need. Many nursing facilities can feel like hospitals instead of homes, but since 2002, the RWJF-funded Green House Project has pioneered a radically different approach to long-term care. Today, 264 homes are open or under development in 32 states. These Green House homes have been designed from the ground up to look and feel in every way like real homes. Research shows that elders are healthier and happier in Green House homes, which cost no more to operate than traditional nursing homes. We will keep you updated on the progress of this new Green House home community. To find a home in your area, please click here

To read the full article in the Elwood City Ledger, click here

"Look Who's Aging", a Conference to Discuss the Future

Last week, The Green House Project participated in a conference presented by The Erickson School’s Institute for Leadership. The School’s mission is to convene leaders in the field of aging services, through summit educational programs and research, to discuss and develop solutions to the common challenges that await in the future. The plethora of creative presentations and conversations worked to create links between person centered services and the creation of competitive advantage and a dominant market position, now and in the future. Some of the major take a ways from the conference:

  • Scott Townsley, Clifton Larson Allen, dissected the DNA of an innovator, and described, The 5 discovery skills of an innovator: Associating, Questioning, Observing, Experimenting, and Networking
  • When a field becomes homogenized, we compete based on price– Differentiate!
  • Robyn Stone of Leading Age described the need for seamless links between acute and primary care, and use of technology to improve home care.
  • Focus on prevention and infusing the community with a range of services to support an aging population
  • Bob Kramer of National Investment Council, says that this not an evolution, but a revolution and the future will represent a wide diversity of options for elders
  • Will we see the aging of boomers as unwilling and unwanted? or willing and wanted?  Unprecendented epedemic of lonliness or unprecedented infusion of workers, volunteers and energy?
  • Don’t underestimate the pace of change once expectations change
  • Carmen Bowman, “Why do we say Independent LIVING, Assisted LIVING, but Skilled Nursing CARE– let’s shift perception to believe that life continues at every stage”
  • Rob Mayer of the Rothchild Foundation talked about creating a culture of philanthropy in aging- there is 298 billion philanthropic dollars out there and currently the Aging field gets less than 1% of that $$!!

It was a very stimulating and thought provoking few days!!

Celebrating the Opening at Woodland Park

Below is an excerpt from As Our Parents Age, a blog by Marti Weston. Marti’s parents are residents of Virginia Menonite Retirement Community and this blog is her effort to record the experiences of loving and living with aging parents. She highlights interesting issues, identifies high quality web resources, and shares memories.  In this piece, she shares her impression of the Grand Opening Celebration of the first Green House homes in Virginia:

Today (January 5, 2013) we celebrated at the first of two Woodland Park grand opening events — almost one year to the day since the groundbreaking. With these first Green House Homes in the Commonwealth of Virginia, VMRC aims to start a trend, encouraging other providers to recast the way they address aging issues and helping elders age well in a caring community that preserves their independence — even when they need considerable medical support…“This is truly transforming the institutional nursing home model as we know it,” explained Melissa Fortner, VMRC Vice President for Supportive Living. “That’s what we set out to do in the beginning, and now we are doing it.”

To read the full entry, click here:


Cleared trees rooted in furniture in Virginia’s first Green House homes

Residents and staff who gather for meals in any of the three Woodland Park homes on the campus of VMRC will be seated at a table made from trees cleared from the site. Several of the white oak trees were cut, dried then hollowed out for preparation for the woodworking phase.

Marv Nisly, vice president of Design & Construction at VMRC, said that

there was talk during construction if there was a use for the trees in the homes. “We considered some options and estimated the amount of wood we would need,” he said. VMRC received in-kind services in part from Willow Run Saw Mill and Lantz Woodworking for the furniture-making process.

The result was three sets of several pieces of furniture for each home in the Woodland Park neighborhood: a dining room table which seats 14, a hutch, a game table, side table and matching bookshelves. The white oak pieces were then stained and finished to match the furniture decor in the homes.

