Evidence on the Green House Model of Nursing Home Care: Synthesis of Findings and Implications for Policy, Practice, and Research

Sheryl Zimmerman
Barbara J. Bowers
Lauren W. Cohen
David C. Grabowski
Susan D. Horn
Peter Kemper
Peer-Reviewed Article
February 2016
Cover of "Evidence on the Green House Model of Nursing Home Care Synthesis of Findings and Implications for Policy, Practice, and Research".


A large study on the Green House nursing home model finds promising evidence for improved quality of care and offers implementation recommendations.


The Green House model of residential long-term care has unique core elements compared with traditional nursing homes. In this model the nursing home has a home-like environment, with no more than 12 residents, and meals are prepared in the on-site kitchen. Residents have more choice in how they use their time each day, and the direct care workforce has more training and self-management than in traditional nursing homes. Since first implemented in 2003, smaller scale studies of this model have found some positive outcomes, including higher rates of quality of life and higher family satisfaction compared to traditional nursing homes. This mixed methods study examines eight years of data across larger data sets from both Green House homes and traditional nursing homes to better understand Green House home implementation and impacts.


The study examined nursing home consistency with the Green House model and characteristics of the workforce compared to traditional nursing homes, as well as hospital transfers, quality of care outcomes, Medicare utilization and expenditures, and other outcome metrics. Generally, findings indicated that the Green House model was implemented with consistency, exhibited important differences from traditional nursing homes (e.g., staff more familiar with residents, increased interaction between staff, residents, and their families), and was associated with lower hospital readmission rates and avoidable hospitalizations. Notably, there were mixed and statistically insignificant findings related to Medicare spending.


The Green House model presents opportunities for improved quality of care, and policymakers and providers may consider applying these findings to promote adoption of Green House nursing homes. A larger percentage of Green House residents pay privately for their care, compared to residents in traditional nursing homes. The authors suggest that Medicare policymakers conduct larger scale research to better understand the Medicare expenditure implications of the Green House model.

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