Green House Blog

The Small House Pilot in California, Changing the Face of Aging

Update, 05/18: The Green House Senior Director, Susan Ryan was honored to join Leslie G. Moldow, FAIA, LEED of Perkins Eastman and Mary Muñoz of Ziegler at the LeadingAge California conference to speak about The Small House Pilot, and how providers can seize this moment to enhance the way elders in California age. Collaborating with strong leaders in our field makes our collective voice louder and our impact greater. 

Originally Published 01/18

It is a pivotal moment in California’s history.  The Small House Pilot Program is now live, and it has the potential to clearly demonstrate that there is a better way to deliver skilled nursing care. This profound opportunity requires that nursing home providers across the state, take a stand, and say, NOW IS THE TIME!

The wait has been long, making this moment all the more powerful.  In 2013, through a tenacious journey, Mt. San Antonio Gardens became the first Green House Project in California. The work that they did to make regulatory gains with stakeholders across the state blazed a trail and were codified in late 2012, as Governor Brown signed into law Senate Bill 1228 (introduced by Sen. Elaine Alquist). The bill created The Small House Skilled Nursing Facilities Pilot Program, which authorized the development and operation of 10 pilot projects to deliver skilled nursing care in smaller, residential settings, “It puts the ‘home’ back into nursing home”, said Senator Alquist (D-San Jose). However, it wasn’t until early 2018, that the regulations to support this bill were released, and the request for applications is now open to the public. As a perennial advocate for elder directed, relationship rich living, The Green House Project is eager to support every effort to ensure the success of this opportunity.

The Green House Project has come to be recognized as the leader of the small house movement to create a high-quality, cost-effective, human-scale alternative to the traditional nursing home. Studies of the Green House model have found that:
• Residents have a better quality of life and receive higher-quality care than residents in traditional nursing homes.
• Staff report higher job satisfaction and increased likelihood of remaining in their jobs.
• Family members are willing to drive farther and pay more to have access to a Green House home for a loved one.

Real Home, Meaningful Life, and Empowered Staff: these core values align well with the regulations of the Small House Pilot in California, and they drive change in Green House homes, creating quality outcomes, consumer demand and preferred partnerships in the healthcare system.

With 15 years of expertise in design, education and evaluation, The Green House Project is a strong partner to support the expedited timeline and in-depth requirements of this pilot. The first deadline for submission is June, 2018. Design tools, like The Green House Prototype, along with educational protocols and policy and procedure expertise, will ensure an organization is able to successfully navigate this application. Susan Ryan, Senior Director of The Green House Project says, “The Green House Project specializes in a comprehensive cultural transformation that shifts the beliefs, behaviors, and systems to ensure a lasting investment across an organizational system. It is more than simply a process from ‘this’ to ‘that’; a real transformation unleashes the best of what can be by accessing collective wisdom.” The national initiative stands ready to support nursing home innovators in California, to ensure better lives for elders and those who work closest to them.

With California’s number of individuals 85 and older expected to triple by 2030, the market for Green House homes and others like them is rapidly growing. Consumer demand for the kind and quality of care that The Green House model provides has long existed, but until recently, California’s regulatory and approval process had been unable to accommodate non-traditional models of care. In fact, it took almost seven years for Mt. San Antonio Gardens to gain the approval it needed from multiple local and state agencies. Inspired by their lessons learned, Senate Bill 1228, and the newly released regulations, will enable innovation without obstacle. The Green House Project calls every organization interested in creating a real home, meaningful life and empowered work opportunities for the citizens of California to contact us, and together we will forge a trail to a brighter future.

Reclaiming Elderhood

Andrea Tyck is the Wellness Director at Mt San Antonio Gardens, a Life Care Community in Pomona, California.  She is also a Green House Educator and helped to open the first Green House homes in California.

