Green House Blog

Green House in Wyoming: A Story of Firsts

In 2007, Doug Osborn and Charles Scott of the Wyoming legislature brought a bill up for consideration. The bill would authorize three pilot projects, in three different communities in Wyoming, to study alternative elderly care homes. 

The passage of the bill was a catalyst for radical change in eldercare in Wyoming. Prior to this bill, Osborn and others had traveled to Tupelo MS to study the Green House model of care. They decided to bring it back to the community of Sheridan. 

Two cottages finished construction at the end of 2011, while two more finished in early 2012. The four cottages at Green House Living for Sheridan opened to residents on January 31 of 2012.

But what is truly remarkable about Green House Living for Sheridan is that it was built not by an established religious organization or nursing home company. Instead, it was conceptualized, funded, and constructed from the ground up by the individuals living in Sheridan. 

When it was built, Sheridan held the audacious title of being the only grassroots Green House community in the nation. 

The Wyoming Life Resource Center 

For a state that set one record with the conception of its first Green House home, it’s no surprise that they’re on track to set another. 

The Wyoming Life Resource Center (WLRC) in Lander, Wyo., is a state-owned Green House community that has long served the needs of the Wyoming population and is being rebuilt as the first Green House home to be established as an Intermediate Care Facility (ICF) for people with intellectual disabilities, in addition to housing cottages established as a traditional skilled nursing facility (SNF). In accordance with federal Medicare and Medicaid regulations, this means that WLRC will serve people who have organic brain syndrome, high medical needs, and those who are “hard to place.”

Construction began in 2018 will host a total of 100 beds in 10 cottages, all built using the Green House model. There are four types of cottages in terms of licensure—ICF Medical Cottages, ICF Behavioral Cottages, SNF Medical Cottages, and SNF Behavioral Cottages. The campus also includes a recreation center with a pool, therapies and gym, an outpatient clinic with a pharmacy and lab, and a kitchen (existing) with a pharmacy and lab. 

Doug Osborn has since passed away, but his legacy lives on in the Green House community he helped to create.

The WLRC is an example of how best to meet the needs of diverse people with diverse needs, all under the Green House core values of Real Home, Meaningful Life, and Empowered Staff. The model of WLRC is innovation at its core. It sets an example that many residential care facilities across the U.S, Green House or not, are looking to replicate and learn from. 

What Is it About Wyoming? 

What is it about Wyoming that makes it such a hotspot for the sort of tenacious idealism demonstrated by Sheridan and WLRC? Former director of WLRC, Virginia Wright, describes it well: “Because we are a small state, we have a different mindset than some of the larger states. We still look at people as people and not just as numbers. I’ve worked in many states, and I have never seen as high of standards as I have seen here.” 

With Wyoming proving what’s possible in terms of diverse eldercare, it’ll be exciting to see how the eldercare landscape across the country shifts in response. 

Biophilia, Salutogenesis & the Roots of Humanity

In this week’s podcast, GHP Senior Director Susan Ryan sits down with Tammy Marshall, founder and CEO of Biophilia Pharma, for a second time, to delve deeper into biophilia, salutogenic approaches to healing, and imagining a future of eldercare that prioritizes a holistic relationship to nature. I ended this podcast completely in awe of the enormous power of nature as a healing force that seems to be completely untapped in our modern, busy lives. Further imagining the power of biophilia in eldercare could result in a radical, refreshing, and humane way to age.

Designing a Better Life with Biophilia 

The textbook definition of biophilia is the innate desire of humans to be in or around nature. Marshall further breaks down biophilia into its two components—bio, or life, and philia, or to love something. I think this is a beautiful way to frame our relationship to the natural world around us. To love nature is really just to love ourselves. 

A salutogenic approach to healing is a mode of “causing” health, instead of attacking a disease, and biophilia fits well into this model. Proximity to the outdoors, sunlight streaming in through windows, even something as analog as a floral motif on a curtain—these biophilic aspects of environmental design have all been proven by research to positively impact our wellbeing and can be seamlessly integrated into our lifestyles.

On Recognizing Our Roots 

For me, a big takeaway from this podcast is that biophilia isn’t for “fringe, sustainable, eco folks,” as Tammy expressed. Instead, biophilia is deeply rooted in what makes us human. And whether or not we recognize it, we know it on an intuitive level. I’ve always felt more relaxed and at peace when I dig my toes into the grass or look up at a massive blue sky. But only now have these benefits been translated to clinical language. 

Marshall brought up a study at Mount Sinai that re-engineered rooms for a stressed-out workforce to recharge and take a break before returning to work. These rooms were designed in a biophilic manner, with sounds of nature in the background, natural materials, and sunlight. A measure of biometrics before and after showed a marked decline in stress-related measures. What’s so profound to me about this study is how easy it is to engineer our own lives for similar results. Simply a walk in a garden, a run in the morning, or a taking a Zoom break by looking out a window can recenter and recharge us. This isn’t hard to do. After all, nature has always been free.

