The Minnesota Legislative Task Force on Aging met this month to discuss opportunities to improve outcomes for the state’s aging population. Last year, the state reached a major milestone of one million older adults—those 65 and above—and the state demographer expects to see tremendous growth in the near future. The increase in the older adult population will require an increase in healthcare services, including long-term care.
Dr. Sheryl Zimmerman, from the University of North Carolina School of Social Work, said the Green House Project was a key culture change for nursing homes due to its focus on creating a home environment, tight-knit relationships, and collaboration with residents in decision-making processes.
“The Green House model grew out of the culture change of nursing homes, which began over 25 years ago. And it was focused on improving resident quality of life and quality of care by omitting the feeling of institutionalization of nursing homes, and focusing more on person-centered care.”
— Zimmerman
A key aspect of Green House homes is making them feel homey. They generally have no more than 12 beds, and are built in a way so they fit into the surrounding community instead of sticking out. Kitchens also offer open access to residents, who are allowed to prepare food with the supervision of staff and built-in safety features. Creating a dining room that enhances home-like features is another positive aspect that allows residents to eat more, Zimmerman said.
Creating a meaningful life for residents is another key value of Green House homes. It is done, in part, by creating decisions with older adults to put them at the forefront of their own care.
“There’s a deep, close relationship between the people who work there and the people who live there, and the focus is on living a life worth living,” Zimmerman said.
Green House homes also redefine the roles and responsibilities of all core staff, since residents are placed at the hierarchy of decision-making processes. Core staff primarily act as guides for residents. Zimmerman said the quality of life in Green House homes is considered to be better than traditional institutionalized nursing home settings, and residents are more socially engaged. She noted statistics from a study that focused on quality and spending.
“Surprisingly, there was actually fewer hospital readmissions, so when people came back from a hospital, they were less likely to be readmitted,” Zimmerman said.
Additionally, Medicare spending decreased by 30 percent per resident per year, or $7,746 annually per resident. With hospitalization being the biggest spending factor, Green House homes are saving more money due to fewer readmissions.
Melissa Schneider, chief operating officer of Episcopal Homes of Minnesota, said the nonprofit has six Green House homes close to the state capitol, and discussed tenants’ experiences in the homes.
“Quality of life and dignity, I think, is really important when we look at our seniors in our nursing homes. Our dignity scores—I’m very proud of. We score at 98 percent positivity for dignity in our homes.”
— Schneider
Schneider has also seen significantly positive outcomes for the homes when compared to traditional nursing homes, including occupation of over 90 percent of beds, and a rehospitalization rate that is 60 percent lower than the national average. The retention rate for direct care staff is approximately 73 percent.
“We have seen significant positive outcomes with this model of care, and I really think it is the empowered staff and the meaningful life focus that we have at the Green House home that contributes to keeping our staff, having our staff engaged, and really having them feel like they are the key in that relationship,” Schneider said.
Even with some of the highest staffing rates in Minnesota’s long-term care facilities, Green House will not meet the incoming federal staffing mandate due to the high caregiver turnover ratio, Schneider said. She emphasized the importance of not penalizing residents for autonomy and dignity when it comes with risks.
“As we give our residents more dignity, as we give them more autonomy, as we give them more independence, there are risks that come with that. And those are things that we talk about with our residents when they move in so they understand,” Schneider said.
The task force will meet again in March.