Last month, I visited the first nursing home that I actually wouldn’t mind living in myself some day. The Leonard Florence Center for Living in Chelsea, Massachusetts (just over the Tobin Bridge from Boston) is built on the “Green House” model pioneered by Dr. William Thomas, a geriatric specialist from Sherburne, New York.
All rooms are private! And they are designed in units of 10, all organized around a common area that includes a kitchen, dining area and living room. The aides are trained to cook and food is commonly available so that residents can eat what they want, when they want.
Each 10-room unit is designed for patients with similar disabilities. Thus a younger resident with ALS or multiple sclerosis lives with similar individuals, rather than being placed with older residents suffering from dementia.
This is a far cry from the typical institutional nature of nursing facilities where everyone must fit into the facility’s schedule, rather than the other way around. To be certified as a “Green House” nursing home, the facility must meet certain criteria. Each unit must be created for six to 10 residents and contain a hearth and outdoor space as well as a kitchen and common area.
There are currently 29 communities of Green Houses in 19 U.S. states, including Alaska, Montana, Michigan, Ohio, New York, and Florida. Thomas estimates that Green Houses will be built in every state in the next five years and 160,000 will go up in the next 20 years.
A typical Green House runs about 5,500 square feet and is located near a church or residential community. The Leonard Florence Center I visited is the first urban Green House nursing home. Green Houses have gardens or pets if the residents want them and also provide services that the residents specifically request, such as rehabilitative care and programs for people with Alzheimer's and developmental disabilities.
Thomas says that a Green House allows residents to make personal choices. The Green House model aims to upend the traditional idea of a nursing home as a “place to die” and make it instead a place to live.
"We are attempting to de-industrialize long-term care," he declares.
"Every person who lives there has a private room and bathroom," he says. "All of the food is cooked in the house. Strangers are not allowed to come into the house without knocking at the door and being invited in."
These simple features give the seniors privacy and space that nursing homes lack, Thomas notes.
"In a typical nursing home, the architecture reinforces the idea that staff efficiency is paramount," says Thomas. "In the Green House, the architecture is designed to maximize wellbeing for the people who live and work there. You can give elder care in a non-institutional, community-based setting even while [adhering] to nursing home regulations."
The concept of Green Houses has been developed partly through the Eden Alternative, a non-profit organization that Thomas founded to focus on improving long-term care for seniors. The Green House Project is funded by the Robert Wood Johnson Foundation and is organized through NCB Capital Impact, a non-profit arm of the National Consumer Cooperative Bank, which provides consulting help and pre-development loans to organizations that want to establish Green Houses. So far the list of organizations that have set up Green Houses includes churches and ministries, nursing homes, counties, medical care facilities, and not-for-profits that serve people with developmental disabilities.
This level of privacy and individual attention doesn’t come cheap. The Leonard Florence Center charges $425 a day to private-pay residents, but it also accepts Medicare and Medicaid.
I have seen the future and it’s not half bad. They even have a day spa!
To learn more about Green House nursing homes, go to www.thegreenhouseproject.org.
Harry Margolis founded Margolis & Bloom LLP, a six-lawyer Boston law firm in 1987. He has been a designated “Super Lawyer” since 2005 and is Founder and President of ElderLawAnswers that supports seniors, their families and their attorneys by providing various online tools and resources.