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'Green Houses' for golden years

Innovative units come to Mass.

Alice Dembner - The Boston Globe
09/30/2006

A nursing home with the potential to transform elder care is coming to Massachusetts.

Its hallmarks: A self-contained house for 10 private rooms, home-cooked meals, and daily routines set by the residents. Scheduled to open in Chelsea in 2008, the new facility represents the cutting edge of a national movement to replace institutional care with a more home-like atmosphere.

The Leonard Florence Center for Living will contain 10 "Green Houses" -- each with 10 bedrooms clustered around an open kitchen and living area -- that will be stacked in a five-story condominium-style structure. The Chelsea units will be the first urban Green Houses, designed to provide an example for the nursing home industry nationwide.

Conceived by a Harvard-trained geriatrician, Dr. William Thomas, the first Green Houses opened in Tupelo, Miss., in 2003 to provide seniors of all incomes with more dignity, autonomy, and choice in long-term care. The name stems from the focus on encouraging personal growth among residents.

Since then, two sets of suburban-style Green Houses with yards have opened in Michigan and Nebraska, and 25 more are in the planning stages nationwide.

"It's a wonderful place. It's just like living at home and having your mother take care of you," said 95-year-old Lottie West, who has been living in a Tupelo Green House for more than two years.

The concept is catching on as nursing home operators try to position themselves to better serve a burgeoning elderly population looking for an alternative to the typical long corridors and impersonal care of traditional nursing homes. That model forces residents to conform to an institutional schedule and can inadvertently encourage dependence.

A few nursing homes are experimenting with a "pod" model, where small neighborhoods of resident rooms are grouped around an atrium. Thousands of others nationwide without the funds to build facilities are embracing a movement called "culture change" -- redecorating to make buildings more welcoming, designating consistent staff to aid each resident, and focusing care on each resident's preferences.

At a conference on culture change Thursday in Worcester, nursing home officials, consumers, and government regulators shared ideas on how to transform nursing homes. About 1 in 6 nursing homes in Massachusetts is making changes along these lines, according to the Massachusetts Extended Care Federation, a trade group for the state's 450 nursing homes.

To drive change nationwide, the Robert Wood Johnson Foundation, a healthcare philanthropy, awarded $10 million last year to a nonprofit development corporation, NCB Capital Impact, to help bring the Green House model to every state.

"We hope that we are pushing the envelope to really rethink nursing homes," said Jane Isaacs Lowe, a senior program officer at the foundation.

The Chelsea Jewish Nursing Home, a nonprofit organization that has been providing care since 1919, won the development corporation's help a few months ago, beating out dozens of other proposals. The aid comes in the form of technical and planning expertise. The corporation also helped Chelsea Jewish secure $5 million in tax credits to help offset the estimated $20 million cost of the project, which they are raising from private donors.

Chelsea Jewish will continue to operate a 123-bed more traditional-style nursing home that gets good marks from state regulators. The home is working on culture change, but the vision of something better led executive director Barry Berman to plan the Green Houses on a small plot of land on Admiral's Hill.

The houses will be named for Leonard Florence, a Chelsea-born philanthropist whose daughter, Faye, is leading the fund-raising campaign. They will be open to people of all faiths, with separate units planned for younger, disabled patients and for gays and lesbians.

The goal is to provide the nursing and personal care that residents need while focusing on quality of life and companionship. "We want to celebrate elderhood, instead of having people dying of a broken spirit," Berman said.

Each of the 10 Green Houses will be managed by the residents and two primary caretakers on each day shift, one of whom is "devoted to loving cooking," Berman said. The caretakers will also do light housework and help residents with bathing, grooming, and dressing.

The residents in each Green House will determine their own daily routine, menu, and activities. Meals generally will be served family-style, around one long table, with staff and visitors joining in. Residents can volunteer to help keep the household running by doing chores like cooking, folding laundry, and accompanying the cook to the grocery store.

"That's a more important activity for some residents than anything we could provide," Berman said.

One nurse will serve two 10-resident Green Houses, but medical trappings will be kept to a minimum.

The Green Houses typically cost no more to run than traditional homes, even though there are more caretakers per resident, because they have less waste and do not need such infrastructure as dietary departments. As at conventional homes, most of the bills will be paid by the Medicaid program for low-income seniors and the disabled.

State regulators support the Chelsea project, and have waived some regulations to allow innovation, Berman said.

A two-year study that compared the Tupelo Green Houses with two traditional nursing homes found that quality of life was better in the Green Houses, with residents saying they had more dignity, privacy, meaningful activity, relationships, and autonomy, according to Rosalie A. Kane, a professor at the University of Minnesota School of Public Health.

Kane said the Green Houses provided small benefits in the quality of care -- residents showed less depression, less incontinence, and less of a decline in the ability to feed themselves.

"It's impressive and worthy of replication," said Kane. "It defies people's idea of what a nursing home is."

Staff turnover, which averages 71 percent annually in nursing homes, fell to just 10 percent, according to the Green House national staff.

For Lottie West, who moved in after repeated falls left her unable to live on her own, that translated into more consistent care and attention.

"They treat you so nice," she said. "They'll cook anything you ask them to. If I'd had my hush puppy recipe, they would have made it."

Many residents choose to sleep late, but West said she is up and about early in her wheelchair.

Despite the different personalities of the 10 residents, West said there have been no conflicts.

Alice Dembner can be reached at Dembner@globe.com.

© Copyright 2006 Globe Newspaper Company.



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