In centuries past, when people got old, they were cared for in the homes of younger relatives until they died. This common custom began to change with the Industrial Revolution when women, who were the primary caregivers for the elderly, started to work outside the home.
What happens now to America’s seniors when family members cannot care for them and assisted living is not affordable or no longer suitable for those with advanced physical or mental disabilities? For those who lack financial resources to pay for round-the-clock professional care at home, is the sterile, hospital-like environment of a nursing home the only option left?
Not if you ask Dr. Bill Thomas, a Harvard-educated geriatrician who helped create the Green House project, a new model for long-term care, its name suggesting a nurturing environment where elders and the frail can thrive. The Green House project, co-founded in 2003 by Dr. Thomas and Steve McAlilly of Mississippi Methodist Senior Services, has since spread to 27 states, with four more soon to join the movement. Green House residents, whose care is financed by Medicaid, Medicare or private funds, live in cottages with private rooms and private baths. They participate, when able, in food preparation and eat in a communal setting that is more like a home dining room than a cafeteria. Unlike the regimented meals in nursing homes, Green House residents are free to choose when to eat.
Already 167 Green House homes in the United States have been built by 39 organizations, and 1,735 people are living in them in cheerful surroundings respectful of their needs and wants. Another 108 similar homes are now in development.
“No one wants to live in a nursing home,” Dr. Thomas states in an inspiring new documentary, “Homes on the Range,” produced by Dale Bell, Harry Wiland and Beverly Baroff of the Media Policy Center in Santa Monica. Yet, he said, “if you reach the age of 65, you have a 50 percent chance of spending a significant amount of time in a nursing home.”
Currently, 1.5 million Americans reside in nursing homes where they are often treated more like patients than residents. Despite the explosive expansion of nursing homes — to a current total of 16,100 — few older people want to live in one. And few family members would choose, if they had a choice, to place a beloved relative in one. The common belief is that nursing homes are depressing places where old people go to die.
The Robert Wood Johnson Foundation, which has provided grants for the project, has called the Green House concept a model that can be “a catalyst for significant social change” in how frail older adults are cared for in this country. Although Green House homes may not be the only way to go, they are demonstrating the undeniable value of starting from scratch to create a new, less-institutional approach that enhances care.
A part-time job in a nursing home when he was in his 30s convinced Dr. Thomas, now 55 and a resident of Ithaca, N.Y., that there had to be another way to care for the frail elderly. “I was struck by the tremendous loneliness of the people who lived there,” he said in an interview. Now a health care system innovator, Dr. Thomas has written “Second Wind,” a book to help people reimagine the latter half of life.
Dr. Thomas deplores what he calls “the medicalization of old age” — treatment of aging as a disease for which there is no cure, with medical care usually provided in an institutional setting. Too often, the impersonal, highly structured life in nursing homes precipitates an accelerated decline in physical and mental abilities. Residents may become rapidly helpless, noncommunicative, even catatonic.
Yet, in a Green House — where the atmosphere is homelike and the staff, dressed in street clothes, considers the residents to be their bosses — it is commonplace for debilitated elders to, in effect, come back to life.
Mildred Adams typifies the transformation. Ms. Adams had for several years been cared for in a nursing home where, her family said, she had “deteriorated physically and mentally,” needed help eating and rarely spoke. But within an hour of moving to the alternative environment of the first Green House in Tupelo, Miss., Ms. Adams was completely transformed. At her first meal there, she grabbed the spoon from her son, fed herself, raised her glass and started singing “Amazing Grace.”
Mr. Bell of the Media Policy Center produced a 25-minute film of life in the Tupelo facility that was shown to possible sponsors of similar homes across the country. One woman who saw it, Carmen Rideout, worked with seniors in Sheridan, Wyo., and became determined to create a Green House there where older residents and retirees who returned to the area could be spared the sterile environment of a nursing home and instead live out their days in brightly colored cottages with professional nursing support.
Through don’t-take-no-for-an-answer grit from the grass-roots organization pulled together by Ms. Rideout, the late Rev. Ray Clark and fellow enthusiasts, the Sheridan home became the first community-sponsored skilled nursing Green House in the country. With strong support from the governor and state government, new legislation was passed to make the $10 million project possible. Funds were raised (enhanced by the American Recovery and Reinvestment Act of 2009), a local real estate developer, Don Roberts, donated the land, and professional builders did the work.
The first residents moved into the cottages in Sheridan three years ago and are fulfilling Dr. Thomas’s goal of having “a life worth living” for the last years of their lives. As one resident put it, “Even the most feeble or demented person can grow” in the environment of a Green House.
“The bare white hallways of a nursing home is what the government wanted, but it’s not what people needed,” Dr. Thomas said. “It’s naïve to believe there’s nothing else that can be done.”
As Mr. McAlilly witnessed in the first Green House in Tupelo, “People who were in wheelchairs are walking again. People who weren’t eating real food are eating again. People who weren’t talking are talking again. People who were losing weight no matter what we did are gaining weight.”
Accordingly, Dr. Seymour Thickman, a longtime physician in Sheridan, has encouraged the Veterans Affairs Medical Center there to look closely at the Green House model for veterans in need.
Both the Tupelo film and three versions of “Homes on the Range” (a 60-minute and 90-minute version produced for public television and an 85-minute theatrical version) can be viewed through the website: www.mediapolicycenter.org.
Mr. McAlilly said it’s imperative that the Green House concept continues to spread. “It’s almost sinful,” he said, “Not to do as much as we can, as fast as we can.”
A version of this article appears in print on 12/16/2014, on page D 8 of the NewYork edition with the headline: Growing Old Without a Nursing Home.
