3 Ways the Green House Model Positions Senior Living for Success

Advocates of the Green House model have long touted the benefits of reinventing the dated, institutionalized skilled nursing facility (SNF) of the 20th century, and they continue to make their case for how this concept better positions senior living providers for success in an increasingly competitive industry.

There are currently about 15,000 institutional nursing homes, the majority of which were built between 1966-1975, said David Farrell, senior director of The Green House Project, during a recent webinar hosted by Capital Impact Partners. Green Houses count 51 total properties nationwide, according to the Green House Project website.

However, those older institutions built and designed nearly 50 years ago are becoming more obsolete with each passing year, especially as they try to survive amid healthcare reforms and impending reimbursement cuts.

“Nursing homes serve, and will continue to serve, a very important link in the care continuum,” Farrell said. “If anything, state-of-the-art nursing homes will flourish under the Affordable Care Act.”

How these facilities flourish will largely depend on their abilities to embrace the most essential reforms by enhancing quality outcomes and strengthening their organization’s position as a potential partner in the healthcare ecosystem.


Emphasis on quality of care is the biggest selling point for Green Houses. Their smaller, more intimate design subscribes to a homelike atmosphere, which advocates say lends a more person-centered approach to the care delivered in these settings.

Typical Green Houses provide housing for 10 to 12 residents in a single home, cared for by a staff dubbed the Shahbazim (shah-ba-zeem), which are certified nursing assistants who undergo 128 hours of specialized training focusing on safe food handling, culinary skills, CPR and first-aid, as well as home maintenance and management skills. Two caregivers typically cover a morning shift, while two cover an afternoon/evening shift and only one for the night shift.

“The layout enables [providers] to keep the number of staff small that work within an individual home,” Farrel said. “In addition, the smallness allows caregivers to stay focused on the elders themselves, which is vastly different than my personal experience in running large, old institutional nursing homes.”

Providers who have already enacted the Green House concept have produced notable results in reducing short-term rehabilitation length of stays.

Since its adoption of the Green House model, the Leonard Florence Center for Living, a skilled nursing facility in Chelsea, Mass., has excelled in short-term rehab outcomes, producing a length of stay of about 19.2 days compared to the national average of 28 days. Furthermore, the Center’s rehospitalization rate is 9.6% versus 18.5% nationwide.

Post-acute reposition

As the healthcare delivery system evolves, providers will be forced to analyze their positions in the continuum of care.

“The reimbursement system is changing dramatically, moving from fee-for-service reimbursement to a Managed Care system, a system where nursing homes will be rewarded for their value within the care continuum,” Farrell said.

SNF providers who reposition their facilities to embrace the Green House model can gain market share, Farrell said, presenting a possible case study involving the transformation of a 120-bed facility.

Such a conversion would slim the total number of units at the facility to 72 private rooms and 24 semi-private rooms, creating three Green Houses that house 12 residents in each. The “less congested” space would also provide for more repurpose space, and ultimately, enable the community a stronger position as a potential partner for other healthcare organizations in the area.

“These strategic moves will help providers get and maintain a network status in a managed care environment,” Farrell said.

Faster fill-up

It might seem like a no-brainer that a 10- to 12-bed building can reach full occupancy quicker than a 100-bed facility, however, the pace of fill-up has more to do with the services provided than the size of the property.

On average, Green House homes maintain an occupancy of 97%, according to The Green House Project. The average occupancy for skilled nursing facilities nationally was 88.3% in the third quarter of 2014, according to data from the National Investment Center for Seniors Housing & Care (NIC).

Green Houses can expand the service offerings for senior living organizations that don’t already provide forms skilled care such as short-term rehabilitation, and can also give a company a competitive edge as a post-acute player.

“Having short-stay rehab is going to increase fill-up to an exponential level,” Farrell said. “If you’re in a competitive market with a standard 100-bed SNF, then investing in a brand new innovation like this is probably a good move to position the organization for the years to come.”

Written by Jason Oliva