Green House Blog

THRIVE: Understanding the Language of Research

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.

As the THRIVE research projects head toward completion later this year, our research team has developed plans to share our research findings.  In addition to publishing articles in a special issue of the journal, Health Services Research, we also will share findings through conference and webinar presentations and blog posts.

Because some commonly used research terms may sound like jibberish to non-researchers (after all, who really knows what a p-value is?), we will devote our next few blog posts to explaining a few terms that will help non-researchers better understand the THRIVE articles, presentations, and posts.  We’ll start by reviewing Quantitative and Qualitative research designs.

When people think of research, they’re usually thinking of a Quantitative research design, which essentially measures and compares things.  Quantitative research asks questions like “How many residents in one nursing home have falls compared to residents in another?” or “Does providing one type of care work better than providing a different type of care?”  A quantitative research design allows a researcher to establish “how much”, whether one thing is related to another (such as whether falls are less frequent when certain care is provided), and also – depending on the details of the design – to establish cause and effect.  The data collected are usually in numerical form, and findings are expressed in terms including percents, means, and p-values (to answer the earlier question, a p-value denotes whether or not a number is or isn’t significantly ‘different’ from another…..we’ll come back to this in a future blog post).

Qualitative research designs essentially answer “how” and “why”.  Qualitative research asks questions such as “Why are so many falls occurring?” or “What conditions are necessary for a nursing home to provide a certain type of care?”  A qualitative research design permits a researcher to better understand events and the circumstances under which they occur and vary.  The information gathered in these types of studies are usually textual, and include the researchers notes and observations, as well as in-depth interviews and quotes from people who have knowledge of the event being studied.  This information is analyzed by looking for common themes across all of the information collected and reporting these findings – often contextualized using exemplative quotes.

The THRIVE team is using both quantitative and qualitative methods in their research, which is considered mixed-methods.  This is the best of both worlds, and is allowing us to answer questions such as:

Quantitative:    What was the annual turnover rate for shahbazim over the past two years?
Was this turnover rate statistically different (higher or lower) than that found
among CNAs in other nursing homes?

Qualitative:      What was the role of the Director of Nursing in the Green House homes?
How might variations in this role relate to shahbazim turnover?

Stay tuned for the next THRIVE blog post.  In the meantime, if you have questions about this post, or suggestions for future ones, please let us know.

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

Assessing the Financial Viability of The Green House Model: Slaying the Urban Myth

Take any urban myth, such as the popular one about alligators living in the sewers;  people talk about it, but nobody has seen it.  The urban myth about Green House homes is that they are not financially viable because they are too expensive to build, and too expensive to run.  But when you really look at it, the facts don’t support the myth, according to Scott Townsley, Principal, CliftonLarsonAllen, LLP, in a presentation at LeadingAge of Pennsylvania.

Public perception of nursing homes continues to be negative.  Despite that, occupancy remains pretty high.  Nursing homes have benefited from Certificates of Need, which peg nursing home bed supply to demand.  Nursing homes have never had to worry about marketing a product that the public didn’t want – demand is guaranteed.

Over the next 10-15 years, utilization will decrease, according to Townsley, meaning that supply will outstrip demand.  Consumers will have more choice and nursing homes will have to compete to keep rooms filled.  To succeed, something will need to change.   And Green House homes represent one of the biggest innovations – and opportunities – for operators.  Research shows that consumers will drive farther and pay more for Green House homes compared to traditional nursing homes.

The Green House model is not just about doing good – you can do well.  In addition to deep culture change, person-centered care, a unique residential environment, and better quality of life, Green House homes also generate better outcomes, improve payor mix and increase occupancy.

In most cases, the urban myth about Green House homes is based on nothing more than rumors or a cursory review.

For example, in a strategy review and financial analysis performed by CliftonLarsonAllen for a struggling provider, they looked at the impact of incremental strategy improvements vs. conversion to Green House homes.  With the incremental approach, the organization was out of business by 2019.  By building Green House homes and improving occupancy and payor mix, and getting a higher private pay rate – typical results with the Green House model – the organization will turn around and ultimately thrive.

St. Johns Homes near Rochester, New York demonstrates the financial impact of Green House homes.  Susan Frazier presented a case study comparing St. Johns traditional nursing home to their recently developed Green House homes.  The Green House homes are generating improvements in occupancy and payor mix, with exemplary survey results, at operating costs that are 30% lower PPD than the legacy nursing home.

Don’t fall for the urban myth about Green House homes.  With 152 Green House homes in operation, and another 150 under development, the facts tell a different story.

Groundbreaking and Grand Opening Ceremonies Fill Our Calendar This Summer

It was a LONG winter for all of us, but the summer promises to be a time of sunshine and celebration for many in the Green House family!  Five homes will be opening and groundbreaking ceremonies will take place for another 12 homes.

View from Elders room

We start the summer off on June 26th with the grand opening ceremonies for the first Green House homes in the land of 10,000 lakes.  The three assisted living Green House homes are called “Water’s Edge” and are located in Mankato, Minnesota.

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.  The new Director of Operations for Water’s Edge will be Brooke Olson.

Congratulations to the team at Water’s Edge…we wish you a wonderful grand opening and are excited to be working with you on this journey with your Elders!

Our next celebration will take us to the sunny state of Florida where our first skilled nursing Green House homes will be located.  Groundbreaking ceremonies are slated to occur in late July.

The Woodlands at John Knox Village will have a total of seven floors and 144 private rooms for Elders.  Two Green House homes will be located on each of six of the floors for a total of 12 homes, with the ground floor featuring a community area with a multi-purpose room, bistro and rehab center.

