Green House Blog

The National Real Estate Investor Highlights The Green House Project

Investors find it hard to believe that “smaller is better” when it comes to skilled nursing homes. In an article this week by The National Real Estate Investor, The Green House Project is noted as an exception to that rule. The article explains that with tweeks to staffing levels and the support of Medicaid supplements, Green House homes not only attract more customers, they can be run less expensively and more safely than traditional long-term care.

 Why was the Green House model created? Director David Farrell, talks about his days as a former nursing home administrator.

 “I remember struggling to provide optimal care in those properties, which are driven by tight schedules and staffing [hierarchies] that places the person directly caring for the senior as the low person on the totem pole,” he says.

The article says the largest difference is staffing.  In the Green House model, the traditional hierarchy is flattened.  

They go on to discuss the Green House advantage with Ingrid Weaver, the Senior Vice President of operations at Porter Hills in Michigan.

“[Porter Hills] typically has about less than half of its residents on Medicaid, and with a full waiting list, the personal services allow the company to charge “a little bit” higher for the Green House care, Weaver says. However, because of the small staffing, the operational costs are actually cheaper. “In our legacy nursing home building, our health center cost per day is about $206.81, while at our Green House homes it’s about $189.60, with a savings of more than $124,000 per year,” Weaver says.

There are 146 Green House homes open in 23 states. There are 123  in development. Click here to find a Green House home near you.

Read the full article from the National Real Estate Investor.



3 words, "What makes Green House homes special?"

In May 2006, Tabitha opened Nebraska’s first—and the nation’s second—Green House® Project transforming the way care is delivered by departing from the traditional nursing home model and bringing long-term care into a home setting. We now have four Green House homes on our campus serving 45 Elders. One evening, the Green House family welcomed three newly trained shahbazim to the household during an evening punctuated with music, dancing, eating, champagne popping and a warmth that can only be felt when one is truly at home. This photo and that evening truly showed how Tabitha Green House homes offer love, family and home.


Fighting the Plague of Lonliness is a matter of Life and Death

According to the Washington Post, a new study published in Proceedings of the National Academy of Sciences, finds that actual social isolation can increase the liklihood of death among elders by 26%.

The Green House model is designed to combat the plagues of lonliness, boredom and helplessness.  In The Green House model, the reorganization of the workforce model shifts power into the home and creates 4 times more meaningful interaction with elders than in traditional long term care.  Additionally, because of the small size and consistent staffing, all people in the home are deeply known as creative, resourceful and whole beings.

Much more than reported lonliness, “Social isolation has practical as well as emotional aspects,” says Andrew Steptoe, one of the study’s authors. “People with few social contacts may not have people around them who can give them advice, recommend that they go to a doctor with symptoms, ensure that they maintain healthy lifestyles, or perhaps they don’t have anyone around when they experience acute symptoms.”

We all have this need to be known, to feel safe, and that we have people around us who care.  In Green House homes, this need for connectedness is intentionally built into every aspect of the model, and can be seen in the positive outcomes that come from real home.

Christian Care Communities Breaks Ground on the First Green House Homes In the State of Kentucky

Congratulations to Christian Care Communities for breaking ground on The Homeplace at Midway, the first Green House homes in the State of Kentucky!  Today, supporters of The Homeplace at Midway gathered to celebrate this very special moment for Elders in Kentucky.

In the words of Christian Care Communities, “With shovels in hand and wearing hard hats, public officials, community and business leaders joined with Christian Care for the groundbreaking, signaling the start of the new $13.5 million Green House® community at 671 East Stephens Street, across from Midway College.”

 To learn more about Christian Care Communities’ and these new Green House homes please click here.


The Wall Street Journal Investigates: How Does Dementia Impact Health-Care Spending?

Researchers from the Rand Corporation recently published a study that found medical costs of treating dementia totaled $109 billion in 2010. This is more than was spent on heart disease or cancer! What can be done now to slow increases in expenses and improve care? The Wall Street Journal Real Time Economics Blog highlights the financial impact of The Green House model:          

RWJ and a nonprofit, NCB Capital Impact, have also funded the Green House Project. Each Green House accommodates 10 to 12 seniors with medical help provided by certified nursing assistants.

David Farrell, The Green House Project director, says the small homes allow for less administrative costs and allows residents to remain ambulatory, even with a walker, rather than depending on wheelchairs.

Plus, the nursing staff develop a closer relationship with a small number of [Elders]. “The [CNAs] can pick up on subtle changes in the elderly,” which leads to preemptive care rather than medical emergencies, Mr. Farrell says. 

In a Green House home more money is spent on care and less on administration.  The Elder to staff ratio makes for better care and less hospitalization of Elders.  To learn more, read about The Green House Project’s cost saving summary.  Read the full Wall Street Journal article here or learn more about The Green House model.

Highlighting the Green House Project Team: Mary Hopfner-Thomas, Project Manager

As the saying goes “when one door closes—another will open for you.”  That was certainly was the case for Mary.  After 19 years in corporation communications, a company merger meant a large scale layoff, and sent Mary in search of a new career opportunity.

