Green House Blog

The Research Initiative Valuing Eldercare, Launched

The Green House Project has partnered with THRIVE (The Research Initiative Valuing Eldercare) to learn more about the Green House model as well as other models of care. The THRIVE team is launching a series of interrelated research projects that together will comprise the largest research effort undertaken to date in Green House homes. This effort is funded by the Robert Wood Johnson Foundation.
The THRIVE researchers represent leading research institutions and long-term care organizations around the country, including Harvard University, the University of Wisconsin-Madison, Health Management Strategies, Institute for Clinical Outcomes Research, Pioneer Network, and the University of North Carolina at Chapel Hill. Many of the THRIVE team members have previously researched the Green House model, and in part, these previous studies – and the questions left unanswered – provided impetus for the current project.
For example, in a comprehensive review of the research literature, THRIVE team members Sheryl Zimmerman and Lauren Cohen found strong support for certain components of the Green House home model, such as that private rooms and bathrooms and communal dining are related to positive outcomes. However, these researchers also found that very little research has been done around the concept of normalized engagement, and therefore there is no evidence to show that this type of engagement relates to better care or outcomes.
Other THRIVE team members, including Siobhan Sharkey, Sandy Hudak, and Susan Horn, found in their earlier studies of work flow that Green House elders receive more direct care time per day than do similar residents in traditional nursing homes. They also found that Shahbaz spend about 20 minutes more per day with elders than do CNAs in traditional homes. In their work on elder outcomes, they also found that elders living in Green House homes maintained their ability to perform activities of daily living such as dressing and eating, to a greater extent than residents living in traditional nursing homes. These findings suggest further exploration into what structures and processes are associated with better outcomes, such as less decline in activities of daily living or fewer falls.
Earlier work by Barbara Bowers and Kimberly Nolet provided important insights into the role of the nurse and how it differs across Green House homes; they found, for example, that there are differences across homes in how the Green House model is implemented. In particular, there are important differences in how Shahbazim and nurses relate to one another and the degree to which they collaborate or work separately. Although this study demonstrated that the choice of model had meaningful consequences for both staff and elders, it did not determine what had led some homes to use one model over another.
It is these unanswered questions – plus many more related to staffing, care provision, clinical outcomes, and costs – that the THRIVE collaborative intends to address. The THRIVE project will be taking place through 2013, and during that time, members of the team will be contacting Green House homes to complete interviews, request records, and schedule visits. In addition to providing homes the opportunity to inform these matters and influence the direction of nursing home care, participating homes will also receive confidential feedback about their organization.
We are excited to be able to learn more about the Green House model, and look forward to working together.

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

First Community Initiated Green House Homes!

In a first for THE GREEN HOUSE ® Project (at least that we know of), resident research contributes to the adoption of The Green House model:

[Excerpts from The Thursday Flyer, a weekly newsletter of the residents of John Knox Village of Florida as published September 22, 2011] “In a landmark move to cement the position of John Knox Village as the premier state-of-the-art nursing home provider in the State of Florida, the JKV Board of Directors…voted to apply for membership in The Green House Project.  That motion, from an Ad-Hoc New Health Center Building Committee including ten members who are JKV residents, came before the Board with the unanimous approval of the Board’s Building Committee and Finance & Audit Committee, and passed the Board by near unanimity.

Board Chair Bill Knibloe pointed out that The Green House Project, with more than 100 homes open and functioning, has gained extensive experience operating in 27 states over the past seven years.  They are the only organization, Knibloe said, to have developed a comprehensive, time-tested model embodying the philosophy of person-directed care, a supportive building plan and a corresponding cost-effective staff reorganization model.  Rather than trying to “reinvent the wheel,” JKV will be better served by adopting the proven Green House model.

Board Member and prominent geriatric neurologist Dr. Murray Todd, who visited an operating Green House home in Birmingham, Alabama, earlier this year with Health Center Administrator Mark Rayner, Director of Nursing Christina Desposito and JKV resident Nancy Matthews, said all four had been impressed with what they saw and that he personally was convinced the Green House model was the way to go.  It is more like a real home than an institution.

Addressing the question of cost, Resident Board Member Norm Rasmussen cited extensive independent scholarly research showing that the costs of Green House construction and operation are on a par with those of other first-class skilled nursing facilities featuring all private rooms, as does the Green House model.  Resident Board Member John Thompson had spoken with the Health Center Administrator and CFO at a 5-star California CCRC operating, as does John Knox Village, with “Type-A” insurance-policy contracts and set to start construction of the first Green House homes  in California in a few months.  Both were enthusiastic about their project.  The Administrator praised in particular the skill of The Green House Project in negotiating their project’s approval through three demanding California state agencies.  The CFO said they would not raise monthly maintenance fees at all due to expected operating costs of Green House homes.”

