When the first Green House campus opened in Mississippi, renowned documentarian Dale Bell was there with cameras rolling. Green House founder Bill Thomas, M.D., called the resulting 20-minute video “the chainsaw,” because it so efficiently cut down people’s objections or skepticism about the new care model. Bell’s latest documentary might eventually be called “the cattle prod.” That’s because it’s set in the ranching hotbed of Wyoming and, more to the point, I believe it could get even more communities unified and working together to create Green Houses.
“Homes on the Range” takes viewers to the ruggedly beautiful town of Sheridan. There, a group of passionate and committed citizens undertook a grassroots effort to build the state’s first Green Houses. The documentary premiered first at the WYO Theater, then on the Wyoming PBS station in late November, and will be shown on other PBS stations nationwide over the next three years. You can also get it on DVD through the Media Policy Center in Los Angeles.
The 85-minute film is remarkable in several ways. The MPC’s Senior Editor/Writer/Producer Beverly Baroff crafted the documentary using 10 years of footage captured by Bell, so there’s inherent drama simply from seeing how some of the key figures themselves age. The film subtly but powerfully conveys the inevitable passage of time and drives home the reality that the need for long-term care is not so distant as some viewers might perceive it to be.
But I especially appreciated how the documentary realistically portrays the Green House project. Thomas is a tireless and inspiring promoter for Green Houses, and he has been joined by many other passionate advocates. I think that’s all to the good, but I also think that sometimes the Green House cheerleading can sound a bit like one-sided propaganda, which seriously downplays the often substantial challenges in building these facilities and figuring out the most effective ways of providing care and measuring outcomes in this still-young model. (It’s been 10 years since the first Green Houses opened.)
“Homes on the Range” is unabashedly pro-Green House. However, Bell emailed me, “We neither expect nor believe that every community can or should build a Green House campus … it is difficult and in some cases CAN be done.”
Bell’s statement does not ring hollow, because so much of the film is about the forbidding obstacles that the group in Sheridan had to overcome. From getting legislative changes and winning over the governor, to fundraising, to coping with effects of the economic crisis, they encountered one hurdle after another. Their persistence really is amazing to behold, but the documentary dramatizes just how hard it can be to create a Green House campus.
I think the film very well could galvanize other communities to follow in the footsteps of Sheridan (which is what the filmmakers hope). But it also could persuade others that the commitment in time, energy and money — without the promise of ultimate success — simply is too overwhelming. I do hope that it inspires some dialogue about the certificate of need process, and I think seeing it might give lawmakers the confidence to relax some of the stringent regulations that can make innovative care models difficult to launch.
The documentary also is not too starry-eyed about the effects of Green House living for elders. The “chainsaw” famously includes footage of a near-catatonic nursing home resident who begins to feed herself and sing almost immediately after moving into a Green House. This type of nearly miraculous improvement certainly seems to be a testament to the benefits (to put it mildly) of long-term care that is homelike rather than institutional. But in “Homes on the Range,” there are no claims that this is to be expected.
The film shows both the vibrant resident who is building birdhouses in his room and the woman with dementia who needs help locating her room even in the relatively small cottage. We don’t see a Green House resident have an amazing rebound to health. But the most emotional moment for me came from seeing a resident sitting on the patio, knitting.
This woman talked about how in other nursing homes, such a simple pleasure was not available to her. Then, a shahbaz informed her that lunch was served, if she was hungry. The elder said she would be in shortly. This brief exchange summed up the benefits of the Green House: the caregivers’ respect for the elders, the independence of the elders, and the truly homelike environment. It’s nothing Earth-shattering, but that made it all the more powerful. It raises the questions that I think are at the heart of this film: How is it possible that such a seemingly basic model for providing care could be seen as outside the norm, and why was it so difficult for Sheridan to get this campus built?
If the viewer is left pondering these questions after the credits roll, it’s easy to see how the film could lead to a groundswell of support for Green Houses in particular and calls for long-term care changes in general. Bell says he hopes the film will “inspire communities to work together” to make sure their elders and frail residents are receiving high quality care, “even if no new Green House is built.”
Bell told me he and his colleagues are interested to see “just what effect the media can have in instilling the concept of change in communities.” I think they can be optimistic that the effect will be noteworthy, and they certainly should take pride in their work.
Tim Mullaney is McKnight’s Senior Staff Writer. Follow him @TimMullaneyLTC.