New Evidence on the Green House Model of Nursing Home Care: Synthesis of Findings and Implications for Policy, Practice, and Research

Abstract

As of May 2015, 174 GH homes were in operation, 80 percent of which provided long-term nursing care. These homes have elicited great interest among policy, provider, and research stakeholders, in large part because they offer a true alternative to traditional models of nursing home care and are consistent with the "culture change" movement by focusing on person-centered care and deinstitutionalizing the nursing home (Koren 2010;Zimmerman, Shier, and Saliba 2014). At the same time, the cost of new construction for GH homes has become a point of concern ( Jenkens et al. 2011) as have questions about whether outcomes are at least comparable to traditional nursing homes in which nurses and allied health staff are more readily available (i.e., in the GH model, the clinical care staff is available but not based in the GH home itself; Zimmerman and Cohen 2010).Between 2011 and 2014, the Robert Wood Johnson Foundation funded an independent evaluation of GH nursing homes by four project teams; their collaborative interrelated research projects examined GH care processes and outcomes. Termed the THRIVE Research Collaborative (THRIVE: The Research Initiative Valuing Eldercare; Fishman, Lowe, and Frazier 2016), these projects collectively constitute the largest and most coordinated evaluation of the GH model to date, and they are described in this special issue of

Caring for Dying Patients in the Nursing Home: Voices From Frontline Nursing Home Staff

“…In this regard, some promising efforts to improve supportive EOL care in long-term care are already underway (e.g., establishing guidelines for best practice for EOL care in NHs that include strategies for involving families in resident care and decision making) in many states including Colorado, California, and Missouri. 29–31 Additionally, models of care like the Green House approach 32 and the culture change movement in NHs 33 with their emphasis on person-centered care, promoting family involvement, and enhancing quality of life have demonstrated successful ways of delivering supportive care, including needed social support, to residents nearing death.…”

Promoting an Alternative to Traditional Nursing Home Care: Evaluating the Green House Small Home Model. An Introduction from the Funders and the Green House Project

“…In addition, model fidelity must be considered when disseminating a model; the GH model must consider how much variability is acceptable and which elements are central, as noted in this issue, when asking how “green” must a GH home be to honor the integrity of the model's core values (Zimmerman et al. ).…”

“…Finally, Zimmerman presents a synthesis and critical examination of the evidence related to the GH model of nursing home care (Zimmerman et al. ).…”

Studying Nursing Home Innovation: The Green House Model of Nursing Home Care

“…)—the evaluation of the latter is the focus of this HSR Special Issue . As Zimmerman et al discusses (), the overriding intent of the GH evaluation—The Research Initiative Valuing Eldercare (THRIVE) study—was to better understand GH implementation and impacts using larger samples and more rigorous methods than has been possible in the past . Additionally, and as the funder suggests (Fishman, Lowe, and Frazier ), the THRIVE evaluation and its findings also have relevance for organizations undergoing more incremental culture change processes.…”

“…; Zimmerman, Shier, and Saliba ). In addition, as Zimmerman et al discusses in this issue (), evaluation of the GH model is further challenged by its early stage of development and by the difficultly in identifying comparison facilities ostensibly not engaged in culture change, as the context of the environment is such that all NH's are aware of these culture issues. The THRIVE study undertook to evaluate perhaps the most prescriptive model of culture change as the GH model requires stand‐alone or vertically integrated small residences (for 8–12 elders), self‐managed work teams, and empowered, consistently assigned Shahbazim (direct caregivers) who function as universal workers.…”