Green House Blog

Early Research Findings from THRIVE

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 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 ( or 919-843-8874).


Episcopal Homes of Minnesota: Despite Harsh Winter, Major Construction Progress has Occurred for Six Green House Homes

While we are all anxiously waiting for spring to truly arrive this year, none could be wishing for that more than the construction workers on the project for the Episcopal Homes of Minnesota!  Warmer weather and fewer snow storms will be welcomed with open arms!  Despite the tough winter season, major progress has been made on the $45 million dollar project.

Midway Village will provide a variety of living options for Elders including skilled nursing services in The Green House homes.  Ten Elders will live in each of the six homes which is being called “Episcopal Church Home – The Gardens”.  Not only will Elders enjoy their own bedroom, bath, home cooking, a hearth and balcony or terrace…they will also be able to enjoy the laughter of children each day.  A day care center will be part of Midway Village.  It’s something the organization has wanted to do for years, but they never had the space to provide the services.  The center will be available to staff and neighborhood infants and toddlers.  A truly wonderful inter-generational experience for all!

Another important aspect to the project includes light rail service that will pass right in front of the project…making transportation more convenient for Elders, staff and families.

The Green House homes are slated to open in February of 2015 and will be the first skilled nursing Green House homes in Minnesota.


Congratulations to Jean Probst for being Trustee of the Year!

Congratulations to Jean Probst, a long time board member of Episcopal Homes of Minnesota, a Green House adopter, for being honored with Trustee of the Year!  Jean was honored at this year’s Aging Services of Minnesota Institute and Expo.

Marvin Plakut, the CEO of Episcopal Homes, nominated Jean for this award while recalling a meeting he had with her; “A petite and soft-spoken woman in her 70s, Jean opened the meeting with the comment…, ‘I’m troubled by how small your thinking is, Marvin.’”

Jean challenged Episcopal Homes of Minnesota’s plan for a $2 million renovation of their Alzheimer’s unit with a successful $10 million campaign because “the program and space needed to be totally transformed.”

In a letter congratulating Jean, Larry Minnix, the President of LeadingAge, expands upon the concept of small thinking versus big thinking, and “invite[s] all of us to hear Jeans Probst’s challenge that we are thinking too small.”

To read more about the difference between small thinking and big thinking, click here.

Congratulations Jean! Green House is honored to be associated with transformative thinkers like you!

Dr. Bill Thomas’ Second Wind Tour Kickoff

Dr. Bill Thomas’ Second Wind Tour kicks off in three weeks. As a sponsor, THE GREEN HOUSE® Project is busy getting ready to revolutionize the national conversation around nursing homes, by bringing attention to our person-centered model with an emphasis on each person living a meaningful life. We are taking this message on the road and hitting 25 cities along the way!

Inspired by Thomas’ new book examining the baby boom generation’s reluctant generational second coming of age—“Second Wind: Navigating the Passage to a Slower, Deeper and More Connected Life” (published by Simon and Schuster March 11 and named by Publisher’s Weekly as a Top 10 Social Science book of 2014)—the Second Wind Tour will visit 25 cities on a national bus tour from March 31-June 6, 2014.

Each half-day performance will be held in a premier theater with two acts. Act one will consist of five fast-paced theatrical monologues featuring a cast of speakers including Dr. Thomas, Susan Frazier or David Farrell of THE GREEN HOUSE® Project, and renowned consumer health expert and TV personality Dr. Janet Taylor. The second act blends the illumination of the deep connections between music, identity, and memory in the form a “marvelous surprise” documentary film preview by director Michael Rossato-Bennett followed by a live musical performance by Musicians for World Harmony founder Samite Mulondo.

If you are interested in attending one of these performances, please visit the Second Wind Tour Website, If you are not near a tour stop or unable to attend, we still want you to be involved! Join the social media conversation by following The Green House Project, @GreenHouse_Proj, and the Second Wind Tour by using the hashtag #secondwindtour.

We are so grateful for the opportunity to spread the Green House vision across America!

First Green House Homes in Minnesota Set to Open in June

It’s been a long winter, but that hasn’t stopped construction crews in Mankato, Minnesota!  The assisted living Green House homes, called Water’s Edge, are slated to be open within three months.

They are being developed and operated by Grace Senior Services.  The owners, Brad and Heather Bass, have been committed to serving Elders for many years.  In fact, they started their journey by opening an adult day service in their home 17 years ago.  They currently have several senior housing cooperatives, two assisted living communities, and an adult foster care program.

Brad and Heather are most excited about bringing The Green House model to Minnesota.  The new Director of Operations for Water’s Edge, Brooke Olson will be welcoming 36 Elders to the homes when they open.  Of course, we’re all hopeful that by June the snow will have melted and the flowers will be blooming!

