Evidence Behind the Green House and Similar Models of Nursing Home Care

Abstract and Introduction AbstractThe Green House and similar models of nursing home care offer a solution to the institutional nature of nursing homes. In The Green House model, small houses are home to 6–12 residents in which care is given as much attention as treatment and is provided by a consistent, self-directed team of staff who are responsible for all care, including preparing meals in a centrally located open kitchen. Residents have private rooms and bathrooms that open onto a central living area. Although a nurse is available 24 h a day and the clinical care team is nearby and visits the home to provide care, the sense is that one is receiving care in a family-type setting. While these homes are expanding rapidly and seem to embody a better culture of nursing home care, their future growth may depend on the evidence that supports or refutes the quality of care that they provide.

IntroductionAt any given time, 1.5 million individuals reside in nursing homes (NHs). Unfortunately, for most of these individuals, the NH is a setting of last resort because despite the care provided there and the improvements that have been witnessed in recent years, their ambiance is essentially one of an institution.[1] Fortunately, the future is not grim in this regard. A most promising development in NH care is encapsulated by the culture change movement, which seeks to change the organizational culture of NHs while attending to residents’ healthcare needs. The best known example of NH culture change is the Eden Alternative, which encouraged companionship with children, adults and pets, promoted meaningfulness and control, and recast medical treatment as secondary to caring.[2] However, the limitation of this and many other models of culture change is that they do not address the fundamental structure of NHs as an institution.

A relatively recent and rapidly growing new culture of NH care is that of small-house NHs, best typified by The Green House homes that grew out of Eden principles. Their very intent is to combat the institutionalization of NHs by deinstitutionalizing them. As of July 2010, there were 89 Green House NHs in operation across 14 states in the USA, and more than 125 in development across 11 states. In The Green House model, small houses are home to 6–12 residents in which care is given as much attention as treatment and is provided by a consistent, self-directed team of staff who are responsible for care ranging from preparing meals in a centrally located open kitchen, to assisting with activities of daily living (ADLs), to engaging in social activities. Residents have private rooms and bathrooms that open onto a central living area, and they reflect the range of impairments seen in traditional NHs. The staffing hierarchy in traditional NHs is flattened in these homes, and although a nurse is available 24 h a day and the clinical care team is nearby and visits as needed, the sense is that one is living in a home receiving care in a family-type setting.[3] The Green House is a registered trademark that can be used only by settings that have a license to do so.

Viscerally, these settings seem to embody a better culture of NH care, and the few outcome studies conducted to date (using a quasi-experimental design in four Green House homes and two comparison sites) found better reported quality of life in four of 11 domains (privacy, dignity, autonomy and food enjoyment), less decline in late loss ADLs, less family involvement in providing assistance, and more activities outside the NH and satisfaction reported by residents and families. However, there were no consistent results related to health, no change in the social environment and less participation in organized activities.[4,5] An examination of workflow conducted in 14 Green House homes in comparison with 13 traditional NHs found the former did not require more staffing; in fact, they had slightly less overall staff time (nursing plus non-nursing; 0.3 fewer h per resident day [HPRD]), composed of 1.6 more HPRD of certified nursing assistant time but 2.0 fewer HPRD of housekeeping, laundry, dietary, dietician, activities and staff education time. The certified nursing assistants spent almost 0.5 more HPRD in direct care in The Green House homes and 0.3 more HPRD engaging outside of ADL care.[6]

Findings related to the Swedish model of group living are informative to this model of care because these settings similarly house up to ten residents and workers have consistent assignment and universal roles. In studies that compared matched residents with dementia in small group homes to those in NHs, over 1 year residents in the smaller settings had better preserved function, less aggressiveness, anxiety and depression, and a lower use of neuroleptics, tranquilizers and antibiotics.[7,8] Staff differences were that group living staff were more in favor of independent activities for residents, were more satisfied and felt more strongly that they were providing quality care, and less often reported that they needed to spend more time with residents.[7,9] In another study, group living favored longer length of stay and less family burden.[10] Considering that these studies represent the bulk of outcomes research that has been conducted in The Green House and similar homes, it is evident that much is yet to be understood regarding the benefits and limitations of this model of care.

The rationale to increase the evidence base on The Green House homes is that by having emerged from within the practice community, they represent a feasible innovation. However, to be adopted sufficiently to actually change NH care, their structures and processes must be shown to have advantage, be able to be broken down into manageable parts so as not to be overly complex and be able to be modified to suit individual needs.[11] Failing these conditions, a promising innovation may fade into oblivion. Consequently, this article examines existing evidence related to the essential elements of The Green House and similar models of NH care gleaned from research conducted in other NHs or related settings. Since these homes did not arise in a vacuum, it is a disservice to restrict the evidence base to the few studies that are specific to the model.

