Empowered Direct Care Worker: Lessons from the Green House Staffing Model

Susan C. Reinhard
Edem Hado
Barbara Bowers
Susan Ryan
Marla DeVries
January 2022
Cover of "Empowered Direct Care Worker: Lessons from the Green House Staffing Model".


Green House model results in improved outcomes for staff and residents compared to traditional nursing home model.


Traditional nursing home models can struggle to maintain a safe and positive work life for the direct care workforce, which can impact quality of care for residents. These challenges were exacerbated during the Covid-19 pandemic. The Green House model offers a different approach to the built environment of nursing homes, how residents are empowered, and how staff are trained and organized. This brief describes the staffing model of Green House homes and summarizes positive evidence behind work-life measures and how these relate to quality of care.


The brief summarizes the unique elements for staffing the direct care workforce in Green House homes. This workforce, known as the Shahbazim, receive additional, enhanced training on emergency preparedness, dementia care, culinary skills, communication, and conflict management. They also are assigned to a consistent site and work alongside nurses — though the roles of Shahbazim and nurses are distinct, with Shabazim performing a wider range of non-clinical tasks. Typically, Shahbazim are compensated at higher rates that the traditional direct care workforce.

The brief also summarizes how this staffing approach leads to lower turnover rates compared to traditional nursing homes (33.5 percent compared to 129 percent), high job satisfaction scores, and improved health outcomes for residents, including lower rates of hospitalization.


Traditional nursing home environments, which may not be able to adopt the smaller-home approach of the Green House model, may consider customizing the model’s approach to workforce. Notably, the relative higher wages earned by the direct care workforce in Green House homes are an important element to the success of the model and core to the Green House philosophy.

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