Working with Elders had always interested her, but she had no idea that interest would translate into a new career track and a decision to return to school and obtain her Masters degree in the Management of Aging Services.

Mary began her journey with the Erickson Retirement Communities in a   variety of positions within the Resident Life Department.  She successfully led a number of initiatives for the organization—from working at the grassroots level with volunteer community residents on in-house television productions to serving as the community, stakeholder and customer interface in Erickson’s new Retirement Living TV (RLTV) cable television venture.  In her role with Community Resources, she served as the Elders’ primary contact for the creation of new activities/events and organizations.  She worked with elders living in independent, assisted, and skilled nursing.  Mary developed programs within the Erickson CCRC as well as outside organizations, always looking for new and creative opportunities for the Elders.  During her tenure with Erickson, Mary was determined to further her knowledge of Elders, and went back to school.

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

  • 9 years in aging services
  • M.A. Management of Aging Services, University of Maryland Baltimore County (UMBC)
  • CCRC community based TV station – teaching Elders to operate studio cameras, audio and editing equipment.
  • Planned, coordinated and executed marketing events to promote RLTV
  • Served as primary contact for Elders when creating new activities/organizations at the Erickson CCRC – Greenspring in Springfield, Virginia
  • Trained Eden Associate

 In addition to her passion for working with Elders, Mary enjoys sewing (baby quilts), cross-stitch, running (completed 3 Marine Corps Marathons) and reading good fiction.

A Small-Scale Solution for Elder Housing and Care

With just 10-12 residents each, Green House homes provide elders with a real home coupled with loving and well trained team of care partners. In U.S. News Money, Philip Moeller examines The Green House model and finds that it offers “a terrific quality of life for seniors that is not beyond their financial reach.”

At Green House homes, the life and care in the home is managed by Shahbazim (certified nursing assistants with 220 hours of additional education) who partner their deep knowing of the elder with the professional expertise of nurses and other clinical team members to keep costs down while providing excellent care. Moeller explains:

Central to making Green House [homes] work, explains project director David Farrell, is that nearly all of the care is provided by certified nursing assistants (CNAs). Traditionally at or near the bottom of the nursing-home skills ladder, these CNAs receive special training to allow them to perform nearly all of the staffing and management tasks needed inside a Green House. This flat management structure can save a lot of money, Farrell notes, while empowering the people in a Green House who know the most about what its residents need.

Today, over half of all people aged 85 and older have some form of dementia. Studies predict that by 2050, up to 16 million will have the disease.   Dementia care costs the U.S. between $157 billion and $215 billion a year (RAND).  All Green House home residents—but especially those with dementia, who make up about three-fourths of all Green House residents—benefit from the model’s most innovative features.  With a growing need for Elder care, The Green House Project has almost 150 homes operating with another 120 homes in development. And the scaling efforts couldn’t come at a better time. Moeller writes:
Obamacare encourages care facilities that produce good health outcomes, and Green House Project facilities do so. Also, nursing home owners are faced with big modernization needs, and Farrell believes many of them will turn to Green House [homes] and other smaller-scale projects that are much more appealing to seniors than traditional nursing homes.
Read the full U.S. News Money article here. Learn more about the Green House model and how to bring a Green House home to your community.


Safety, danger and risk: The environment as crucible for lifelong development

As many of you may already know, Bill Thomas and I came up with the notion of “surplus safety” in 2009 during a class in the Erickson School Master’s degree program to characterize the result of a culture of safety that does harm by preventing people from achieving future development that comes from taking risks and learning from the resultant success/mistakes. Since then, we and others have been working on the concept to refine the concept, catalogue its many manifestations, the roles of various stakeholders, and how current regulations and practices frame the issue and potential solutions. We learned in our Surplus Safety Symposium last September, sponsored by the Hulda B. and Maurice L. Rothschild Foundation, that was attended by over 50 stakeholder representatives that safety and risk have numerous definitions and a complex relationship with issues like choice, legal liability and OBRA 87. Carmen Bowman, culture change advocate and Symposium planner and leader, blogged about, there are a slew of reasons why this culture prevails. Let’s be clear about something: safety is good; danger can be bad, even very bad. Risk, or the probability that the outcome will be different than expected, is what lies between danger and safety. Risk has two variants: downside risk- the probability that the outcome will be worse than expected, and upside risk, the probability that the outcome will be better than expected.

We know that human development and growth doesn’t take place without taking risks. If the person is to survive, he/she must get good at knowing the difference between upside and downside risk, and how likely each may occur as a result of any action. The human brain seeks novelty – that is what is behind learning and increased competency. In environments with little or no novelty, the brain will motivate the person to search for it mentally by using their imagination, or physically, by scanning the environment for new information and moving toward it. Human development is predicated upon the dynamic of person-environment interaction where the person tends to engage with stimuli that are just different enough from what it knows to be interesting and therefor inspire exploration resulting in a modification of its store of knowledge. The child’s developing motor maturity and brain work in tandem and rely on this to happen so that the person becomes able to live safely on his/her own. This dynamic relies on engaging with the environment so as to learn about what is out there, what is safe, what is dangerous, i.e. how to improve upside risk and reduce downside risk, and what must be done to safely expand and differentiate knowledge and autonomy.