02

‘It’s really revolutionary’: UNL professor, students building sustainable small house to target climate change

A University of Nebraska professor and his students are working on a sustainable small house to fight back against climate change. It’s designed to be net zero energy use and they’re already working on funding to even more research opportunities.The small sustainable house is nestled just behind the UNO baseball field.”It’s really revolutionary. I think this is the first time somebody has not maybe attempted but got this far successfully in making something that’s very sustainable,” said Braxton Smith, a UNO sophomore working on the project.Dr. Bing Chen and his students are working on a completely sustainable house. This one targets the elderly.“Make it ADA-compatible so that seniors would feel safe in such an environment,” Chen said.Several departments at the university are working on the project to make affordable sustainability a reality.”The idea then was to make it so it would use a thimble full of energy and meet the energy goals of the IEA in 2050. ‘There should be enough energy being collected with our storage batteries to be able to take it and make it basically a net zero house,” Chen said.The solar panels collect energy which powers the house. A proposed study to collect rainwater in a cistern and filter it will hopefully take care of the home’s water use.“We want to prove that that water is safe and we want to prove that this building really does what we intended to do,” Chen said.Chen’s focused on renewable energy efforts for the better part of five decades.Each year, the concerns about the environment grow. “I’m just attacking one small part of the fossil fuel usage, and that is with residential and commercial buildings,” he said.This project is his part in making a better future, both in the work itself, and instilling the importance of sustainability in the next generation.”It’s kind of mundane. When you just sit down in here with Dr. Chen talking about specs and stuff, where you going to put stuff? But you think about it as a whole and realize what you’re actually working towards. That’s when you really get the motivation to work on it,” Smith said.This specific house won’t be on the market anytime soon.The plan is to run a myriad of sustainability, conservation and performance tests on it. But when it’s done, the blueprint could be mass-produced.The group said it’s the beginning of a roadmap for a more climate-friendly future. “You’re running on what the earth gets you in, what the sun gives you,” Smith said.“This should be the shining beacon on the hill to demonstrate to people the viability of sustainability and that we can live with nature rather than against it,” Chen said.To learn more about the project, email Dr. Chen at bchen1@unl.edu.Get the latest headlines from KETV NewsWatch 7

OMAHA, Neb. —A University of Nebraska professor and his students are working on a sustainable small house to fight back against climate change.

It’s designed to be net zero energy use and they’re already working on funding to even more research opportunities.

The small sustainable house is nestled just behind the UNO baseball field.

“It’s really revolutionary. I think this is the first time somebody has not maybe attempted but got this far successfully in making something that’s very sustainable,” said Braxton Smith, a UNO sophomore working on the project.

Dr. Bing Chen and his students are working on a completely sustainable house. This one targets the elderly.

“Make it ADA-compatible so that seniors would feel safe in such an environment,” Chen said.

Several departments at the university are working on the project to make affordable sustainability a reality.

“The idea then was to make it so it would use a thimble full of energy and meet the energy goals of the IEA in 2050. ‘There should be enough energy being collected with our storage batteries to be able to take it and make it basically a net zero house,” Chen said.

The solar panels collect energy which powers the house.

A proposed study to collect rainwater in a cistern and filter it will hopefully take care of the home’s water use.

“We want to prove that that water is safe and we want to prove that this building really does what we intended to do,” Chen said.

Chen’s focused on renewable energy efforts for the better part of five decades.

Each year, the concerns about the environment grow.

“I’m just attacking one small part of the fossil fuel usage, and that is with residential and commercial buildings,” he said.

This project is his part in making a better future, both in the work itself, and instilling the importance of sustainability in the next generation.

“It’s kind of mundane. When you just sit down in here with Dr. Chen talking about specs and stuff, where you going to put stuff? But you think about it as a whole and realize what you’re actually working towards. That’s when you really get the motivation to work on it,” Smith said.

This specific house won’t be on the market anytime soon.

The plan is to run a myriad of sustainability, conservation and performance tests on it. But when it’s done, the blueprint could be mass-produced.

The group said it’s the beginning of a roadmap for a more climate-friendly future.

“You’re running on what the earth gets you in, what the sun gives you,” Smith said.

“This should be the shining beacon on the hill to demonstrate to people the viability of sustainability and that we can live with nature rather than against it,” Chen said.

To learn more about the project, email Dr. Chen at bchen1@unl.edu.

Get the latest headlines from KETV NewsWatch 7

03

Green Builder Media Announces Grand Opening of VISION House Sussex: Homes That Are Sustainable and Attainable

Lake City, Colo., Sept. 05, 2023 (GLOBE NEWSWIRE) — Green Builder Media and Tim O’Brien Homes are pleased to announce the grand opening of VISION House Sussex on Saturday, September 9.

Click here for more information and to register to attend.

The green demonstration project is located in Vista Run, a mixed-use, master-planned development offering 300 new homesites and 60 acres reserved for community amenities. The VISION House Sussex highlights next-generation, mainstream green homes that are attainable for working-class American families. (Check out photos, floor plans, and more information on the VISION House Sussex here.)

The tour will feature the brand-new Birchwood Model, which is outfitted with green and sustainable products from the top manufacturers in the country and built by Tim O’Brien Homes, a building company that has built more than 2,000 high-performance homes in the Milwaukee area.

“The goal of our latest green demonstration project is to show building professionals and prospective home buyers that homes can be high performance, sustainable, healthy, and smart–and all at an attainable price point,” says Green Builder Media CEO Sara Gutterman. “We want to start moving the needle on green toward mainstream ‘missing middle’ housing, which is so desperately needed in this country.”

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