猫咪社区

Over the summer, housemates Thelma and Dave enjoyed distanced, masked socializing on their patio with family members. Thelma was growing zinnias and marigolds in raised planter beds, while Dave could often be found scooting around the trails surrounding their wood-framed home in Washington鈥檚 breathtaking Methow Valley. While many other residents of elder-care homes found themselves confined to their rooms by COVID-19, the ones at Jamie鈥檚 Place could continue enjoying many of the small pleasures that bolster well-being and bring meaning to daily life.

 is one of 300 homes across the U.S. that are part of the , an innovative model for residential care. Green House Project homes house small groups of elders in non-institutional spaces staffed by specially trained 鈥渦niversal workers鈥� known as Shahbazim. Though they aren鈥檛 new鈥擥HP and other 鈥渟mall house鈥� elder homes have existed since 2003鈥攖hey have garnered attention recently for having deftly weathered the pandemic.

From January through June, GHP homes have  only 32.5 confirmed cases per thousand residents as compared to 146 cases per thousand residents in all certified skilled nursing homes. As GHP senior director Susan Ryan explains, the very scale and design factors that helped Green House homes lower COVID rates also enabled staff to 鈥済et far more creative鈥� in reacting to the pandemic.

鈥淵our Home鈥� Versus 鈥淎 Home鈥�

The nonprofit Green House Project was founded by Dr. Bill Thomas, a Harvard-educated geriatrician who recognized a need to humanize the often sterile environment of traditional nursing homes. Long, monotonous corridors with identical doors are a , who rely heavily on cues in their immediate environment, for instance. Visiting facilities across the country in the 1990s that were 鈥渁ging more quickly than the people living in them,鈥� Dr. Thomas realized that the care reform he envisioned required a radically different architectural form鈥攐ne that would create an optimal environment for nurturing resident elders and staff, the way a greenhouse nurtures plants. Pilot Green Houses were built in Tupelo, Mississippi, in 2003, with a replication initiative beginning soon after.

But Jamie鈥檚 Place, founded in 2007, has a special origin story. When Methow Valley resident Jamie Finlan was diagnosed with cancer, she bequeathed her estate to a local food bank with the intention of funding community resources to serve her beloved valley. Local leaders identified a need to enable Valley elders to remain close to friends and family as they aged, and worked with GHP to build and run Jamie鈥檚 Place according to the Green House philosophy. GHP has facilitated training and design guidance to help senior living providers like Jamie鈥檚 Place in 32 states, transforming them through mentorship and guidance rather than operating the homes themselves.

Walking into Jamie鈥檚 Place, 鈥淵ou really feel like you鈥檙e in your home,鈥� says Thelma Oakley, 85. 鈥淣ot a 鈥榟ome鈥� home that鈥檚 an institution, but that it鈥檚 your house.鈥� Inside, a bright, open-plan space showcases a long dining table at the center, surrounded by doors to individual bedrooms on the periphery. Armchairs are clustered around a fireplace nestled between built-in bookshelves, and a stationary bike sits near a half-wall lined with potted plants. A house calendar and homemade artwork hang above a small piano, where, before the pandemic, visiting children from a nearby preschool used to sing songs with the residents.

Dave (who preferred not to share his surname), has a desk in the common space where he works on his primary passion: digitizing photographs he鈥檚 taken in bird-watching visits to 60 countries. Staff members keep the space flexible for the varying needs of six elders, but the walls and bookshelves seem to hold a mix of books and knickknacks from different residents鈥攎uch as one would expect from a busy home for a family of this size.

The 12-Person Table

At the heart of every Green House is a communal table, where residents and staff normally sit down together to share meals cooked in an adjacent open kitchen. Creating a sense of community around this shared table was critical to determining the ideal scale of the Green House model. Collaborating with architects, GHP and other stakeholders concluded that going beyond 12 seats at a dining table loses 鈥渢he fabric of what it鈥檚 like to be family,鈥� Susan Ryan explains. This meant capping households at 12 elders each, though facilities may have multiple homes on a single property.

Their hunch about ideal group size finds support in behavioral science, where 20th century researchers such as John B. Calhoun identified 12 as a psychological group-size threshold鈥攖he number of significant social interactions we can cope with on a daily, intimate basis, above which stress reactions are common. Further, a body of environmental psychology research known as 鈥渟taffing theory鈥� has suggested that smaller groupings for institutions like  and  foster greater self-efficacy for members. 

In traditional nursing homes, sometimes serving  older people in one facility, residents may share bedrooms and shower facilities, and often have to adhere to an inflexible group schedule for meals and bedtimes, being woken early for showering to make large operations function efficiently. Greater flexibility was a major factor for Oakley, who likes to sleep in, when choosing Jamie鈥檚 Place. Staff have arranged their schedules to make sure she鈥檚 the last elder they help to get up in the morning. Simple acts of dignity like this make all the difference. 

