Nontraditional Small House Nursing Homes Have Fewer COVID-19 Cases and Deaths

Sheryl Zimmerman
Carol Dumond-Stryker
Meera Tandan
John S. Preisser
Christopher J. Wretman
Abigail Howell
Susan Ryan
Peer-Reviewed Article
January 2021
Cover of "Nontraditional Small House Nursing Homes Have Fewer COVID-19 Cases and Deaths".


The Green House model for long-term care residents found reduced COVID-19 incident and death rates compared to traditional nursing homes.


Nursing home residents were disproportionately impacted by the COVID-19 pandemic and had high mortality rates from the virus. While some of the impact is attributed to medical vulnerability, the congregate nature of nursing homes makes it difficult to limit the spread of infection. The nontraditional Green House model may protect against the spread of infection due to the smaller size of these homes (10-12 residents) and the design, which provides private rooms and bathrooms. This study examined COVID-19 data from Green House homes and traditional nursing homes to explore if Green House homes had reduced infections.


The study compared COVID-19 cases within traditional nursing homes with Green House homes, hospital admissions and readmissions, and related deaths in 2020. Overall, the median incidence and mortality rates of COVID-19 were significantly lower in Green House homes compared to traditional nursing homes. Beyond the built environment, the study authors noted that the consistent staffing and availability of outdoor family visiting that Green House homes provide may have also played a role in limiting the spread of infection. 


This study found the Green House model limited the spread of COVID-19 compared to traditional nursing homes, adding to the literature on the advantages of the Green House model for long-term care residents.

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