Green House Blog

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

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 ( or 919-843-8874).

National Handwriting Day

When was the last time you sent a handwritten letter? January 23rd marks National Handwriting Day. Appropriately, this is also the birthday of John Hancock.  This nationally recognized day began in 1977 to acknowledge the significance of handwriting throughout history.  The embrace of penmanship as a subject in schools has changed significantly since computers have become common in the classroom.

So what makes the art of handwriting so noteworthy today? For many people, there are mementos in the form of handwritten notes, letters, and announcements that mark special times in their lives.  The Meaningful Life and Engagement modules, a training resource for staff in Green House Homes, highlights one woman’s experience with letters she saved from friends at camp when she was a young girl.  Click here to watch her story, The Story of Sadie.

Green House homes as an Innovation for Short-Term Rehabilitation

In the December print version of Long Term Living, an article by the Director of THE GREEN HOUSE® Project, David Farrell explores the new customer for Short Term Rehab and how The Green House model can meet their needs.

The customer for short-term rehabilitation is changing, and as the baby boomers continue to age, providers must adapt to meet the needs and desires of this influential demographic.  Long Term Living Magazine highlights one of these innovations, by demonstrating how rehabilitation thrives in a Green House setting.

This new patient is more empowered, more likely to question care decisions and seek alternate opinions, and generally be a more active participant in his or her care. The Boomer also expects to remain active, stimulated and social during recovery—not isolated and treated as frail. Given this significant shift in their consumer base, nursing homes must rethink their approach to short-term rehab (and long-term care, for that matter). Boomers will be seeking—and expecting—a lot of it in the coming years.

Director of The Green House Project, David Farrell, writes about this changing customer and the success of The Green House model to meet their needs by highlighting Leonard Florence Center for Living, “The reason that the Green House Project offers such a strong model for short-term rehab boils down to the concept of home. By making elders feel truly at home, the Green House model actually helps residents rehabilitate faster—and in a safer environment.”  Bob Richman experienced rehabilitation at Leonard Florence and shares the difference that he attributes to the real home environment, “I’ve been in skilled rehab two times: once at a traditional nursing home and once here in a Green House home. It’s not just the exercise here that gets you well again…it’s the people around you having a similar experience. It’s coming together around the table for our meals. It really works.”

It is not only the anecdotes of success, but also the data that is telling a positive story, ” On average nationwide, 20 percent of elders return to the hospital within their first 30 days of stay at a nursing home.At Leonard Florence, the rate has been half that—around 10 percent. Staff members also have reported an increase in the number of referrals from discharge planners, orthopedic doctors and repeat customers who need new procedures. ”

The Green House Project currently has 150 homes in 24 states around the country, and sees short term rehabilitation as an innovation that will continue to grow as the customer demands more personalized care in a setting that is both comfortable and effective.

Full Article in Long Term Living >>


Highlighting THE GREEN HOUSE ® Project Team: Tara Cugelman-McMahon, Sr. Operations Coordinator

“I deeply care about people and I like to work for causes that I believe in.”  That’s how Tara describes herself and working at The Green House Project allows her to do both.

She pursued a degree in International Affairs because she has a strong interest in international human rights work.  However, Tara recognizes that we have our own set of challenges within this country and is quick to identify the importance of deep, transformational change in the skilled nursing industry.  The Green House model provides the right environment for Elders, and she understands that the voice of Elder is central to a meaningful life.

Tara worked with Elders, as part of her legal education, providing free legal services to those in need.  She attended The University of the District of Columbia, David A. Clarke School of Law—it was a good match for her because it is a public interest law school, thus allowing her to help others.

Policy and politics are two other strong interests of Tara’s.  She recently worked with a company that utilized the latest techniques to analyze political data and strategically target the prospective voter.

As the Senior Operations Coordinator, Tara brings her many talents to support the team with an emphasis on Green House education programs and marketing activities:

  • B. A. International Affairs, The University of Colorado
  • J.D., University of the District of Columbia, David A. Clarke School of Law
  • Catalist, LLC, Associate General Counsel
  • Legal Fellow, Office of Congressman Steve Kagen

In her spare time, Tara enjoys participating in all kinds of sports, she likes to write and has her own blog.  She is also extremely active in the DC chapter of her alumni club.  One other interesting note about Tara—she has citizenship in three countries: United State, Canada and Ireland!

