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'Green Houses' an alternative to traditional nursing homes



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TUPELO, Miss. - Dr. Bill Thomas is on a mission to close every nursing home in America.

"Most nursing homes are sad and lonely places," the Harvard-educated geriatrician said. "Our elders deserve better. They need places where they can enjoy life and grow."

The founder of the Green House Project has a plan for reinventing how this country cares for frail, older adults.

Residents of the Franks House in Tupelo, Miss., sit down to home-cooked meals. Gone will be the large nursing homes that treat residents like hospital patients. Instead, there will be "Green Houses" for 10 to 12 elders who live like a family.

They will sleep in their own bedrooms, eat home-cooked meals, pursue their hobbies and, if they choose, help with light household tasks such as folding linen.

Thomas has caught the attention of many in the nursing home industry who are looking for less institutional settings for their 1.6 million residents.

Those executives acknowledge that their new focus on creating homier environments springs from the nation's growing frustration with the its 17,000 nursing facilities.

A recent Kaiser Family Foundation survey found that only 35 percent of Americans are satisfied with the care in nursing homes - just slightly better than people's opinion of HMOs. And experts expect the Green Houses' kinder, gentler ways to appeal to many families.

"Dr. Thomas is the best thing to come along in nursing care in decades," said Sandy Ransom, director of the Texas Long Term Care Institute at Texas State University in San Marcos.

Mississippi Methodist Senior Services became the first group in the country to move its nursing home residents into Green Houses about two years ago.

The nonprofit group had planned to expand its nursing home in Tupelo, Miss., until chief executive Steve McAlilly heard of Thomas and agreed that more of the same wasn't the answer.

"If we're honest, most of us say a silent prayer when we walk into a nursing home: 'God, save me from this!'" he said. "That's because nursing homes aren't homes."

The group decided to spend its money on building 10 Green Houses that bear all the markings of home but are designed for skilled nursing care.

The ranch-style houses resemble any other home on the street, even down to their garden patios with barbecue grills.

When visitors ring the doorbell, they're greeted by one of the two elder assistants on duty.

The entryway leads to a large common room where, on a recent visit, elders were sitting in front of the hearth and exchanging stories about grandchildren.

Each elder's room opens onto the common room, so no one has far to walk.

"Too many nursing home residents end up in wheelchairs simply because they can't navigate the long corridors," explained project director Jude Rabig.

There are no schedules to keep in a Green House, so the residents wake up when they want and go to bed when they please.

As in many homes, a Green House's open kitchen and dining area are a hub of activity.

The smells of stews simmering and cookies baking waft through the house as the elder assistants prepare favorite family recipes.

"It's always good home cooking," said 100-year-old Mildred Lee as she enjoyed her lunch of baked chicken, mashed potatoes, collard greens and cornbread.

Family members who seldom visited the cold, sterile nursing home are frequent guests at Green Houses.

All five generations of 85-year-old Mildred McDonald's family were represented on a recent visit.

"When they come to see me, I'm so proud to show them around," she said. "Back at the nursing home, I felt like I was staying at somebody else's place. Here, I know I'm home."

Key to each Green House's success are the assistants who maintain the household and tend to everyone's needs. Thomas calls them the Shahbazim, or midwives to the elders.

The assistants are certified nurses' aides who enjoy more autonomy than they would at nursing homes.

"I was always following a rigid schedule at the nursing home," said Renea Reid, one of the Shahbazim. "Now I have time to get to know my elders."

In an emergency, the elder assistants can call a clinical support team that arrives within minutes.

Green Houses are designed to follow existing regulatory requirements and to cost no more to build or operate than a nursing home with private rooms.

Mississippi Methodist Senior Services spent $9.2 million to build 10 Green Houses for 112 elders, as opposed to the $12 million it would have paid for a new 140-bed nursing home.

The nonprofit agency also operates its Green Houses on the same government reimbursements and private charges it gets for its nursing home - an average of $145 a day from the state for the 70 percent of elders on Medicaid and $155 a day from private-pay elders.

Many of the residents have thrived in their new homes, McAlilly said.

"It's been amazing," he said. "People who were in wheelchairs are walking. People who were losing weight are eating. You can see a twinkle in their eyes again."

An independent research project confirms his assessment.

The University of Minnesota researchers compared the elders in the Green Houses with the residents in two nursing homes over the last year. The first group fared significantly better.

"We would expect some physical decline in any nursing setting, but we found it was much slower in the Green Houses," professor Rosalie Kane said.

Green Houses have also eliminated the high staff turnover that typically plagues nursing homes, she said.

Those results are getting noticed. Twenty groups from across the country are committed to building Green Houses, Rabig said.

Baptist Memorials Ministries in San Angelo, Texas, plans to begin construction on two Green Houses for Alzheimer's patients next year and wants to replace its 169-bed nursing home after that.

"I'm impressed with what I've seen in Tupelo," chief executive Pat Crump said.

Still, not every long-term care expert is ready to follow Thomas and tear down neighborhood nursing homes.

"Green Houses make a lot of practical sense, but they may not be the only answer," said Hal Daub, president of the American Health Care Association, an industry group.

Daub said nursing homes may be able to achieve the same results by remodeling existing facilities and creating smaller living spaces for a few dozen residents.

Industry executives point to Beverly Enterprises Inc. of Fort Smith, Ark., a leading for-profit operator of nursing homes that's renovating several dozen of its 350 facilities to make them homier.

Green House Project officials remain convinced that most for-profit enterprises will someday replace their institutional-style buildings with homes like Thomas'.

"They'll have no other choice because consumers will demand it," the geriatrician said.

America's over-65 population will double in 25 years, and he predicts aging boomers won't put up with the nursing home conditions that earlier generations have tolerated.

"We're at the beginning of a revolution," he said.

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(c) 2005, The Dallas Morning News. Distributed by Knight Ridder/Tribune News Service.

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