Supply of Medical Services

Green House Project

Although there have been quality improvements in nursing home care over time, most elderly (including my own grandmother) dread the thought of entering a nursing home. According to a Mattimore et al. (J Am Geriatrics Soc 1997) study only 7% of patients surveyed were “very willing” to live permanently in a nursing home, while 26% were “very unwilling” and 30% would “rather die.”

A New York Times (“Rethinking Old Age“) gives an illustrative anecdote

“Nursing home priorities are matters like avoiding bedsores and maintaining weight — important goals, but they are means, not ends. [One patient] left an airy apartment she furnished herself for a small beige hospital-like room with a stranger for a roommate. Her belongings were stripped down to what she could fit into the one cupboard and shelf they gave her. Basic matters, like when she goes to bed, wakes up, dresses, and eats were put under the rigid schedule of institutional life. Her main activities have become bingo, movies, and other forms of group entertainment. Is it any wonder most people dread nursing homes?”

The Green House Project is trying to change these attitudes through an innovative way of structuring elderly care. The program was developed by Dr. William Thomas and based on the Eden Alternative model. The Green House methodology does not only focus on medical quality measures, but quality of life measures as well such as reducing boredom and loneliness. The NYT article continues to explain that the Green House Project utilizes

“…houses for no more than 10 residents, equipped with a kitchen and living room at its center, not a nurse’s station, and personal furnishings. The bedrooms are private. Residents help one another with cooking and other work as they are able. Staff members provide not just nursing care but also mentoring for engaging in daily life, even for Alzheimer’s patients. And the homes meet all federal safety guidelines and work within state-reimbursement levels”

Kane, Lum, Cutler, Degenholtz and Yu (J Am Geriatrics Soc June 2007) find that controlling for baseline characteristics, Green House residents reported significantly higher quality of life ratings than those in a traditional nursing home owned by the same parent company.

I have two concerns regarding the Green House. The first is cost. While the Green House certainly seems like an improvement over traditional nursing homes, one may ask if they are generally affordable or if the cost if prohibitive. Secondly, the Green House model may work best with the relatively healthy elderly. Will this model be able to function for more severely ill patients?