California Health Report: “This Green House Grows Humans”

Via: California Health Report

When the Green House homes opened in California last fall, there were a number of people who were very happy to see that day come to fruition.  One person who was very pleased to see those doors open was Yolie Zepeda.

Yolie vividly recalls the words of her uncle after he was placed in a state funded nursing home after suffering from a number of health issues.  Her uncle told her that he felt so worthless at the facility, explaining that he could be sitting alone for endless hours in a soiled diaper.  He told her “they actually treat you worse than I’d ever treat a dog.”

Today Yolie is a Shahbaz in the Green House homes, and is happy she can tell a different story.    

Click here to read more about Yolie and her dedication to the Elders in her home…a home that the California Health Report says is “a welcoming vibe that gushes home.”



Read the story behind the man who led the effort to bring those Green House homes to California, President and CEO of Mt. San Antonio Gardens, Randy Stoll.  Some people come up through academic programs, which Randy would eventually do, but first he ventured in another direction.  Click here to read about his journey in aging services.

Senior Housing Forum – An Interview with Sally Abrahms

Sally Abrahms, an award winning writer on aging and baby boomers, sat down for an interview with Steve Moran of the Senior Housing Forum to discuss senior housing options. She lends her thoughts on the needs of the aging boomers and the desired housing communities (including Green House!) of the generation that is not “going to take aging lying down.”

They refuse to accept today’s traditional nursing homes. Rather than grow old in isolation, the Me Generation (which should be retitled the “We” Generation!) plans to do it together. That could mean aging in place with community support and services, sharing housing or moving into a Green House family-style nursing home.


OWhen asked about the perfect senior housing community, she describes her dream home; “A good balance of privacy and social interaction, fabulous exercise facilities, first-rate medical care, a warm and responsive staff, and the ability to call the shots as much as possible.” And when compared to traditional style nursing homes, she adds that, “when boomers hit the nursing homes, most will be following the Green House, neighborhood ‘home’ model.”

Click here to read the full interview.





Generations Journal focuses on Person-Centered Care for People Living with Dementia

“More than 5 million people in America currently have some form of dementia, a number expected to rise to 13.8 million by 2050.”   As Kathy Greenlee, Assistant Secretary for Aging, US Department of Health and Human Services, says, “The numbers capture our attention.  But it’s the number one that captures our hearts.  To most of us, dementia is about a loved one.”   While a large part of the work to date on dementia has been to find a cure, however there is a larger story to explore– one of improving the lives of those who have dementia and the people caring for them.  Generations, the quarterly journal of the American Society on Aging, devoted their Fall 2013 issue is devoted entirely to Person-Centered Care for people with dementia.

By focusing this publication on Person-Centered Care, the importance of a holistic approach to dementia is highlighted.  Sam Fazio, director of Special Projects, for the Alzheimer’s Association in Chicago, and guest editor of the Generations issue, discusses the power of words in how they influence our perceptions of people, “very simply, words affect thoughts and, ultimately actions…The loss of memory is not equal to the loss of self.  If someone thinks of a person with dementia as someone without a self– they think of him or her as not being a person.”

Green House Project team members contributed an article called, ” Seeing the Person First: Living with Moderate-Stage Dementia” .  Drawing from experts in the field, this article emphasizes, “To keep seeing the person as creative, resourceful and whole requires a major reframing of our thought processes.”   By seeing the person, not just as a stage in a disease, but rather as an individual through the framework of their physical and emotional health, environment and care partner relationship, there is potential to create well-being.

The Green House Project is an evidence based model that returns control, dignity and a sense of well-being to elders living with dementia.  By transforming the environment, organizational structure and philosophy of long term care, the elder is placed at the center of the model where they can grow and thrive.  To learn more, visit:



Purchase the complete Fall 2013 isues of Generations >>

View Select Articles on the American Society on Aging Blog >>