Green House Blog

THRIVE (The Research Initiative Valuing Eldercare) Update on Green House Homes

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.
The THRIVE research team is committed to the timely dissemination of findings relevant to The Green House Project homes and stakeholders.  Members of the THRIVE team recently presented preliminary research findings at the 2013 Green House meeting and in a January 2014 webinar.  Highlights from these presentations include:

David Grabowski (Harvard Medical School) debunked several common myths about The Green House model.  Using administrative data, David’s presentation showed that although higher resource nursing homes are more likely to adopt the Green House model than are lower resource nursing homes, these lower resource homes can be successful adopters with adequate vision and internal and external support.  His data also looked at culture change more generally, and found that culture change homes perform better on survey inspections — in fact, they lowered their health-related survey deficiencies by almost 15%!  David’s findings appear in the February issue of The Gerontologist journal:

Culture Change and Nursing Home Quality of Care

Who Are the Innovators?  Nursing Homes Implementing Culture Change

Lauren Cohen (University of North Carolina at Chapel Hill) presented data comparing the characteristics of Green House, higher culture change, and lower culture change nursing homes.  Interviews with guides and administrators found that a greater proportion of Green House homes offer resident choice in bedtime and get-up time, but not in bath time.  Lauren noted that previous research has shown that the desire for choice is not universal, and that predictability may be most important.  Her data also showed that Green House homes were less likely than culture change nursing homes to offer prescheduled daily activities, but were more likely to empower caregivers to lead activities.  So, it remains essential that empowered caregivers offer activities and encourage participation.

Kim Nolet (University of Wisconsin – Madison) reviewed the variations in how the Green House model is being implemented across homes, and discussed the implications of this variation.  Kim described variations in several Green House elements, including the role of the Shahbazim and the use of the den.  Her presentation suggested that model variations occur due to the challenges presented by critical events, organizational changes, daily routines, and subtle evolution in how things are done in Green Houses.  These challenges lead to problem-solving that sometimes results in reinforcement of the model and its core values, and other times in practices that are inconsistent with the core values of the model.

The THRIVE team will be expanding upon these and other findings in 2014.  We have planned conference presentations, webinars, blog posts, and journal articles to communicate our findings to you and others, and invite your feedback about the best ways to keep you informed of the latest findings.

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