Barbara George's 97-year-old mother used to live in that nursing home. "Although my mother had wonderful care in the old place, it was more like a hospital, and she was scared. I'd cry every time I'd leave her," says George. "In the Green House, she knows the staff well. My mother will tell them she loves them, and they do the same. She's gotten her identity back."
The same staff is permanently assigned to one Green House home, giving residents a feeling of security; it's also less confusing for those with dementia, typically 50 percent or more of residents who live in long-term care. Certified nursing assistants (CNAs), called "shahbazim" — which means "royal falcons" in the Farsi language — in Green House parlance, not only take care of residents' personal and medical needs, but also do their laundry and cook meals. A nurse floats between houses, and a physician, social worker or physical therapist is just a call away. Rather than having to wheel a big cart around, medicine is kept in a locked cabinet in each resident's room.
The Green House model may be a potent antidote to a health care industry known for its tremendous turnover. "I used to work in a hospital, where I didn't build relationships," says Wendy Barrientos, a CNA where Jack Cassidy lives. "Here, I know what the elders want for breakfast, what they like and don't like. I'm not just in and out and then go on to the next room. We sit and talk. I value them more as people, and they value me, too. They're like my grandmother and grandfather. I fall in love with them."
According to Alexandra Reilly, a nurse and colleague of Barrientos', "not only have I formed close relationships with the elders, but I get to be with them throughout the day, rather than just spend 20 minutes with each one. I know their baseline, so if anything changes, I can address it immediately."
Green House advocates point to studies that show the model's positive impact on residents' quality of life as well as improved satisfaction for their families and staff. Skeptics have questioned whether a model that gives CNAs so much responsibility (cooking, laundry and medical needs) can provide comparable clinical care as a traditional nursing home — not to mention the same amount of direct care.
One soon-to-be-published study shows that residents receive a similar amount of direct care with both the traditional nursing home and Green House models. At Eddy Village Green, Farnan used the same clinical indicators to compare residents in their old nursing home to those in their Green Houses, finding fewer falls and less depression, weight loss, agitation, pain and crying out for help in the newer model.
"The staff knows when the residents are quieter than normal or in pain, and there is so much less institutional noise than in traditional skilled nursing units," says Laurie Mante, vice president, Residential Division, of the Eddy Village Green and was involved in the study.
New model for a new age
Since geriatrician William Thomas, M.D., created the first Green House homes in Tupelo, Miss., in 2003, more than 100 have been constructed in 26 locations across the country, with about 100 more in development. Typically, they are built as a cluster of single homes in suburban or rural areas. The Leonard Florence Center for Living is the first urban Green House in the country, comprising 10 homes in a building. They're more like condos, with two separate, self-contained living areas per floor. Visitors get off the elevator, find the right mailbox, ring the doorbell and wait for the staff to let them in, just as they would in any freestanding home. Like many Green House projects, this one is part of a health care campus that includes other medical facilities, such as assisted living.
"With Green Houses, we are planting the seeds of the new American nursing home," says Thomas. "We are building what the boomers will rely upon when it's their time."