Andrea Tyck, Green House Educator, Mt. San Antonio Gardens, Pomona, CA
Andrea Tyck, Green House Educator, Mt. San Antonio Gardens, Pomona, CA

In Jerry Spinelli’s book Hokey Pokey, Hokey Pokey is a place where there are no adults. Kids are in charge and free to roam.  The main character, Jack, is the de facto leader and is loving his life until things start to change.  A tattoo, present on the bellies of all the inhabitants of Hokey Pokey, begins to fade.  When his bike, the symbol of his power and influence is stolen, he oddly begins to adjust to its absence. And what’s worse is that his enduring disdain for girls and a girl named Jubilee, in particular, is beginning to lose its grip.  She might even become a friend.   In addition Jack begins to sense that he is going to be leaving Hokey Pokey although he doesn’t  know why or how.  Jack tells Jubilee he thinks he is leaving that night.  When she asks “How do you know?” he replies “I don’t. It’s like” – he stares up into her eyes – “I’m on a bike I can’t steer, can’t stop.”  “So….,” she says, “Where to?”  He hangs full weight from her eyes.  “Beats me.”

The book cover explains that it is “a timeless tale of growing up and letting go, of reverence and remembrance of that moment in childhood when the world opens up to possibilities never before imagined.”   Ever since I read it I have been thinking of how the process of children becoming adults might be similar to the process of adults becoming elders.

Dr. Bill Thomas makes a case that elderhood is a distinct part of human development and that part of the process of that development is leaving adulthood. In very broad terms that means moving from a primary focus on doing and generating to embracing the “being-rich responsibilities of making peace, giving wisdom, and creating a legacy.”  In the land of Hokey Pokey, Jack’s transition out of childhood is perceptible but vague.  The reader has a sense of what might be happening to Jack (he is growing up) but the steps are still somewhat confounding.  Might that be similarly true of one’s growth out of adulthood and development into elderhood?  Are there signs that the purposes in your life and the mechanisms by which you enjoy, ponder and resolve things have been transformed?    Are there treasured parts of you or your life that you no longer have (like Jack’s bike) that you realize you are ok without?

The book ends with Jack back in the “real world” preparing to redo his bedroom with his dad to make it less childish.  There is a sense of hope, that all is right.  That the magical world he left behind wistfully has been left for “possibilities never imagined.”  Perhaps the journey into elderhood can also be hopeful, that leaving adulthood is as it should be, and that it is , per Dr. Thomas, a “complex ripening, a richness that is unavailable to those who remain in the fevered grip of adulthood.”


Media Coverage of The First California Green House project

There was such a buzz created by the dedication and celebration of Mt. San Antonio Gardens, the first Green House project in California. It seemed fitting to share the list news outlets that covered this event, with many more who reposted and amplified the message.


Leading Age California

March 2013

Green House Comes to California

Inland Valley Daily Bulletin

June 3, 2013

California’s First Green House homes Open, Ushering in New Kind of Nursing Care

Grantmakers in Aging

June 1, 2013

Evergreen Villas in Claremont offers new model of senior living (Cross-posted on Contra Costa Times, SGV Tribune and

Claremont Courier

June 1, 2013

Larry Wilson: A restful rest home? You’re talking ’bout my generation (Cross-posted on Pasadena Star and SGV Tribune)

May 29, 2013

A New Type of Green House

McKnight’s Long Term Care News

May 29, 2013

First Green House homes in California

Inland Valley News

May 23, 2013

California’s First Green House® Homes Open, New Era of Nursing Home Care

Pending (interviews completed)

California Healthline, Stephanie Stephens

On the Frontline: Randy Stoll and Mt. San Antonio Gardens

Randy Stoll once watched a woman on staff wash a wall in the skilled nursing facility where he’s the president and CEO. He noticed how she washed—from the bottom up. Smart, he thought, that way there are no drip marks. But what he really noticed was that she was wearing high heels. She wasn’t a housekeeper—she was a director—but she knew how to do every job.

Randy knows about this. Not the drip marks maybe, but the idea of a versatile worker—everybody being able to do everything, everyone being responsible. While he’s currently the president and CEO of Mt. San Antonio Gardens, a Life Care senior community in Southern California, he started off in a completely different place and got there via a different route. Some people come up through academic programs in administration, which Randy would eventually do, but first, he worked at a hospital.

“My dad was a stickler,” he said. “When I quit college he told me to go get a job, so I did—first as an orderly—and I loved it. I was serving the patients—they were my customers, not the hospital.” Eventually he became a housekeeper, a supervisor, and then a director. And after doing almost all the jobs that he could within the hospital, only then did he go back to school in administration—another versatile worker.