Taking Action

In the last podcast episode with Marshall, there was mention of Florence Nightingale, the founder of modern nursing in the 1800s. She was an early example of taking a salutogenic approach to caring for patients. We saw a shift to pathogenic approaches to illness with the onset of the Industrial Revolution. Speaking to that point, Susan related the back-and-forth of health approaches in history as a pendulum swinging. She posited that maybe, the pendulum is finally swinging back to what feels right. That thought is chilling to me, but in a thrilling way.

To see healthcare shift before our eyes is truly to witness history, and after the destruction of COVID-19, I hope that we take lessons from the pandemic to heart and aim to “cause” our health proactively.

Meghna Datta is a GHP intern and a pre-med student at Duke University.

Medical & Policy Perspectives on Eldercare with Michael Wasserman, MD

Meghna Datta
Meghna Datta, GHP Summer Intern 2021

Hello! My name is Meghna Datta and I’m an undergraduate intern with The Green House Project (GHP) this summer. I’m a student at Duke, originally from the Midwest, and working here has been a dream of mine for such a long time that being here feels surreal. 

I will be blogging about podcast episodes, webinars, and other GHP content for the duration of the summer and am excited to do a deep dive on developments in the world of eldercare. 

I’ve been following GHP since I read Being Mortal by Atul Gawande, MD, in high school. That book—combined with a rather serendipitous series of events in college—pointed me down the pre-medical path. Specifically, I’m drawn to eldercare and mitigating the impacts of neurodegenerative diseases. So, I am doubly excited to be sharing some reflections on the latest Elevate Eldercare podcast episode.

On His “Why” 

In this episode, Susan Ryan sat down with Mike Wasserman, MD, a geriatrician and tour de force in the world of eldercare and geriatric medicine. When answering the question of why he wanted to be a geriatric doctor, Dr. Wasserman made a joking admission that he was “born an old man”—which he later remarked is a common thread among many people that end up working with older adults. I really resonated with this. It seems like many of us who enjoy working with older adults have had multiple positive experiences with them in our own lives. He later spoke to the dangerous impacts of ageism, which brought me back to the idea of why certain people decide to go into geriatric medicine.

If there’s one thing I think could really bolster the national policy response to eldercare, it would be combating ageism. In other words, instilling in our youth-obsessed society that older adults are holders of a lot of generational wisdom and history, and that their wellbeing matters. Policy reflects priorities, and until the crippling problems with eldercare in the U.S are brought to the front, effective policy is unlikely to emerge.

Dr. Wasserman decided in his third year of medical school that he wanted to go into geriatrics but ended up diversifying later in his career with a gig as CMO and then CEO of Rockport Healthcare Industries—the largest nursing home chain in California.

Effective Nursing Home Reform 

This experience gave him the kind of unique perspective that few doctors are able to receive. Dr. Wasserman was able to speak to what he believes is the real obstacle to nursing home quality improvement, which is not poor administration but the larger hand at play. Criticism of the nursing home industry should really be criticism of the money in the industry, and not nursing staff or administration, who work tirelessly, generously, and with very little pay. So when talking about ways in which to elevate care in the nursing home industry, he pointed out that the profit in the nursing home industry exists in private equity and real estate, not in operations. In other words, when nursing home operators say that they need money, it’s wise to believe them. 

Dr. Wasserman also spoke of the impact of COVID-19 on nursing homes and elders. In his eyes, the key to managing a crisis of this type lies with the nursing home infection preventionist, which every nursing home has. But when talking about the crisis response on a national level, he minced no words, positing that the U.S. response to COVID-19 will likely be regarded as the worst crisis management example in the history of the country. It’s devastating to me that it took the loss of hundreds of thousands of lives, disproportionately from the most vulnerable populations in America, to bring the many problems in medical care access to light. On the other hand, I can’t help but think that sometimes, the largest transformations require the most massive catalysts. 

The Future of Eldercare 

In response to poor healthcare policy, grassroots activism has been especially effective—geriatricians and eldercare experts have been featured in news publications large and small, voicing opinions that have been needed to be heard for a while. But as Dr. Wasserman pointed out, the real impact is at a policy-making level, and few of these types of positions in government are held by geriatricians or eldercare experts. Until that happens, the fight for improved policies and funding to elevate nursing homes and eldercare is stacked, but certainly not insurmountable. 

If there’s one thing I took from this podcast, it’s that there’s no reason to be pessimistic about the future of eldercare. If anything, after COVID-19, there’s a momentum driving the need for change that many experts in the field are riding on.