Although much time and money has been included in the construction, maintenance, and operation of nursing homes, nursing homes have not provided older people adequate care or living standards.

Consider taking an inventory of the furnishings and accessories in the former homes of Green House residents to create a similar atmosphere in their current assisted living facility.

The Green House concept was developed by William Thomas, MD, to provide a homelike alternative to institutional nursing homes with the intention of improving the quality of life for residents. Green Houses are ideally designed for seven to ten people and incorporate rooms typical to homes (e.g., living room, hearth, dining room). Institutional features (e.g., long, double loaded corridors) are avoided. Each elder is given their own room with a bathroom attached. Technology is incorporated with the residential furnishings and accessories of the home (some of which come from the former homes of the residents) to support medical care and communication. The den in the house serves as an alternative to the nursing stations in nursing homes.

One of the main goals of the Green House concept is to minimize the hierarchy of bureaucracy and give more control to the direct-care workers, such as certified nursing assistants (CNAs) through a safe working environment, higher levels of training, and better salary and benefits. Different terminology is used in the Green Houses in order to distinguish the staff from that of more typical nursing homes (e.g., administrators are called guides, residents are called elders).

Four Green Houses were built by the Mississippi Methodist Senior Services to house dementia-care and other nursing facility patients. Green Houses were mainly considered a success with a high level of satisfaction from residents, families, and employees, in part due to a successful collaboration with the state. Challenges implementing the concept included a tendency to use institutional materials rather than residential ones, concerns about resident’s safety (particularly in the kitchen), and concerns about changes to the power structure in the new organizational model.

The Mississippi Methodist Senior Services planned to build an additional six Green Houses so that 114 of their residents would be housed in a Green House. A few adjustments were made for the future green houses. For example, the homes would be built to house twelve residents instead of seven to ten to increase efficiency. The concept is spreading throughout the US with 20 organizations in 15 different states developing Green Houses for all or part of their operations.