Today Randy oversees an entire team of versatile workers at Mt. San Antonio Gardens, a senior community in Pomona, CA. This summer, the Gardens will open the Evergreen Villas—the first Green House retirement homes ever built in California.

“The Gardens has always been a ‘resident-driven’ community,” he said. “I inherited that when I came on board in 1995. There have been six residents on the board for years.”

And over time, the Gardens did everything they could to keep up with that ethos—remodeling social spaces and common areas, putting in flat screen TV, hiring skilled nurses and training the staff thoroughly and ethically—but the traditional medical-model skilled nursing facility just doesn’t lend itself to providing person-centered care that would be attractive to elders. Randy knew there had to be a better way.

Having tried all they knew, some key stakeholders visited the first-ever Green House home in Tupelo, MS. Intrigued by the model’s promise, they then sent five residents with a board member to visit The Green House homes in Lincoln, NE to gather information and stories about the concept. Everyone came back wanting to bring this model home to California.

“Green House homes gave us the best chance of surviving without creeping back to the old way of doing things,” Randy said. “The Green House Project provided the philosophical framework and the extensive training and support we needed.”

Green House consultants also shepherded Mt. San Antonio Gardens through regulatory and legislative processes by calling state senators and seeing it through to approval.

Randy knew that The Green House model would help the Gardens improve upon the delivery of their core set of values which are built on the principles of person-driven care. He knew it could be a complete culture change. They all knew. But Randy also understood that while the residents would approve it, and that eventually he would get the state to approve it, he also wanted something else.

“The CNAs, the front-line caregivers,” said Randy. “They’re the ones who are really there at the end of life. They’re the ones who should be enabled to be advocates for the residents.”

It took over two years to get it pushed through the state, and during that time, five housekeepers went back to school to become CNAs at the new Green House home. Instead of the director of housekeeping being upset that 25% of his housekeeping workforce were transitioning to the new homes, he knew that if the employees wanted to be there, that it would make a difference to the residents. In fact, he threw a party for them and invited the residents.

“ Isn’t it nice that my favorite friend will be there to care for me?” Randy heard one resident say.

Continuity of care is part of the culture. Everyone on staff at the Evergreen Villas were employees at Mt. San Antonio Gardens. And that’s just one of the reasons Randy says that from an operational standpoint, The Green House approach costs the same to operate as the model it is replacing, not including depreciation. “But we didn’t do it for the money,” he emphasizes. “We did it for the residents and staff.”

It goes both ways, as the residents have pitched in, privately donating over $1.3 million to the Gardens—not a couple lump sums, but a bit from each of the 400 residents currently living there. They knew they were all working towards something good. Something that should be universal: Real care.

Visiting Mt. San Antonio Gardens, A Reflection on The First Green House Project in California

Visionary leader Randy Stoll, CEO of Mt. San Antonio Gardens, and his dedicated team have been toiling away for years to navigate California’s complex regulations in order to introduce the very first Green Houses to the state. As we toured the construction site, you could see the home taking shape – the fireplace, the kitchen, plenty of windows and the 10 bright, private bedrooms with private baths and showers. At the end of the tour I thought – the day the elders move in, these two homes will immediately become the top two places to receive skilled care in the state.

I felt a great sense of relief to see Green House homes under construction on the campus of Mt. San Antonio Gardens. After all, I have been a licensed Administrator in the state of California since 1989. We have over 1,150 licensed Skilled Nursing Facilities here – more than any other state. In California, many well-intentioned providers are struggling to deliver high quality care and service to over 100,000 people each day. The typical setting is an old institution with 2, 3 or 4 beds per room with an adjoining single bathroom (one sink and one toilet for 4 – 8 people to share). Speaking from experience – we paint the walls, we buy new beds, we add flat screen TVs, but…at the end of the day, it’s still not the place we would want for our loved ones or ourselves.


I am grateful for the leadership team at Mt. San Antonio for making this happen. California needs to see this. When The Green House homes open this spring, California’s providers, regulators and policy makers will see the future of skilled nursing care. It represents a radical change from what we are all used to, because, these Green House homes are the places that we would want for our loved ones or ourselves.

