"Green House" model

Sour Lemon · Sep 9, 2018

I'm journeying back to LTC/ rehab world, but with a twist. I've accepted a position with a company that has successfully opened several Green House model "homes" in my area. I did my research (about the agency and the Green House concept) and think that this job will be a good "fit" for me and my skills set. I'm hearing positive feedback from a current nurse who works there (and I worked with at another agency), a friend who was a patient there and from several professional contacts I have in the local medical community.
Curious if anyone else is working in a facility that uses this model of care, I'd love to hear what your thoughts are... All the threads I found were quite "old" and I suspect this model of care has evolved from when it first was being implemented.

I had to look it up. Sounds a whole lot like board and care, but with a new marketing twist.

heron, ASN, RN · Sep 9, 2018

I wonder how such facilities deal with total care or behaviorally disturbed/severely demented residents.

vampiregirl, BSN, RN · Sep 10, 2018

I had to look it up. Sounds a whole lot like board and care, but with a new marketing twist.

Glad to know I'm not the only one not familiar with this concept!

The facility is a state licensed SNF with the beds certified either Medicare/Medicaid or Medicare (for the rehab homes). They also accept private insurance and have a few private pay patients (long term care).

Welcome Home - The Green House Project

vampiregirl, BSN, RN · Sep 10, 2018

I wonder how such facilities deal with total care or behaviorally disturbed/severely demented residents.

Good questions! I already asked about behaviors - they have a psych provider contacted but it doesn't sound like they have many behaviors. I didn't see any when I toured. This model has better staffing and is more individualized to the patients - I suspect that contributes to few behaviors. The houses are designed for safety for dementia patients and they are not in the same "home" as the rehab patients where I will be.

Hmmm. I will have to inquire about total care though.

Thanksforthedonuts, BSN, RN · Sep 10, 2018

From what I know, the Green House Project is not necessarily a "model" of care but a franchise that helps independent owners to open up LTC/ALF or Adult Family Home. It is a franchise that will help with the organization of a facility (from the business aspect) and help fund (to some extent) the opening of a facility. the GHP shadows them for a few years to help them get off the ground. They do mention that people interested in working with them need to have plans assisting financially needy residents in someway or another...such as, taking medicaid/medicare or providing reduced monthly rates, it cannot be a "private pay only" facility. I considered working with them to construct a AFL but decided against it.

Their website is confusing in the sense that they appear to be a LTC/ALF company that provides a different approach to care... but it isn't really..it is a franchise to help create more senior LTC facilities with a "do good" component.

Dean Uguan · Sep 10, 2018

They are trying that model at the Milwaukee VA.Green House Community Living Center opens soon; revolutionizes long-term care - Milwaukee VA Medical Center

Kallie3006, ADN · Sep 11, 2018

Is this like a "community" built for "residents" to maintain a somewhat independent life style? Like with the coffee shop, grocery store ect within this gated community? Or am I completely in left field with the concept?

vampiregirl, BSN, RN · Sep 11, 2018

Is this like a "community" built for "residents" to maintain a somewhat independent life style? Like with the coffee shop, grocery store ect within this gated community? Or am I completely in left field with the concept?

That's a different concept, I think that is more popular somewhere in Europe. But that one sounds fun too!

kfostercma · Jun 29, 2019

I have been working in a "Greenhouse Model" nursing home for 3.5 years. Here is what I have observed:

Intent: and in addition to promoting independence like any traditional long term care setting, elders are encouraged to garden, help with preschool/daycare, and even meal preparation.

Reality: out of 20 patients (a light workload compared to other LTC settings), only a handful, 2-3 at a time might be capable of these activities. In 3.5 years I have never witnessed an elder stepping foot into the kitchen, let alone assist with meals.

Intent: Shahbazim (nursing assistants with extra training, singular: Shahbaz) have a smaller workload (5:1 ratio as opposed to 10:1), but are expected to take on housekeeping and maintenance roles.

Reality: out "Greenhouse" facility still has housekeeping because even at a 5:1 staff ratio it is difficult for our Shahbazim to keep up.

Intent: Shahbazim to prepare meals to order in a home-like kitchen

Reality: Professional chefs cooking meals just like any other nursing home, except without the benefit of an industrial kitchen.

The single biggest complaint about our "Greenhouse" facility is the food. Our elders were made to expect home style cooking every day and got something quite different. Additionally, even if a person is admitted to our facility with a level of functioning which allows them to participate in all of the tasks intended for the Greenhouse model, they inevitably decline and choose not to move when their acuity level changes. Often, since management is under pressure to keep rooms filled, many of our new admits are total care patients.

A few things to mention as a positive: our elders are generally on fewer anxiety medications than traditional institutional style nursing homes. The hallways are shorter (ten elders to a floor); and the shorter distances are less intimidating for a person who is barely ambulatory. With one aide for five elders, I do a lot less wound care than I did at my first nursing home which had one for ten.

Older post, I know but I hope that helps!