Most older adults don’t want to live out their days in a traditional nursing home. But when an elder with serious health issues needs 24/7 care, it might be the only option. Family caregivers may not have the wherewithal to cope, and the monthly median cost of around-the-clock home care services — 168 hours per week — tops $24,000.
Another long-term care option is gaining popularity: Green Houses. These elder-centered, long-term care residences are smaller than most long-term care facilities and designed to look like and feel a typical residential home. Green House homes support about a dozen residents at a time, but units are often grouped together, so people feel like part of a community.
Higher resident and family satisfaction
Since their launch in 2003, Green Houses have generated greater resident and family satisfaction, lower staff turnover, better overall clinical outcomes, improved quality of life, and lower mortality rates during the first two years of the COVID-19 pandemic, according to a report from the AARP Public Policy Institute. Journalists can use the information in this report as a launchpad to delve deeper into Green Houses and other alternative long-term care options.
There are nearly 400 Green Homes in 35 states and Australia. Residents in each home typically have more day-to-day input on everything including activities and meals; they enjoy private rooms and shared homey, communal spaces with the look and feel of traditional living and dining areas. Meals are prepared in an open kitchen, and residents have control over even the most basic aspects of their lives, like when to eat, wake, or sleep. As the AARP report noted, “residents can get what is essential for them and what is important to them.”
Green Houses are licensed as either stand-alone nursing facilities, or they can be part of an established, traditional long-term care institution, wrote Charles Sabatino, former director of the American Bar Association Commission on Law and Aging, in an April, 2023 article in Health Affairs. Staff, particularly certified nursing assistants, are cross-trained, and are empowered to work as a team to help residents reach their personal goals, he wrote. Not only does this approach give residents a greater sense of control over their lives, but it helps reduce staff turnover and boost job satisfaction.
More about Green Houses
The majority of Green House residents pay out of pocket to live in one of these homes, although most homes accept Medicare for short-term care, and 45% are covered by Medicaid. The Green House model may also reduce Medicare spending. Sabatino pointed to a 2016 study showing lower overall Medicare costs among Green House residents compared with traditional nursing homes. That same study found that these small group home residents had lower hospital readmissions.
According to the AARP, among the existing Green Houses:
- 87% are licensed as skilled nursing facilities
- 37% are located in rural areas
- 63% are located in urban areas
- 82% are not-for-profit
- 18% are for-profit
Both AARP’s report and Sabatino’s article highlight the need for more of these facilities, as well as other alternatives to traditional nursing homes. Sabatino called for increased state and federal spending, boosting financial and reimbursement incentives to create more of these individual-oriented, higher-quality homes. He also called on states to change their thinking, and policies, towards long-term care — including promoting more alternatives to institutional care, increasing the number of single-occupancy rooms within these facilities, and redeveloping existing buildings into these smaller home models.
And construction financing, improving return on investment, revenue and operating costs are all considerations for providers willing to consider alternative models. AARP advocates a public-private investment approach, as well as eliminating regulatory barriers to entry as means to encourage more innovative approaches to long-term services and supports.
Reporters might want to find out what their state is doing to encourage a shift in traditional nursing home care. Or, in states where Green Homes exist, journalists can explore how they are faring in terms of occupancy, cost, staff turnover, quality and safety metrics compared with larger facilities, particularly four years after the COVID-19 pandemic began.
Resources
- The Green House Project
- CMS Nursing Home Compare
- Small House Nursing Homes AARP Report
- The Household Model: Creating a ‘Home’ in Nursing Homes from Public Health International
- The Big Idea behind a new model of small nursing homes from Health Affairs
