The Green House Project for the Elderly

Apr 24, 2003 12:24 PM EDT

TUPELO, Miss. – Plants bloom and thrive in the warmth and light of a greenhouse, and developers of the Green House Project, a groundbreaking system of care for America’s elderly, hope the first-ever Green House is a place where the aged can also bloom.

United Methodist Senior Services of Mississippi Inc. will open the first Green House in the nation May 2 on the Traceway Retirement Community campus.

"I’m convinced society is reflected in how we treat our elders," says Steve McAlilly, president and chief executive officer of UM Senior Services, citing the commandment to honor father and mother. "The whole country is watching this project. A lot of organizations are waiting to see how this goes. I’m grateful our board had the vision and courage to step out."

The Green House Project moves away from the institutional model of nursing homes and borrows from the highly successful group-home model used with troubled teens.

The concept revolves around a facility built specifically for elders that creates a "home" atmosphere. The core of the small homes is a common living room, complemented by a large, open kitchen, lots of windows and other amenities. The 10 residents may bring their own furniture, including pieces for the living room. Meals will be cooked in the home, and all will eat together around a family-style table. Outside are fenced yards and a small patio in front.

McAlilly and Dr. Bill Thomas, a United Methodist and founder of the Eden Alternative, helped develop the Green House Project, along with members of Thomas’ organization. The New York-based Eden Alternative is a system of elder care designed for retirement communities. UM Senior Services, a self-supporting agency affiliated with the Mississippi Annual Conference, has adopted the Eden Alternative for all of its facilities.

The Eden Alternative is a philosophy that seeks to change the environment of today’s nursing homes and other long-term care institutions by making life better for those who live and work there. Its core principle is that housing for the elderly must be habitats for human beings, not sterile medical institutions. The Eden Alternative is dedicated to eliminating the loneliness, helplessness and boredom that make life intolerable in many nursing homes.

Those involved in the Green House Project wanted to find a better way to care for frail elders, or those who need skilled nursing assistance. McAlilly says the idea grew out of numerous conversations over a period of years.

"We conceived the idea of a small home for elders that provides as much of the things of a home as possible," he says. "This home will be state-of-the-art technologically and will provide all the services of a nursing home but in ways not offered before."

UM Senior Services has four units under construction, with the first scheduled to start receiving residents May 2-3. Plans call for eventually moving all 140 residents of the Cedars nursing home on the Traceway Retirement Community campus into Green Houses, McAlilly says.

Jude Rabig, executive director of the Green House Project, spent a week in Mississippi training those who will work in the homes. Actively involved in nursing home reform for many years, Rabig says she’s excited about the possibilities of the Green House Project.

"There are only two groups we consistently institutionalize for life – murderers and frail elders. Everyone else can eventually get out of an institution," she says. "There is no reason why frail elders can’t live in a home like this."

Watching the training, the amount of thought that went into how the homes will operate is evident. Rabig points out to the 10 or so "shahbazim," as the universal workers of the Green Houses are called, that when they smell something cooking, they probably get hungry. The same is true for elders. By cooking the meals in the homes, residents are more likely to become hungry and eat better. The fact they’ve helped plan the menus should also be a plus.

All of the workers have experience in nursing homes. Rabig spent time showing them techniques for dealing with everyday issues that allow the elders to maintain their dignity, yet still receive the care they need.

For example, while discussing dementia, Rabig had a shahbaz play the role of an elder trying to communicate a need. Rabig pointed out how traditional nursing homes usually handle the situation and how it should be handled in a Green House.

"This is a step in the right direction," says Matt Belue, a shahbaz. "If we do our jobs, we’re both better off. We will have more one-on-one time and be better able to nurture, sustain and protect (the elders)."

Samantha Fullilove says she likes the idea of residents having more control over their own lives. "At a nursing home, they can’t make their own decisions. We have to decide," she says. "Here, we let them make decisions."

Belue says she likes the fact that she will get to know the residents better than in a traditional nursing home. "We’ll take care of them every day," she says. "We can become a family together."

The shahbazim will have more input into residents’ care, she notes, contrasting that with nursing homes, where nurses usually make all the decisions. By being in close contact with a small group of elders, a shahbaz will be able to make better decisions, she says.

The workers will be a mix of current UM Senior Services employees and newcomers, McAlilly says. UM Senior Services looked for those with a commitment to elder care, he says. All workers are certified nurses’ aides.

The Green House Project has attracted interest from elder care groups around the United States. Thomas was able to secure a grant that has paid for the shahbazim training, and leading researchers in the field are already studying the project.

Dr. Rosalie A. Kane, an expert on quality-of-life issues for the aging, is leading a team of researchers exploring the concept. She and team member Lois Cutler visited Tupelo March 6.

The research team will watch the development of Green Houses from various perspectives, including those of health and social services personnel in the community and state. In addition, they want to gain knowledge from the experiences of seniors living in the Green Houses, their families and those who provide care for the elders.

The lessons learned from the planning and implementation of the Green House concept in Tupelo will be applied to similar projects across the nation. Besides additional Green Houses in Tupelo, others are planned for Nebraska and Michigan. Tabitha Health Care Services, owned by the Evangelical Lutheran Church in America, will operate one in Lincoln, Neb., and local government will operate another one in Powers, Mich.

Each of the initial Green House buildings is about 6,000 square feet and cost about $480,000 to build. UM Senior Services already owned the land.

"The Green House Project addresses a key problem in the structure of nursing homes today, providing treatment to people in a setting governed by strict routines," Kane says.

"The Green House is designed to provide that same care and treatment for people in a normal, home-like setting. It will be exciting to see the concept become a reality."

The Green House developers have been creative in meeting state requirements without taking away the "homey" feel, McAlilly says. Certain telltale signs of a nursing home, such as a nurse’s station, have been moved behind closed doors. Lights over each door that signal assistance is needed have been incorporated into a unique design.

Each resident will wear a small transmitter that, when pressed, will signal a nurse. Response time should be no more than five minutes – about standard in a nursing home, McAlilly says. While shahbazim will serve a single home, nurses will rotate among several.

Once Senior Services decided to embrace the Green House Project, a presentation to the Mississippi Department of Health was necessary. McAlilly says the state requires nursing care facilities to meet 114 criteria. The new Green House model met 111 criteria immediately. Two items had to be approved by someone who could not attend the entire meeting, and the third has since been met.

Response among Cedars residents and their families has been mostly positive, McAlilly says. Some are taking a wait-and-see approach, while others are enthusiastic, he says.

"I’ve never had anyone call and say they wanted to move into a nursing home until they had to," McAlilly says. "Every time a story about the Green Houses is in the paper, we get calls from people asking to move in."

Much of the landscaping is being left to the residents. They will choose plants for inside and outside, where a fenced patio area has room for a small flower garden. Those who are able will be encouraged to take part in planting. Members of the Master Gardener program at Mississippi State University will assist them.

Standing on the cusp of a groundbreaking project is heady stuff, but McAlilly hasn’t forgotten the first two words in his organization’s name – United Methodist.

"I’m proud of the United Methodist Church because of its support for, honor and respect of elders, and its ability 35 years ago to see the need to provide meaning and abundant life to elders," says McAlilly, the son and brother of United Methodist clergy.

"When we do what we do, it is because of the church. Our organization believes it is called by God and the church to be at the forefront of providing meaning and quality of life for elders."

More information on the Green House Project is available at online.

By Albert H. Lee
[email protected]