Green House homes are Coming to California

Joanne Handy, CEO of LeadingAge California provided the introduction in her publlication, Agenda, to  the feature article on The Green House Project, “The Green House model was born from necessity – from a realization that there had to be an alternative to caring for older adults. But without the persistence of a relatively small group of people, this new and innovative model may never have seen the light of day. And just as Mt. San Antonio Gardens is helping to lead change with its Green House, [Leading Age California] is helping to lead change by stimulating and fostering innovation.” The Green House Project is grateful to the leadership and partnership of many groups in California, together we are creating real homes for elders in this state.

In California, “the state’s population continues to age rapidly. The number of Californians over 65 is expected to
double – if not triple, by 2030, and seven in 10 of those seniors will need long-term care at some point.”  There is a call for innovation in long term care, a need for a model that will care for people as individuals, putting their person-hood at the same level as their medical needs.

After many years of striving to partner with regulators in the state, “two new homes will open at the Mt. San Antonio Gardens senior community in Pomona, Calif. They’ll fit right in among the apartments and cottages – with their patios and gardens – that already populate the 30-acre campus, beside its putting green, arts center and more. But these homes will be different. In fact, they’ll usher in the beginning of a new era of a nursing-home care in California.”

The gains made by Mt. San Antonio Gardens will be further solidified through legislation, “Late last year, Governor Brown signed into law Senate Bill 1228, introduced by State Senator Elaine Alquist (D-Santa Clara)… The bill will facilitate the development and delivery of “skilled nursing care in a homelike, noninstitutional setting” like never before, by creating The Small House Skilled Nursing Facilities Pilot Program.” Housed in the Department of Health, this bill calls for 10 organizations to participate in this pilot program which will demonstrate the positive outcomes that come from creating real home, meaningful life and good jobs in the long term care field.

The Green House Project urges every eligible provider to consider applying for this unprecedented opportunity to bring small home, person-centered care to market with the urgency that consumers are demanding and the efficiency for which providers are striving. To read the full article in the Leading Age California publication, click here.


Conference in California Today, Changing the Physical Environment of Nursing Homes: Addressing State Regulatory Hurdles

Partnership is key to any innovation. Robert Wood Johnson Foundation’s CEO and President – Risa Lavizzo-Mourey recently expressed why Green House homes are crucial to California’s aging services in an opinion piece for The Sacramento Bee. Today, regulators, legislators, advocates, providers and other leaders in the field come together for a day-long conference by Chi Partners and The California Health Care Foundation to discuss the changing landscape of long term care in California.

Much has changed this year to encourage providers to implement upgrades to their physical environment, and culture change practices:

• OSHPD’s new “Household” regulatory model for nursing homes allows providers to create a more home-like environment for their residents.
• Two small home (The Green House® Project) projects are working their way through the regulatory process, creating a blueprint for addressing key regulatory challenges to this type of model.
• Important Life Safety Code changes for nursing homes have been made by NFPA with the assistance of Pioneer Network that support the implementation of culture change.
• Some states (like Michigan and Arkansas) are successfully overcoming regulatory challenges and are now instituting legislation that supports providers in building new small home and culture-change models providing lessons learned for future changes to California’s regulations.

Leaders such as Pioneer Network CEO, Peter Reed, Director of Arkansas’ Office of Long-Term Care, Carol Shockley, The Green House Project, COO, Susan Frazier, join California regulators to discuss the value of partnering to change the physical environment of skilled nursing homes to support the quality of life and quality of care for the elders and staff in California.

Green House homes are crucial to California's Aging Services

The Green House Project has been working hard to support Mount San Antonio Gardens (MSAG) open the first Green House homes in California. As part of our work to be sure that MSAG’s and Green House adopter’s enjoy broad support in the state, the GHP team worked with The Robert Wood Johnson Foundation (RWJF) and their skilled communication team to get the word out about why Green House homes are crucial to California’s aging services in an opinion piece written by RWJF’s CEO and President – Risa Lavizzo-Mourey:

Add a comment if you have time!

Green House homes are crucial to California’s Aging Services

The Green House Project has been working hard to support Mount San Antonio Gardens (MSAG) open the first Green House homes in California. As part of our work to be sure that MSAG’s and Green House adopter’s enjoy broad support in the state, the GHP team worked with The Robert Wood Johnson Foundation (RWJF) and their skilled communication team to get the word out about why Green House homes are crucial to California’s aging services in an opinion piece written by RWJF’s CEO and President – Risa Lavizzo-Mourey:

Add a comment if you have time!