The Green House Project is thrilled to be working with such a strong partnership of staff and residents.

GE Healthcare Finance Award for The Green House Project

Today, The Green House Project had the honor of accepting the GE Healthcare Award for Best Paper. Over 1,800 leaders, including top lenders in health care finance, assembled at the National Investment Center (NIC) conference in Washington, DC. The National Investment Center for the Seniors Housing & Care Industry (NIC) is committed to advancing the quality of seniors housing and care by facilitating informed investment decisions for investors, lenders, owners, operators and developers through groundbreaking research, actionable data and dealmaking events. NIC is driven to empower the industry with the insight needed to accurately measure performance, drive business decisions and communicate performance to key stakeholders.

Important findings from The Green House journal article were summarized by NIC’s president:

• Significantly more direct-care and nursing time is delivered in The Green House home
• Overall staffing needs and costs do not increase compared to traditional settings due to a shift from supervisory and department hours to direct care hours.
• The Green House model uses time more effectively, delivering significantly more direct care and nursing hours within lower total direct service hours.
• Average operating costs for Green House homes are between the 50th to 60th percentile of nursing homes nationally.
• Consistent and financially important differences were found in Green House providers’ overall occupancy (7% higher) and private-pay occupancy (a 24% increase) compared to nursing home averages.
• No hidden or unexpected costs were associated with The Green House model.
• Green House homes’ capital costs, including all private rooms and bathrooms, were found to be at the low end of culture change models.

The full journal article, Financial Implications of The Green House (r) Model, can be found in the 2011, Volume 19, Number 1 edition of Senior Housing and Care Journal

Sweet Homes Alabama- Green House Annual Meeting 2011

Sweet Homes Alabama: 4th Annual Green House Meeting and Celebration
September 8-9, 2011, Pre Conference September 7
Birmingham, AL
Wynfrey Hotel – 1-800-996-3739

Wynfrey Hotel- Birmingham, AL

Announcing the Fourth Annual Green House Meeting and Celebration! This year’s gathering is an exclusive time for Green House Project Adopters to share, learn and celebrate!  We will convene at the Wynfrey Hotel in Birmingham, AL. Green House Projects, mark your calendars, you won’t want to miss this exciting opportunity!

**At this time, the GH Annual Meeting is only open to Green House adopters under contract with The Green House Project**

Click here to download the conference brochure

This year, registration and payment will be done through a convenient online registration form, which you can fill out below. You can pay right through this website and you’ll receive email confirmation of your purchase once done.

Hotel information, transportation and information on additional programs can all be found in the GH Annual Meeting 2011 Brochure. We have reserved a special hotel guest rate for our attendees so please be sure to book early and mention “The Green House Project” for the special event rate.

This year’s theme, “Sweet Homes Alabama” gives a nod to The Green House Cottages at St. Martin’s in the Pines and all of the organizations working to create sweet homes throughout the country, where elders and persons living with disabilities can live lives of meaning and power. We honor the commitments you have made and the hard work you are doing to make this vision a reality in your communities. We hope this experience provides you with the opportunities for the learning, growth, replenishment and fun that you so richly deserve!

There will be learning, information-sharing and ample networking opportunities for everyone, so come join the celebration!

For questions or more information: or 703-647-2311. Registration below:

Continue reading “Sweet Homes Alabama- Green House Annual Meeting 2011”

The Green House Project Welcomes New Team Members

The Green House Project welcomes two new team members!

We are so pleased to welcome Peer Network Director, Dan Klein, and Project Associate, Heather Marshall to our team!

Dan is joining the project from the New Hampshire Health Care Association, where he served as Assistant Executive Director. In this role, Dan was instrumental in areas of policy, communication, research, and advocacy. One of Dan’s achievements was to serve as the primary facilitator and advocate for Seniors Aid New Hampshire, a coalition of nursing home and assisted living community residents who lobby state and federal governments and raise money for charities.  In his role as The Green House Peer Network Director, Dan will facilitate and explore ways in which education, information, and accountability support project success.

He can be reached via e-mail at:

We also welcome Project Associate, Heather Marshall.  Heather’s education and experience will make her a valuable asset to the team.   As an intern at National Council on Aging (NCOA) , she participated in many creative, evidence-based solutions to the issues impacting elders.  This experience bolstered her opinion that sustainable solutions require education, support, and investment from the entire community. As a student at the Brown School of Social Work, she tailored her curriculum to focus on gerontology and more specifically, the mental health needs of older adults.  In addition to this coursework, a previous internship and subsequent work experience at Concord Adult Day Enrichment Services further developed her skills and passion for elders.  As a Project Associate, Heather will partner with a Project Guide to jointly support long-term care organizations interested in embracing the Green House model to improve the lives of elders. education.

Project Associate, Heather Marshall

Heather can be reached at: