The Atlantic had an interesting article on how to improve the quality of care in the nursing home industry.  “Nursing homes have been run the same way for decades, in part to meet government regulations and to qualify for government payments such as Medicare and Medicaid.”  A better nursing home would look totally different from the traditional model. It would be based on innovative experiments from elsewhere, and it would accept people of all different incomes, as well as non-elderly people with debilitating diseases such as ALS and MS. It would be a home, not a hospital, no matter how sick residents were, and it would allow them to make their own choices and live their own lives.  One facility has done that–The Leonard Florence Center for Living—opened in 2010—in an effort to transform the nursing home where he’d first put his mother into a place that looks more like the Leonard Florence Center.

America is aging, and still hasn’t come to terms with it. By 2050, one-third of the population of the U.S. will be 65 or older, according to the Congressional Budget Office. About 4 percent of the population will be 85 or older, and more than half of them have difficulty performing one or two “activities of daily living,” which include bathing, dressing, eating, walking, transferring out of a bed or chair, and using the toilet, the CBO says.”

Studies have shown significant rates of depression among nursing-home patients, and anticipation of being placed in a nursing home can lead to patient suicide.  “Our elderly are left with a controlled and supervised institutional existence, a medically designed answer to unfixable problems, a life designed to be safe but empty of anything they care about,” wrote Atul Gawande in his powerful book, Being Mortal, about aging and the problems inherent in long-term care.

“When Barry Berman was looking for an alternative to the traditional nursing home, he stumbled across a concept called the Green House Project that seemed promising. It was created by Bill Thomas, a doctor who started working at a nursing home in upstate New York in 1991, and wanted to make residents less lonely. As Gawande recounts in his book, Thomas brought in dogs, cats, and 100 parakeets; and created an after-school program, which brought the residents into contact with kids, with extremely positive results.”

“Thomas persuaded an organization in Tupelo, Mississippi to build the first “Green Houses.” Each home consisted of 10 to 12 private bedrooms, each with its own private bath, arranged around a communal living area and kitchen. In each home, there are primary caregivers called Shahbazim, certified nurse assistants who also handle some food preparation, light housekeeping duties, and plan activities for residents. They work as a team with other Shahbazim, which gives them the ability to manage their own work schedules and make decisions collaboratively.”

“Studies showed that Green House residents experience a better quality of life than people in traditional nursing homes, that their families were happier with the setting, and that the staff were happier with their jobs and more likely to remain in their positions.”

“With funding from the Robert Wood Johnson Foundation, Thomas then created what’s now called the Green House Project, which sought to help non-profits and businesses build Green Houses around the country. Green Houses are all very different, but share a few commonalities—each is designed for just 10 to 12 residents, and are built around a common living room and dining room. Each resident has his or her own bedroom and bathroom, and has a say in the residence’s menu. The other two parts of it are cultural change, which is focused on person-centered care, and organizational change—we use a very progressive organizational model that focuses on empowered teams and a coaching approach to leadership.

People are healthier and happier in Green Houses than they are in traditional nursing homes, and research supports this claim. One study found that Green House residents reported higher quality of life than seniors in traditional nursing homes in subjects such as privacy, dignity, autonomy and food enjoyment. The rate of hospitalization per resident over 12 months was seven percentage points higher in a traditional nursing home than in a Green House, another study found.

“Staff are also happier in Green Houses, studies have shown. That’s an important metric in an industry with high turnover and a reputation for elder abuse (happier staff means lower turnover, which means less hiring, which in turn means less risk of hiring people who may be abusive). Shahbazim say they feel less rushed and are able to spend more time with the elders in their care, and also feel less stress and guilt around their jobs.”



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