Nursing Home Abolitionist Offers Homelike Alternative

Dr. William Thomas, a Harvard-educated physician, doesn't believe in nursing homes.

"I want to be there when they turn the lights out on the last nursing home in America," says Thomas, who has termed himself a "nursing home abolitionist."

"There are two groups in America that are routinely institutionalized -- convicted criminals and frail older people," Thomas adds. In both types of institutions, he says, residents are deprived of basic choices.

Thomas says that a more flexible, smaller-scale alternative to nursing homes would work better, and he has come up with just such an alternative that is spreading around the nation.

Thomas' revolutionary solution to the drawbacks of conventional facilities is the Green House, a large residential home built for 8 to 10 people in which residents live their lives with the help of qualified nurses and caretakers. Thomas came up with the concept of the Green House after hearing an elderly resident of a conventional nursing home complain that she was incredibly lonely.

There are currently 29 communities of Green Houses in 19 U.S. states, including Alaska, Montana, Michigan, Ohio, New York, and Florida. Thomas estimates that Green Houses will be built in every state in the next five years, and that 160,000 will go up in the next 20 years.

Thomas, who is a geriatric specialist in Sherburne, New York, designed the Green House to be the antithesis of the nursing home. Instead of a cafeteria, a Green House has a home-style dining room with tables and chairs. In place of hospital rooms, a Green House has bedrooms. Although Green Houses lack large lawns, they have a backyard, a front yard, and a patio.

A typical Green House runs about 5,500 square feet and is located near a church or residential community. Green Houses have gardens or pets if the residents want them, and also provide services that the residents specifically request, such as rehabilitative care and programs for people with Alzheimer's and developmental disabilities

Thomas says that a Green House allows residents to make personal choices.

"Every person who lives there has a private room and bathroom," he says. "All of the food is cooked in the house. Strangers are not allowed to come into the house without knocking at the door and being invited in." These simple features give the seniors privacy and space that nursing homes lack, Thomas notes.

"In a typical nursing home, the architecture reinforces the idea that staff efficiency is paramount," says Thomas. "In the Green House, the architecture is designed to maximize wellbeing for the people who live and work there. You can give elder care in a non-institutional, community-based setting, even while [adhering] to nursing home regulations."

Costs Comparable to Conventional Nursing Homes

But isn't all this privacy and personal attention wildly expensive? Thomas says no, that Green Houses cost about the same as a nursing home. Although Green Houses save money by eliminating middle-level management, they spend it to retain quality caregivers. Green Houses are able to accept both private-pay and Medicaid patients.

The concept of Green Houses has been developed partly through the Eden Alternative, a non-profit organization that Thomas founded to focus on improving long-term care for seniors. The Green House Project is funded by the Robert Wood Johnson Foundation and is organized through NCB Capital Impact, a non-profit arm of the National Consumer Cooperative Bank, which provides consulting help and pre-development loans to organizations that want to establish Green Houses. So far the list of organizations that have set up Green Houses includes churches and ministries, nursing homes, counties, medical care facilities, and not-for-profits that serve people with developmental disabilities.

Often the organization interested in setting up a Green House has operated a nursing home in the past, says Thomas. The organization finds that managing a Green House is a very different experience. Thomas says that nursing homes waste money on management, a problem that Green Houses avoid.

"The typical nursing home does not pay CNAs [certified nurse assistants] very well. It retains a significant chunk of the dollar to pay for middle-level management," he says. In the Green House, the caregivers, who are called "shahbazim, " from the Persian word for "royal falcon," take on a variety of roles. Shabazim can be certified as CNAs, "safe serve" food handlers, and infection control specialists. They perform a variety of tasks for residents in the home, including cooking, health care, and CPR. Unlike nursing home staff, shabazim work in tandem with the elders for whom they care.

Thomas believes this is an improvement over the impersonal way in which care is provided in a nursing home.

"We are attempting to de-industrialize long-term care," he declares.

Thomas says there are obstacles to establishing Green Houses. "I think there are powerful organizations that would like to maintain the status quo," he notes, but he believes the boomer generation and the market's rising expectations for long-term care have changed how elder care providers want to serve their target audience.

Thomas is the author of five books, the most recent of which is What Are Old People For?: How Elders Will Save the World. Thomas' original model for the Green House was his own extended family. He grew up in one of a chain of family residences in upstate New York within sight of his grandmother's and great-uncle's homes.

"When I grew up and moved away, I had an image of older people fully engaged in the world around them. I guess that stuck with me as I went about my work. [Now] I just believe that older people deserve the opportunity to live as they always have," Thomas says.