Traditional System is Challenged by an Alternative Long-Term Care Model

By Cecilia Grefalda

The Wall Street Journal recently published a critical profile of the Green House alternative to traditional nursing home care. The article assessed the opportunities and challenges facing the growth of this elder care housing model.

The Green House concept is an attempt to transform the traditional institution-based care environment into small homes that can serve long-term care needs of older adults. Green Houses are meant to provide an environment where residents receive nursing support and clinical care without it becoming the sole focus of their life. The goal is to provide a better quality of life to residents in the hopes that it has positive physical and mental health rewards.

A Green House is designed to look like a private home or apartment. Each resident has their own room and shares common living space at the heart of the house, including a living room, kitchen, and dining room. Medical care is delivered in this environment in a manner that is more discrete and in tune with the natural flow of the residents’ lives—unlike a traditional nursing home environment where residents often lack a sense of autonomy.

The Robert Wood Johnson Foundation (RWJF) has invested $15 million over 5 years to encourage the construction of Green Houses. There are currently 41 Green Houses in 10 states (including those operating and in development). The Foundation has set the goal of building Green Houses in all 50 states.

The Journal reported that supporters of the Green House model find it to be “nothing less than a revolution that could overthrow the rigid, impersonal, and—at times—degrading life the elderly can experience at large institutions.”

However, despite funding from RWJF to build more Green Houses, major obstacles remain including “a thicket of elder-care regulations,” the need for enormous capital to build new homes, stiff resistance from many parts of the existing nursing home system, and lower overhead at larger communities.

RWJF officials remark that they do not know if Green Houses are a viable economic model, but “they’ve decided not to wait for an answer” and could provide more funding in the future, the Journal reports. Thomas Hamilton, who oversees nursing home quality and regulatory issues for the Centers for Medicare and Medicaid Services (CMS) said, “The Robert Wood Johnson Foundation is making an important investment in trying to ensure there is a sufficient cadre of early adopters of the Green House model—and research to make sure the model is actually working,” adding that CMS is trying to encourage nursing homes to create more “patient-centered” models.

Furthermore, Robert Wood Johnson executives say financial sustainability is a question they are scrutinizing intently. Based on this "first round" of Green Houses, they believe that it is financially doable, but they are rigorously testing the model and developing software that should help providers determine whether they have the financial means to develop Green Houses within their communities..

To read the article online, visit: http://online.wsj.com.
Source: Lucette Lagnado. (June 24th 2008). Rising challenger takes on the elder care system. The Wall Street Journal.

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