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The Green House Model: Transforming Long Term Care

May 12th, 2016 by

After a fainting episode, 80-something Lawson knew his family was right when they insisted he no longer live alone. But the place he moved to in Baltimore, though technically a nursing home, defies everything we’ve come to associate with the typical nursing home model. Like the other 10 to 12 residents in his “house,” Lawson enjoys a private room and private bathroom, which wraps around a central hearth (Living/Kitchen/Dining). At mealtimes, he can sit down around a large table with other residents and staff members to enjoy conversation and a home-cooked meal. Or if he’d prefer to have a peanut butter sandwich, that’s fine, too. On warm days, he can sit on the screened porch to watch kids play ball on the field across the way, or tend the pots of flowers growing there.

Lawson’s home is based on the innovative Green House Project, founded by Dr. Bill Thomas in the 1990’s. A geriatrician, Thomas set out to “abolish” the traditional nursing home. He envisioned a new approach to long-term care in small, home-like environs, where people could live a full and interactive life, avoid loneliness, and maintain their independence. The first Green House homes opened in Tupelo Mississippi, in 2004. A year later, the Robert Wood Johnson Foundation announced a five-year $10 million grant to establish Green House models all over the United States. The grant has been renewed multiple times.


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In 2008, Marks Thomas began to work on the Green House Residences at Stadium Place with GEDCO (Govans Ecumenical Development Corporation). Once completed, it provided a home for 49 “elders,” as residents are called there . In 2013, NPR broadcast a feature on the Green House Residences at Stadium Place, “Move Over Nursing Homes — There’s Something Different.” The NPR story, which included Lawson’s story, noted that though the Green House model sounds expensive, its costs are about the median for nursing homes nationally. And studies indicate that residents are happier and stay healthier longer in homes of this model.

How does the architecture of the building create the home-like environment that the model envisions?  Each house must have a variety of rooms to allow for different levels of socialization. At the most intimate level is the bedroom. Each bedroom has a full bathroom and warm, comfortable furnishings. It has a nurse call system, a hospital bed, accessible bathroom and a patient lift, all carefully concealed within a room that looks like it could belong in anyone’s home. Next is the heart of the home, the “Hearth.” It is comprised of a spacious living room, dining room, and kitchen. All materials are warm and would fit in a traditional home environment.


The kitchen in the Green House is not sterile and institutional. Instead it is equipped with granite countertops, residential appliances, wood cabinets and tile floors. And yet it includes commercial refrigerators and freezers, high-temp dishwashers, commercial hoods and all the other safety features necessary to make the Green House compliant with safety regulations. The dining room has a wood table large enough for the entire “House” to eat together if they choose, and the living room offers lots of comfortable seating and a fireplace. There is a den for watching TV and a salon with a hairdressing station and a spa tub. There are also two large screened porches, one facing east and one facing west, where elders can lounge in the fresh air or grow herbs in the planters.


How can this welcoming, intimate environment be created within the boundaries of health and building codes? All the requirements of an “institution” are met — these features are simply provided in inconspicuous ways. The nurse call system, for example, does not have red lights above the bedroom doors; instead the call goes to pagers, which all the caregivers carry. There are no nurses’ stations, just a niche with cabinets and counters —which looks like a library in anyone’s home,  yet contains all the technology necessary to run the facility. There are no administrative offices, just a small study where caregivers can prepare paperwork or meet with elders’ families.


The Green House Residences at Stadium Place was the first Green House in Maryland. It took a lot of effort to navigate various governing bodies and regulations to create such a home-like environment. We are proud to have been on the cutting edge of a housing model that puts a premium on the happiness and welfare of elderly residents — one that is fast becoming the new standard for long-term care.

To learn more about trends in senior living, download our recorded webinar, “Designing The Future of Senior Housing: The Market, Emerging Trends and New Models.”