Green House Blog

The Green House Project research study: “Prove it works.”

You wouldn’t buy an expensive medication without confidence that it works, would you?  Because the Green House model requires an investment, people are asking for evidence that it works and to understand why it works.  In response, the Green House Project has partnered with THRIVE (The Research Initiative Valuing Eldercare), funded by the Robert Wood Johnson Foundation, to learn more about how the Green House model works and how it differs from other models of care.  The THRIVE team is launching a series of projects comprising the largest research effort undertaken in Green House homes.  Many of the THRIVE team members have previously researched the Green House model, and their earlier work in part shaped the questions that THRIVE will be answering.  Here is some of what is known from previous work:

  •  Do specific components of the Green House model relate to better outcomes for elders?   THRIVE members Sheryl Zimmerman and Lauren Cohen (University of North Carolina at Chapel Hill) reviewed research literature and found strong support that certain components of Green House homes seem to relate to better outcomes — such as that private rooms and bathrooms and communal dining relate to less infection and better intake.  However, they also found that little research has been done regarding many other components of Green House homes, so several questions remain as to which components matter in terms of better quality of life for elders. 
  •  How does daily practice of front-line caregivers differ in Green House homes compared to traditional settings?  THRIVE members Siobhan Sharkey, Sandy Hudak, and Susan Horn (Health Management Strategies and the Institute for Clinical Outcomes Research) observed that elders receive more direct care time per day in Green House homes than do similar residents in traditional nursing homes – about 20 additional minutes more per day, in fact.  They also found that elders in Green House homes maintained their ability to perform activities of daily living, such as dressing and eating, to a greater extent than those living in traditional nursing homes.   It is not clear, though, what it is about the Green House model that might relate to better outcomes. 
  • How does the role of the nurse differ in Green House homes?  Work by Barbara Bowers and Kimberly Nolet (University of Wisconsin-Madison) found that Green House homes have used different models for how Shahbazim and nurses work together to provide care for elders.   Each model had meaningful consequences for both staff and elders, but it is not clear why there were such differences across homes. 

These three studies left us asking, “Are Green House homes helping elders more than are traditional nursing homes, and if so, which specific elements and practices are making the difference?”  The THRIVE team will be answering this question, and also looking at other topics including staff turnover, who is adopting the Green House model, and costs.  Participating sites will help answer these questions, and also will receive confidential feedback about their organization.  It’s an exciting opportunity for researchers, Green House homes, and other nursing homes to work together toward improving care.

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

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