Still, it’s not clear that the Green House model can be widely duplicated. Though the day-to-day costs are no greater than those of larger nursing homes, the homes are typically built in clusters of two or more and require comparatively large initial capital investments. “It would increase long-term costs if it were implemented to replace every nursing home in the country,” said Dr. Catherine Hawes, director of the program on aging and long-term care policy at Texas A&M Health Science Center.
Perhaps more important, whether the Green House model improves care for the elderly, compared with institutional settings, is not known. Several small studies, none particularly rigorous, have found that Green Houses deliver similar care for no more money than traditional nursing homes. The homes do this largely through reducing supervisory positions and training certified nurse assistants to take on more responsibility.
Green Houses also have a lower vacancy rates than conventional nursing homes, and they accept patients on Medicare and Medicaid, making them an option for low-income elderly. On average, about 54 percent of Green House residents are on Medicaid, while the rest pay for the care privately.
Residents of Green Houses experience fewer bed sores than those in conventional nursing homes, according to one survey, and each day they get 24 minutes more of direct and personalized care and 1.5 hours more of nursing staff time than those living in traditional nursing homes. Residents say they feel like they have deeper relationships with the staff, and family members report higher satisfaction with the physical environment, privacy, their own autonomy, health care and meals. Employees, too, report less stress. The turnover rate is significantly lower than in a traditional nursing home. Green House certified nursing assistants are paid on average about 5 percent more than those in institutional settings.
Even if this model of elder care turns out to be impractical on a large scale, Ms. Wells said, “we can learn a lot from what the Green House is doing and can translate these methods into things that existing nursing homes can use.”
Many residents and their families find the Green House to be a substantial improvement over standard nursing home care. Diane LoCicero moved her 88-year-old mother, Evelyn, from the traditional nursing home into one of Green Hill’s Green Houses this year. Her mother is far more relaxed now, said Ms. LoCicero, and she actually enjoys visiting the place.
“Before, it was like a hospital and I hated to visit,” Ms. LoCicero said. “Now, I’ll stay here for hours.”
On a recent day in September at Green Hill, Jane Larkin, 82, a retired home economics teacher who suffered a stroke in 2007, sat in her wheelchair at the long dining table and marveled at the differences between this residence and the traditional nursing home in which she’d once lived.
“There’s more opportunity to be social here. We can get outdoors easily, and people like to visit more,” she said. “Sometimes, I give the girls advice when they’re cooking, like I’m their teacher. There was no opportunity to do that in the other place, because we were isolated in our rooms.”