Spatially, the Green House model of individual bedrooms and bathing facilities is simply 鈥済ood infection-control practice,鈥� explains Ryan, who worked as a nurse for many years. 鈥淪haring rooms is the last thing you want to do right now,鈥� says Oakley, whose sunny bedroom also features the 鈥渂ig treat鈥� of starry views each night. Decentralized kitchens and laundry services (separate cycles for each elder, with machines sterilized between) also minimize risk. Jamie鈥檚 Place, for instance, is actually composed of two separate homes on one property, each with its own kitchen.

Empowering Shahbazim

Shahbaz comes from a Persian word for royal falcon, named for a fable in which falcons circling the skies became protectors and nurturers of people in the kingdom below. GHP Shahbazim (the plural) are universal workers鈥攃ertified nursing assistants who also do cooking, cleaning, and laundry, and provide activities for up to 12 elders, instead of task-distinct staff serving a larger group as in traditional facilities. For this reason, the Shahbazim model requires fewer staff per facility, lowering the number of people coming in and out, thereby lowering infection risk during the pandemic.

As Jessica Kulsrud, an administrator at Jamie鈥檚 Place explains, this also empowers staff, allowing them to make the best care decisions for each elder, 鈥渢he way family would.鈥� A  published in the Journal of the American Geriatric Society found that a Green House Shahbaz spends an average of 24 more minutes per day in direct care activities with elders than certified nursing assistants in traditional skilled nursing facilities.* Given the smaller number of elders to focus on and greater familiarity with each, Jessica believes Shahbazim will be more likely to notice subtle changes in elders鈥� health during these pandemic times.

Imagine a small high school where most of the 400 students get to play on a sports team and have a leading role in a club or theatrical production, versus a large school where 4,000 students compete for a smaller ratio of valued roles. Staffing theory researchers have found that members of smaller group settings are called upon to perform more meaningful roles than in larger groups, strengthening their confidence. The Green House model consciously assigns more roles to Shahbazim, elevating certified nursing assistants (typically at the bottom of the caregiving pyramid) to 鈥減rotectors of the flock.鈥�

But this small-group dynamic may also offer more meaningful daily roles for elders like Oakley, who enjoys helping Shahbazim cook dinner and sharing favorite recipes like pea soup and chicken thighs with crushed tomato and ginger. Shahbazim also benefit, learning from elders with a lifetime of cooking experience. When one Shahbaz at Jamie鈥檚 Place was struggling to prepare pork chops for the first time, Dave stepped in to prevent a cooking catastrophe. Today, Oakley says, they have that recipe 鈥渄own pat.鈥� 

Smaller Footprint

Good things are said to come in small packages, and the modest dimensions of Jamie鈥檚 Place allow elders easy access to the outdoors, another core Green House principle. 鈥淭he smaller footprint is better,鈥� explains Ryan, 鈥渘ot only because every square foot costs money鈥� but from a functional mobility perspective.鈥� In larger facilities, elders may struggle to move between sleeping, dining, and outdoor facilities, increasing reliance on staff and potentially decreasing personal sense of agency. Within the cozy scale of a family-style home, even many elders with reduced mobility can easily get themselves outside for fresh air and 鈥渟unshine鈥� vitamin D (which has been  COVID-19.) 

As for the communal dining table, social distancing modifications have been made to keep elders safe during the pandemic. But thanks to the small scale of Green House homes, staff have been able to adjust flexibly and creatively. At Jamie鈥檚 Place, two elders may now sit at either end of the long table, another eats in her room, and others on TV trays in the lounge area, all depending on their needs and preferences. Oakley鈥檚 greatest complaint is that she can鈥檛 play Scrabble with her son鈥攐utdoor distanced visits are limited to a half-hour, which isn鈥檛 quite long enough for a game. But in the meantime, she鈥檒l still be able to see him, aided by masks and industrial patio heaters for the colder months. When her own mother-in-law went into a nursing home, Oakley gave her a plaque reading, 鈥淏loom where you鈥檙e planted.鈥� One of the Shahbazim made a little sign for her with the same phrase鈥攁 philosophy she tries to live by at Jamie鈥檚 Place.

Gathering Gratitude

On Nov. 23, Green House operators and Shahbazim from around the U.S. came together on Zoom for their first 鈥淕ratitude Gathering,鈥� sharing stories, tears, and thanks in a year when many staff members must forgo in-person Thanksgiving celebrations with their own families. The Green House network has not been spared from tragedy, but staff members from Detroit to New York and Kentucky resoundingly expressed gratitude for a social and architectural model of care they believe has saved lives.

鈥淲e鈥檙e so grateful to the Green House model for having private rooms for the elders,鈥� as Susan Haley of Village on the Isle, a Florida retirement community partnering with GHP through a new initiative to bring 鈥渃ultural transformation鈥� to more traditionally constructed facilities, explained. 鈥淲e truly believe that this has kept our elders safe and healthy during this time.鈥�

*Please note, the majority of Green House homes (87%) are skilled nursing facilities, though Jamie鈥檚 Place is not.

This story originally appeared in , and is republished here as part of the SoJo Exchange from , a nonprofit organization dedicated to rigorous reporting about responses to social problems.