Or even before. Many nursing homes were built in the 1950s and 1960s and are due for major renovations, if not complete do-overs. In remote Seward, Alaska, the only nursing home in town was replaced last year with four Green House homes. A $10 million grant from the Robert Wood Johnson Foundation in 2005 to replicate the Green House model across the country has propelled this new, skilled long-term care option.
A typical Green House home costs $1.2 million to $1.8 million to construct, comparable to a new traditional nursing home with private bedrooms, bathrooms and equivalent common space. Experts claim the operating costs for both kinds of skilled nursing homes are similar. But because Medicaid doesn't factor into its reimbursement rates the cost of the additional square feet required for private bedrooms and bathrooms, Green House and other new models of skilled nursing care are difficult to provide to those with low incomes. This means Green House homes need to have extra subsidized funding. On average, 50 percent or more of Green House residents receive Medicaid, and 30 percent are privately funded; the rest have other funding sources.
The cost of a Green House home ultimately depends on location and amenities. The price tag for the Chelsea, Mass., project was $3.7 million for each house — there was complicated site work, top-of-the-line furnishings and kitchens, art, ceramics and glassware throughout, a café, chapel, deli and swanky lobby with a fountain — while the ones in Arkansas were built for under $1 million each.
While Thomas wants to abolish old-style nursing homes, Barry Berman, CEO of Chelsea Jewish Foundation, believes traditional nursing homes are not going away and can still do a good job.
"But in order to survive," Berman says, "they have to embrace culture change by making them more homelike and as noninstitutional as possible, and give residents more choice."
Says Farnan of Eddy Village Green: "I want to create a place I wouldn't mind putting my parents if they needed it. My feeling is that if this isn't the answer, it's closer than the old way of doing things."
For more on Green Houses, go to www.thegreenhouseproject.org.
Sally Abrahms, a writer from Boston, wrote this article as part of her MetLife Foundation Journalists on Aging Fellowship in partnership with New America Media and the Gerontological Society of America.