Green House Blog

Nursing Home Workflow Study: Analysis of Staff Workflow in Traditional Nursing Homes and THE GREEN HOUSE® Project Sites

A new study funded by the Robert Wood Johnson Foundation found that The Green House model’s organizational and staffing redesign delivers more direct care time, a key component of improved quality, without increasing staff hours and maintaining expenses at levels similar to traditional nursing homes.  This new, yet to be released, study examines front-line staff daily workflow in skilled nursing settings, including Green House homes, and confirms the model’s design to redeploy, but not increase, staff time.  Thirteen organizations, including 27 sites, participated in the study.

According to the study, conducted by the Institute for Clinical Outcomes Research (ICOR) and Health Management Strategies (HMS):

  • Total staff hours: The total difference in staff time was approximately 30 minutes less per resident day in Green House homes compared to traditional settings.  However, the quality of interaction in a Green House home is stronger.  For example, staff in a traditional nursing home spend 45 minutes more simply transporting residents than in a Green House home.  Elders in a Green House home receive 1.5 hours more nursing staff time than those living in traditional nursing homes.  In Green House homes, fewer staff hours (approximately two hours) are spent on non-nursing services such as food preparation, housekeeping and other support services.
  • Direct care time: An elder in a Green House home receives approximately 30 minutes more in direct care activities per day compared to a resident in a traditional setting.
  • Engaging elders: The Green House model provides more direct and personalized interaction between caregivers and elders than traditional nursing homes. On average, Green House elders receive 25 minutes of direct engagement outside of assistance with activities of daily living compared to five minutes for residents in a traditional setting.