John Knox Village of Florida is the second largest not for profit Continuing Care Retirement Community in Florida with almost 1,000 residents in Pompano Beach, Florida.  John Knox Village was the recipient of the Governor’s Gold Seal Award in recognition of excellence in long term care.

We will keep you posted on the events surrounding their groundbreaking ceremonies as soon as they are finalized!  We are most excited to see this project under construction…it is slated to open in late 2015.

Our final summer celebration will take place in Wisconsin!  Two new Green House homes will have their grand opening on August 14th.  It is part of the U.S. Department of Veterans Affairs, the Tomah VA Medical Center located in Tomah, Wisconsin.  We are so pleased to know that 20 veterans will experience REAL HOME in Tomah.



So as you can see, it will be a very eventful summer season for our Green House family and we couldn’t be happier to celebrate such success!


The Second Wind Tour: Act III Begins

When we heard that Bill Thomas was working on a “non-fiction theatrical experience” we knew this would be a once in a lifetime chance to join a national conversation about what it means to age in today’s culture. From March 31st to June 6th we have visited 25 cities with Bill Thomas’ Second Wind Tour.  It has been such an experience to be on the road touring with visionaries in elder care. But even more exciting were the discussions we had with attendees who want to change how we think about the aging process.

In two acts, the performance used a blend of the spoken word, innovative set design, film and music to stimulate a new conversation about aging, and to re-frame “life after adulthood” as an exciting stage of human growth and development.

The third act, as Bill Thomas told us, is up to us.  That means it’s up to all of us to continue the national conversation the Second Wind Tour started.  With the help of the people who participated in the tour, and all the others who know there’s need for change, we can change the misconception of what it means to age.

We are so thankful for the local support and the positive energy that came from the audience at every performance and every event.  We can see now, more than ever, our country is ready for a new way to care for elders.  We are thrilled to be a part of this journey.

If you couldn’t join us, you can get a glimpse of the show with this video.

National Nursing Home Week® 2014 Success Stories

Green House adopters and enthusiasts across the country came together last month during National Nursing Home Week to educate their local communities and policymakers about The Green House difference. This year, the American Health Care Association used the Hawaiian theme, “Living the Aloha Spirit,” for the week. The Green House model’s core values of Meaningful Life, Empowered Staff, and Real Home, aligned closely with this year’s theme and we were excited to invite communities across the country to see the difference that our model offers for elders and their families.

Here are just some of our success stories from that week:

  • From February 2014 to today, we have gained 220 followers on Twitter totaling 1,635
  • From April 2014 to today, we have received 73 new likes on Facebook totaling 2,483
  • Two templates were added to our Support the Movement page
    • Sample Letter to the Editor
    • Sample Letter to a Policymaker
  • Editorial from the Guide at The Green House Homes at VA Illiana Health Care System in Danville, IL was printed in two local papers
  • The Guide with the Green House homes at Mirasol in Lakewood, CO wrote an editorial
  • Three policymakers site visits occurred in conjunction with National Nursing Home Week:
  • Photos like the one you see above from St. Martin’s in the Pines in Birmingham, AL were shared and added to our Flickr account

A big thank you to all who participated!

Want to learn more? Visit our Support the Movement page and use our policymaker site visit letter and editorial sample and share these tools with your Green House home friends and colleagues.

Contact Meaghan McMahon at ( with your questions or comments.

Sr. Director of THE GREEN HOUSE® Project, David Farrell, Honored by California Medical Organization

Citing his extensive work in transforming long-term care in California, the California Association of Long Term Care Medicine (CALTCM), honored our own Sr. Director, David Farrell with their 2014 Leadership Award.

CALTCM is the professional organization for California physicians, medical directors, nurses, pharmacists, administrators, and other professionals working in long-term care.  CALTCM is the state chapter of the American Medical Directors Association (AMDA).  It is an organization that advocates quality patient healthcare, provides long-term care education and seeks to influence policy within the industry.

The Leadership Award presentation took place at the CALTCM 40th Annual Meeting for group.  Prior to joining The Green House Project, David served as a nursing home administrator and regional director of operations in California.  As many of you know, David has long been a strong advocate for person-directed care and culture change within long-term care.

Click here to read the full announcement.

We congratulate David on receiving this award!

Learn New Skills to Keep a Healthy Mind

Green House Homes are known for providing a healthy and stimulating environment to their elders. Meaningful life is key to the Green House Project’s mission. And now there is research to support the importance of intellectual stimulation as one ages.

The Association for Psychological Science conducted a study whereby 221 people, ages 60-80 were randomly assigned an activity to engage in, ranging from learning a new skill to participating in more familiar activities, to study the effects on one’s memory.

“Some participants were assigned to learn a new skill — digital photography, quilting, or both — which required active engagement and tapped working memory, long-term memory and other high-level cognitive processes.

Other participants were instructed to engage in more familiar activities at home, such as listening to classical music and completing word puzzles. And, to account for the possible influence of social contact, some participants were assigned to a social group that included social interactions, field trips, and entertainment.”

The results indicated that those who learned a new skill showed improvements in their memory.

“‘It seems it is not enough just to get out and do something — it is important to get out and do something that is unfamiliar and mentally challenging, and that provides broad stimulation mentally and socially,’ says psychological scientist and lead researcher Denise Park of the University of Texas at Dallas. ‘When you are inside your comfort zone, you may be outside of the enhancement zone.’”

THE GREEN HOUSE® Project strives to provide a home setting where elders can take part in any activity they wish, whether it be a familiar hobby or learning a new skill, to keep them engaged and living a meaningful life. So, get out there and take a photography class or learn to paint your surroundings, as it will have lasting effects on your memory.

Click here to read the full study.