VMRC officials say the response has been overwhelming when people learn the


story of the furniture. “Many white oak and ash trees graced the property where the original Woodland building was located on VMRC’s campus. When the building was razed to clear the site for Woodland Park, we intentionally kept as many trees that we could,” said Maureen Pearson, VMRC’s director of Communications. “Using the wood from


the cleared trees means that the residents of Woodland Park will continue to enjoy those trees but in a different form.”


Highlighting THE GREEN HOUSE® Project Team: Heather Marshall, Project Manager

Heather fondly remembers her childhood and much of that happiness in her life is because her Grandparents were so involved in her upbringing.  In fact for a long time Heather thought she had two Moms—her Mom and her other “mom” which was her Grandmother!

Her Grandmother worked in the school system as a Truant Officer, so Heather would not only spend time at home with her, she was also at the school with her every day.  Those early years formed a unique foundation for Heather—one where she was most comfortable being around adults and also showed the importance of being grateful for the many blessings in her life.  Giving back to your community was part of those lessons learned from her childhood.

So it should be no surprise that Heather pursued a degree in Social Work and was the only one in her undergraduate class with an interest in Gerontology!  Her undergraduate work earned her many awards including being published in a national industry periodical, Social Work.  An internship at an Adult Day Enrichment program turned into a full-time position after she graduated with her B.S. in Social Work.  A year and half later Heather went back to school for her Master of Social Work degree at Washington University in St. Louis.  A highlight for her graduate work was the time she spent as an intern at the National Council on Aging where she organized a national summit for the Multi-Generational and Civic Engagement Initiative which brought together leaders to share successful methods of engaging older volunteers in leadership positions.

Today, as a Project Manager for THE GREEN HOUSE ® Project, Heather is excited to be part of the team and share her knowledge of the model and support current adopters.

  • Master of Social Work, Gerontology; Washington University in St. Louis, Missouri
  • Emerging Leaders in Aging (ELA), Co-Director of D.C. mentorship program
  • Trained Eden Associate and Embracing Elderhood Guide
  • 5 years in aging services
  • Publication in Social Work.  The big picture:  How social work can effectively utilize photography.  October 2009.
  • National Association of Social Workers Bachelor of Social Work Student of the Year for Tennessee; Dr. Clara Louise Myers Outstanding Practicum Student Award in Gerontology

In addition to her passion for working with Elders, Heather enjoys photography, game nights with friends, attending live concerts, and playing Ultimate Frisbee!

Is There a Recipe for Culture Change?

Is there a recipe for culture change? The Green House ‘recipe’ for culture change uses many ingredients. These include specific environmental features, like an open kitchen and private bathrooms, and also re-conceptualized staff (or Shahbazim) roles. Other nursing homes that have embraced culture change have a different recipe. Some, for example, have retrofitted, remodeled households, while others have more traditional environments; some utilize universal workers, but others do not. If culture change can appear unique on so many levels, what is it about the philosophy that really makes a difference? Are there any key ingredients for culture change? To better understand these questions, the THRIVE research team surveyed culture change adopters to learn more about their practices and environments.
What do most adopters report? These adopters most often reported certain relationship-based practices such as the use of staff consistent assignment or family member participation in care conferences. They also reported similar components of work organization and decentralized decision-making such as non-activity staff helping to choose activities and the ability of staff to fulfill requests without prior approval from an administrator. Adopters also reported similar mixtures of ingredients to enhance resident choice including dining in the small house or household to support choice in mealtime.
Are there differences in the culture change components that adopters report? Yes. There were distinct differences in the recipes of small houses, households and more traditional environments.  For example, small house models were more likely to report that direct care staff schedule themselves and choose care assignments, but these were some of the least adopted practices for other adopters. Small houses are also more likely to have CNAs attend care conferences and less likely to use overhead pagers or med carts than other adopters. Meal preparation varied for all three models. For example, small houses were more likely to prepare food in a kitchen in the home while households were more likely to use steam tables with food prepared in a centralized kitchen.
The THRIVE research team is in the process of studying the survey results to better describe the recipes of culture change adopters. As pay-for-performance and policy programs are developed to incentivize culture change, understanding the core ingredients in implementation can promote a recipe for change that is attainable for a broad range of providers.
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.

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