Michigan Warms To 'Green House' Concept

July 16, 2008
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GRAND RAPIDS — There’s a radical movement underfoot to deinstitutionalize nursing home care, and West Michigan is part of it.

“Green House” homes for the elderly are beginning to replace traditional skilled nursing homes and assisted living facilities because outcomes have already demonstrated that the Green House model both enhances the quality of life for the elderly and also heightens job satisfaction among the nursing staff that care for them.

Green House homes are dramatically different from nursing homes in terms of their size, design and organization: They create warmer communities that offer privacy, autonomy, support, socialization and enjoyment, according to the nonprofit NCB Capital Impact, a national organization that promotes improved and more affordable assisted living, housing and services for the frail and elderly.

Under the Green House model, residents’ quality of life is everything. Residents receive personalized care in self-contained homes designed for seven to 10 people who need long-term skilled nursing care. Residents have private rooms and bathrooms and share a central family-style kitchen and communal dining area. Green Houses have the look and feel of real homes. Gone are the institutional elements, such as medication carts, public address systems and nurses’ stations, as well as the regiment of an institutional schedule: Residents have the freedom to sleep, eat and join in enrichment activities as they choose.

Porter Hills broke ground on two Green House homes May 5 and will be the first in the Grand Rapids area to offer the model when its two 10-bedroom homes are completed in the spring of 2009.

The Green House model more or less flips tradition on its head, said Ingrid Weaver, vice president of operations for Porter Hills Retirement Communities and Services. It changes the hierarchy of the institutional staff and gives more responsibilities to certified nursing assistants, who provide care for residents and manage their routine household tasks. 

“The residents are at the center of everything, and as their direct caregivers, the CNAs are the second most important person in the home. Together, they are the key decision makers,” Weaver explained “The medical director, the therapists, the nurses and administration are all support resources for the direct caregiver.” 

Before residents move in, the Porter Hills staff members selected to work in the Green House homes will undergo at least a month’s worth of training within the homes, Weaver noted.

Porter Hills Village on Fulton is a 101-bed nursing home, but only 29 beds are in private rooms. So what Porter Hills is doing, figuratively and literally, is taking beds from its nursing home and transferring them to the two Green Houses. In essence, the move will create 20 more private rooms.

The Green House concept is rooted in the Eden Alternative, a model of elderly health care that focuses on changing the culture and structural environment of traditional nursing homes. Porter Hills already embraces the Eden Alternative concept corporate wide, Weaver said.

“The Eden Alternative is a more person-centered approach to elder care that uses plants, animals and children to liven up the environment and create spontaneous interactions, and in essence, create a more natural environment,” Weaver explained.

The Porter Hills Green House homes are part of a nationwide project. NCB Capital Impact, with grant funding from the Robert Wood Johnson Foundation, is pursuing the rapid replication of the Green House model on a national level, offering technical assistance and pre-development loans to organizations that want to establish a partnership with the Green House Project. Porter Hills received a grant from the foundation for education and training of staff. As of early July, Porter Hills has raised $2.7 million towards its $5 million Green House project. There are some 33 Green House neighborhoods established or in the process of being established in the United States, according to NCB Capital Impact.

“We can contact all these Green Houses that are already up and running, and they can tell us how they’ve made things work and what they’ve had to adjust,” Weaver noted. “Since we’re on the second wave of these Green Houses, we have a great opportunity to learn from others who started with this initiative before we did.”

Resthaven Care Community in Holland operates one Green House home. Also in Michigan, Presbyterian Villages of Michigan in the Village of Redford and Pinecrest Medical Care Facility in Powers both operate two Green House homes.

Christian Care Nursing Center in Muskegon is seeking a certificate of need from the state to construct a one-story Green House facility on 12 acres about 2.7 miles from its present location at 1275 Kenneth St. Using the Green House model, Christian Care is striving to create an atmosphere closer to that of a home by arranging its 49 beds into two smaller neighborhoods, its CON application states.

Jonathan Anhalt, human resources director and a member of the center’s building committee, said Christian Care decided to go with the Green House concept because it believes it’s one of the best concepts out there.

“We think it will make for a better life for our residents,” Anhalt said. “It’s going to foster a home-like atmosphere they can really thrive in. We’re excited about the opportunities the Green House home is going to present us in the future and the quality of life it’s going to offer our residents.”

In a study comparing health outcomes and quality of life for Green House residents with residents at two traditional nursing homes, Green House residents were found to experience a better quality of life, with the same or better quality of care than those in the comparison homes. The study, “Resident Outcomes in Small-House Nursing Homes: A Longitudinal Evaluation of the Initial Green House Program,” was published in the Journal of American Geriatrics Society in June 2007. Its authors are Rosalie A. Kane, Ph.D., Terry Y. Lum, Ph.D., and Lois J. Cutler, Ph.D.

Green House residents reported significantly higher satisfaction with their facility as a place to live than did residents of traditional nursing homes and had better scores on many dimensions of self-reported quality of life. They had lower rates of depression, bed rest, reduced activity and decline in functional abilities. Green House residents also scored significantly higher on emotional well-being indicators, according to study results.

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