Great Minds Gala at PEAK Leadership Summit

This year the Leading Age PEAK Leadership Summit will be held March 17-19 in Washington D.C. and THE GREEN HOUSE® Project is excited to send some of our team members to the event.  This summit aims to expand the world of possibilities for aging; a vision we support and work toward wholeheartedly. Not only will we engage with peers in the field by attending sessions and exhibiting at the summit but also through our sponsorship of the Great Minds Gala.

The Great Minds Gala is a fundraising event that will honor Leading Age members and other individuals in the field who have shown courage and leadership as they work tirelessly to improve the lives of those affected by Alzheimer’s disease and other dementias.  One honoree at the event will be Glen Campbell, renowned country music singer and actor, who was diagnosed with Alzheimer’s disease in 2011.

You can join the summit conversation by following @LarryMinnix, @LeadingAge and @LeadingAgeCAST on Twitter using #PEAK14 or by liking the Leading Age PEAK Summit Facebook page.


9 Green House Homes Receive Best Nursing Home Honor

US News & World Report released a list of the Best Nursing Homes. Of 16,000 facilities evaluated, less than 25% earned a rating of five stars. Among those, 9 Green House Homes made the list!

Photo credit

 Asbury Park Retirement CommunityBEST NURSING HOME


Buckner Westminster Place – BEST NURSING HOME

Eddy Village Green – BEST NURSING HOME

Eden Rehabilitation Suites and Green House Homes – BEST NURSING HOME

Lebanon Valley Brethren HomeBEST NURSING HOME

Resthaven Care Center – BEST NURSING HOME

The Leonard Florence Center for Living – BEST NURSING HOME

Valley Health Center – BEST NURSING HOME

US News based their results on 3 factors; “Each nursing home receives an overall rating of one to five stars, based on its number of stars in three categories: state-conducted health inspections, how much time nurses spend with residents and the quality of medical care.”

To read the full listing, click here.

Convivium: Good Food and Good Company leads to Good Outcomes

Mealtime is an important part of The Green House day. We even have a name for it, “convivium”. This term describes good food, good company and good conversation. In every Green House home, there is an open kitchen where food is cooked in the home, and it is served around one large table to create a feeling of belonging. Smells of delicious food waft through the air, and the dining room table is filled with conversation as elders, staff members and visitors sit together and form an intentional community. This normalized environment creates not only a sense of well-being, but also has a positive clinical impact. Watch the below short video to hear what a dietitian from a Green House home says about her experience:

At the Table: Dining and Nutrition in The Green House Model (2 mins 33 secs) from The Green House Project on Vimeo.

According to a recent article in McKnight’s Long Term Care News, “’Undernutrition’ is the most common dietary problem related to dementia… This refers to insufficient intake of calories, protein or other nutrients. It affects up to 30% of residents in long-term care facilities…” The article goes on to talk about how improving the environment and increasing staff education can help to improve elder nutrition. Through intentional design and deep education, Green House homes have seen positive outcomes and stories that demonstrate the value of focusing on food and mealtime.

Dr. Bill Thomas, founder of The Green House model, has always seen food as central to how we connect as human beings. As our physical needs increase to a skilled nursing level—this deep human factor does not change. In this short video below, Dr. Thomas shares his vision for “convivium”. By creating an environment of deep knowing where we honor an elder’s preferences and natural rhythms, issues like “undernutrition” will dissipate.

Convivium from The Green House Project on Vimeo.

Highlighting THE GREEN HOUSE® Project Team: Scott Brown, Director of Marketing and Business Development

Scott remembers visiting his grandmother in a traditional nursing home. He remembers the institutional environment, and how uncomfortable it was for him. He wondered how this could be the best place for his grandmother.

This experience played an important role in bringing Scott to THE GREEN HOUSE® Project.

“Green House homes are wonderful places for elders. In addition to being a place where elders can thrive, this model addresses the changes in healthcare that emphasize quality care and outcomes. And consumers are clamoring for a new and better model for elder care. The Green House model can be the solution for elder care providers trying to adapt to these trends. It can help them deliver high quality care in an environment that is nurturing, supportive and caring.”

Scott joins THE GREEN HOUSE® Project as Director of Marketing and Business Development. He was previously an executive at Lincoln Healthcare Group, an organization that’s mission is to improve healthcare in the United States by advancing excellence in leadership, strategy and innovation. As Senior Vice President, he was responsible for Lincoln’s Post-Acute segment, which included long term care, senior living and home care. In addition to his focus on the development of thought leadership and innovative education for senior executives, he was responsible for financial results, sales management and marketing strategy, and customer delivery and operations. During his time with Lincoln, Scott combined a fervent dedication to clients with a commitment to healthcare transformation.

Scott held a number of high level executive and marketing positions, including: Vice President of Marketing for Insurity, an enterprise software company; Vice President, Database Marketing & Global Lead Management for Gartner; and General Manager & Executive Vice President for BroadReach Partners, a professional services firm providing outsourced new business development and consulting services.

Scott is a Cum Laude graduate of Connecticut College, and has an MBA from the University of Connecticut with a concentration in Marketing.