Green House Model Gains Traction as Providers See Payoff

With increasing regulatory pressures and focus on quality care metrics, more than 100 skilled nursing facilities (SNFs) have turned to a new model of care to help them adapt their operations.

Now with several years of history under way, providers are starting to say with confidence that the “Green House” model also nets savings in addition to a new way of providing care.

The Green House Project is a concept that hinges on revamping traditional nursing care by clustering nursing home residents into smaller domiciles of 10 to 12 individuals within cottage-like residences, each with assigned staff that specifically cares for the residents within that particular Green House.


The idea counters the longtime model of the “mansion” style of senior caregiving where most residents live in a single construction.

Now with 11 years of experience in repositioning senior care, the concept has been catching on nationwide as providers from California to Massachusetts have been taking cues from the Green House Project for their own communities.

The Green House Project takes a 100-bed nursing home and breaks it down into 10, 10-bed Green House homes, for example. The original facility still retains its license as a 100-bed SNF, however, each one of the 10 homes operates independently from one another.


Depending on the scope and size of the project, a typical Green House home encompasses approximately 6,800 square feet with each resident room surrounding the hearth of the home, thus enabling residents to ambulate and more easily access the living room, dining room and fully-functional kitchen area.

“The Green House is a good example of a model where providers can keep the scale of environment small enough to help elders walk as long, and as much, as possible,” said Davi Farrell, senior director of The Green House Project, during a webinar Monday. “It is meant to be a small, intentional community to promote easy access for elders to get around and to their rooms.”

As regulations mandated by the Affordable Care Act emphasize initiatives related to providing better patient experiences, better outcomes and at lower costs—especially considering the looming threat of hospital readmissions for SNFs beginning in 2019—a Green House model may be able to produce cost savings and operational efficiencies for SNFs.

Those behind the model say it can pay itself off in two years’ time, with the most significant savings realized through the facility’s post-acute functionalities.

“The best way that states and payers save money is via the post-acute safe transitions, lower lengths of stay and lower re-hospitalization rates,” Farrell said.

For a Green House model, Farrell predicts providers who adopt this concept will realize profitability in year two after implementation.

One organization used the Green House model to re-position its facility and gain market share, according to a case study outlined by Farrell during the webinar.

Originally, the property was a 120-bed SNF containing 60 semi-private rooms. After employing the model, the SNF contained three Green House homes of 12 residents each, moving 36 residents to Green Houses and converting 36 rooms to private rooms in the current SNF.

The reposition helped the organization create less congestion in the older SNF, and also provided extra space that was repurposed into a pharmacy, Farrell said.

“We don’t want to replace an institutional nursing home with another institutional nursing home,” Farrell said. “We believe the Green House model has set a new standard for what that can look and feel like.”

The homes also feature private bedrooms and bathrooms for each of its inhabitants—an element that’s “super important” to clinical outcomes of care, Farrell said, as privacy can be the best way to stop/prevent the spread of infections and facilitate a good night’s sleep.

Currently, there are 153 up and operating Green House homes nationwide and about another 160 projects in the pipeline, Farrell said.

Costs to adopt the Green House model vary from state-to-state and largely depend on the scope and size of the project.

One of the least expensive projects to date, located in Arkansas, ran about $1.4 million per Green House, according to Farrell, while in other markets like New York or New Jersey, for example, the development costs might run a bit higher.

The largest of these forthcoming developments stands to be a 22-story urban Green House model currently under construction in Manhattan, New York. The project, that will be operated by Jewish Home Lifecare, calls for 22, 10-bed homes within its urban model.

While nonprofit organizations have historically been more interested in adopting the Green House model, for-profits are now beginning to realize similar efficiencies.

“What changed for them to get interested is the short-term rehab and the outcomes being achieved at these facilities,” Farrel said. “It really opened up the door to for-profits.”

Written by Jason Oliva

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