News Analysis -- More operators are likely to go 'Green'

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Is this concept the future for nursing homes? Care advocates think so, and want change now.

Many nursing home operators pondering their future now find themselves at a crossroads.
With buildings near or at the end of their useful life spans, these operators realize change is needed. But how? Remodel, renovate, or rebuild? And what about organizational priorities? Offer new ancillary services? Change focus or build on established strengths?
Within this uncertain framework, a new approach -- the Green House concept -- may offer many operators a real alternative to traditional practices. When and where appropriate, Green Houses just might be a better way to deliver quality services without sacrificing the bottom line.
So what are Green Houses? The Green House concept borrows heavily from The Eden Alternative, which Dr. William Thomas established in 1991. Green Houses focus primarily on improving the quality of life for the nation's frail elders. They do this via group homes that use a social and habilitative model of care that relies heavily on empowered staff to make good caregiving decisions. A Green House meets typical regulatory requirements for skilled nursing, assisted living and adult homes. The goal is to provide the resident with an environment that promotes autonomy, dignity, privacy and choice, according to advocates.
The first four Green Houses in the nation have been housing elders since May in Tupelo, MS. Preliminary but strong evidence suggests that they work for residents and providers.
Stephen L. McAlilly, president and CEO of Mississippi Methodist Senior Services, Inc., recently discussed life care quality at the Green Houses of Tupelo and two traditional nursing homes he operates. He said his Green House residents are walking and gaining weight, using fewer psychotropic drugs, and enjoying more visits from family members.
"People who walk in the door recognize instantly that this is the answer to a system that is broken and crying out for replacement," he said.
Project Director Jude Rabig agrees: "They are places that focus on life, and at their heart is the relationships that flourish there."

Raising Kane
Dr. Rosalie Kane and other investigators from the University of Minnesota are currently trying to quantify how well the Green Houses actually perform. She said the early findings are encouraging.
"The excitement to us is in being able to learn about the art of the possible for transforming and 'deinstitutionalizing' nursing homes," she said.
Kane's examination has multiple components, including issues and lessons from the perspective of stakeholders in the Green House and the surrounding environment; a post-occupancy evaluation of the unique environmental features of the Green House; a financial study; and generalizations for other sponsors adopting and adapting the Green House idea. Minimum Data Set information will be used to calculate quality indicators in all three settings, while administrative data will be used to assess staff issues such as turnover, absenteeism, and work-related injuries.

Out with the old
Thomas has been a frequent critic of traditional nursing homes. He sees them as being ill equipped for the challenges of tomorrow.
"Because nursing homes are operated as therapeutic institutions, machine-like efficiency is their ideal. The best facilities are thought to be those that deviate to the minimum extent possible from predetermined schedules and routines," he said.
He sees a showdown looming in the not-too-distant future.
"America has a choice: nursing homes or Green Houses," he said. "With the nation's nursing homes deteriorating from age and the baby boom generation moving into the later chapter of their lives, should we build many new traditional institutions or replace them with an alternative that deinstitutionalizes the frail elderly and truly celebrates elderhood?"
Thomas lauds Green Houses, largely because they respect what he calls the "rhythm of life" and the well-being of the people who live there. This rhythm is created by, and evolves through, household decisions made jointly by the seniors and th