Three concepts are important here:

1. Safety and danger are distributed along a continuum of risk that in large part varies according to an individual’s abilities and judgment and environmental conditions at any given time. Risk happens, then, in the context of person-environment interaction. What constitutes safe and risky behavior changes as we grow from infancy and develop more competencies and better judgment of our risk tolerance and probability of success in doing anything. Risk is a factor that goes into each person’s motivational calculus before an action and is the result of a subjective appraisal made by a person and/or persons in their environments (or memories of what they said) based on a sense of the specific skills needed for success and if the person has them. Sometimes the risk assessments are congruent, sometimes widely incongruent – and arguments ensue. For example, a person may decide that it’s safe to walk around their neighborhood. The relative safety or danger depends on any given day on factors such as the time of day, weather, kind of neighborhood, orientation ability, gait and balance, vision, etc. of the person. This is true for a person at any age.

2. Risk, a broad territory that lies between safety and danger, is relative to each person’s competencies, and is an appraisal in the person’s mind that is the product of an assessment of his/her ability to produce an outcome that is at least equal to or better than expected when they contemplate the action and its results. If the probability of success is less than expected, depending on one’s risk tolerance, the behavior may not be initiated. A person may take a chance, or decide it’s not worth the risk. But it is important to remember that what I decide is relatively dangerous for me because I lack the requisite skills for success may be for pretty safe for you. So except for extreme conditions, like jumping out of an airplane without a parachute where the danger is so high that it is universally considered to be a sure recipe for danger and therefore a bad idea, risky behavior exists along a continuum for and among people. That is, the probability of a better or worse outcome than expected (our definition of risk) is not fixed. It is a variable depending on how well the risk taker appraises his/her ability be safe and avoid danger that would cause grave harm. When the appraisal is not made and the person takes a risk that has not been appraised, we call it impulse.

3. Development is a big factor in diversifying the range of actions that each person comes to see as acceptable risks. In fact, we can think of development in one sense as a process of taking risks and learning how appropriate the risk assessment was and what we can and can’t do. In that process, the most important result is learning what we are capable of and where we need to improve our abilities and knowledge to reduce danger in pursuit of a goal and thereby lower risk. The older people become, the more individualized and diverse become the range of skills, risk tolerance, risk aversion and what is considered a good risk worth taking. Physical limitations, wisdom and interests, as well as the proximity of needed resources are some of the factors that determine which risks people will take as they age. In extreme situations, elders may take greater risks when a particular goal is perceived by them to be important that appraisals of potential danger are minimized. That is, they are worth the risk. This happens, for example, when people feel desperate, are bored, feel that they are in danger, or have lost contact with their actual skill levels such that they remember themselves as they once were but not as they are now.

Changing the culture in environments where elders’ development is not blocked as they age through surplus safety practices means that at a minimum, we have to come up with accurate, reliable ways to assess each elder’s risk tolerance, accuracy of their future planning strategy for appraising the expected outcome of an action, and their readiness to act safely in light of the attendant dangers. Bill [Thomas] and I have taken great care to specify that this does not mean that all downside risk is bad and all upside risk is good. Our intention is that places where elders live develop ways to promote opportunities for continued development by optimizing conditions where upside risk can be found, downside risk reduced, and danger and safety go from being seen as binary and age specific (something is safe or dangerous for everyone who is old) to a portfolio of individualized opportunities for growth that meet the needs of all who live there depending on each one’s risk tolerance. Our task is to go beyond anecdotes and develop research programs that test these concepts to that we can affect policy and society at large.


Dr. Ronch is a nationally renowned expert on improving the treatment and mental well-being of elders. Prior to coming to the Erickson School, Dr. Ronch was Vice President of Resident Life, Mental Health and Wellness for Erickson Retirement Communities, where he was responsible for developing person-centered, strengths-based approaches to best serve the mental wellness needs of Erickson’s over 20,000 residents on 18 campuses.  He has been on the faculties of Vassar College, the University of Miami and Dutchess Community College. His numerous publications include the critically acclaimed Alzheimer’s Disease: A Practical Guide for Families and Other Helpers and The Counseling Sourcebook: A Practical Reference on Contemporary Issues (winner of the 1995 Catholic Press Association of the United States Book Award). He is co-editor of Mental Wellness in Aging: Strength Based Approaches (winner of the 2004 Mature Media Award), and Culture Change in Long-Term Care – the first text published about culture change in aging services.

He is currently working on co-editing a new two-volume set called Making the Case for Culture Change in Elder Care, due out in 2012.  His numerous journal articles and professional presentations include contributions in psychotherapy and counseling with the aged, care of persons with Alzheimer’s Disease and related disorders, caregiver issues, staff training and service delivery issues in geriatric care. He has also been named a Fellow of the New York Academy of Medicine.