California Lawmakers Make Way for Small House Senior Care Pilot

California senior care providers are awaiting the state’s first pilot program allowing Green House Project and other small house style skilled nursing facilities after legislation was passed in late 2012 allowing the nursing home model to exist.

Senate Bill 1228 amends the state’s Health and Safety Code to allow for the development, licensure, and operation of Small House Skilled Nursing Facilities. The bill went through around three years of approvals before being signed into law by California’s Gov. Jerry Brown, effective Jan. 1, 2014.

“It was a challenge even though agencies and providers were working together closely and cooperatively, because regulations weren’t set up to allow for the Green House Project,” explains Robert Jenkens, the immediate past director of the Green House Project, which worked with state legislators—including the bill sponsor Senator Elaine Alquist—to advance the skilled nursing model.


Currently, providers wishing to build such a model need to apply for “alternative means for compliance” waivers, a process that’s both long and costly, says Jenkens.

Senator Alquist worked with the Green House Project to devise a better process and settled on a demonstration that would involve 10 small house-style skilled nursing campuses. The legislation had strong bipartisan support and passed both the state Senate and House before being signed by Gov. Brown, according to Jenkens.

Since it passed, the California Department of Public Health has been designing and putting together the program guidelines for the pilot, which were supposed to be released in July 2013. The CDPH told SHN that it has been working with stakeholders to develop the Small House Skilled Nursing Facilities standards, and that they are in “the final review stage.”


“CDPH plans to release the standards with an All Facility Letter soon,” the department said, adding that the standards will be available on its website upon being released.

“The exciting part of the legislation is that once they get the program out, it’s an expedited process to gain approval [for alternative skilled nursing models],” says Jenkens. “It’s spelled out in the pilot program; you don’t have to go through the lengthy alternative means for compliance waiver process and have a greater certainty of being approved, since what you’re proposing to do is within the guidelines of legislation.”

Once the program designed is completed and announced, the state will issue a request for proposal (RFP) for providers to apply to be one of the 10 sites. If not all 10 slots are filled the first time around, they’ll run a second round of RFPs.

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Already, there are already four projects lined up that have begun to do due diligence on participating in the pilot, and another three or so that are interested, according to current Green House Project director David Farrell.

“We’re all still kind of waiting on pins and needles for the state to release the applications and the final Small House regulations,” he says. “Everybody’s anticipating that release. Hopefully in the new year, we’ll see it.”

Launching a pilot program “provides a great opportunity for a big state like California to stick their toe in the water,” says Farrell, calling the pilot a “radical departure” from state regulations, which govern a more institutional nursing home style.

“[The Green House Project pilot] gives exposure to the state’s 1,100-plus operators as a different way to deliver skilled nursing services, which has the potential for much higher quality outcomes and much higher satisfaction for all involved,” he says, citing studies the Robert Wood Johnson Foundation has done on the model.

At the end of the pilot, the Green House Project will conduct surveys on the participating campuses to monitor the satisfaction levels and hospitalization or rehospitalization rates, says Farrell, which will then be handed over to the state.

Written by Alyssa Gerace

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