Is it easy being green? Tracking the latest developments in Green House senior living: its state-of-the-art, homelike residences have only been around a few years, but in that time, the Green House[R] project has become one of the long-term care industry's most compelling design developments.

Born of Dr. William H. Thomas' Eden Alternative[TM] concept in the 1990s, the first Green Houses opened in 2003 in Tupelo, MS. They established what is now the Green House design paradigm: single family--size residences homing 10 or fewer residents, each of whom lives in a private bedroom, has a private bath, and shares a large common area, including a kitchen where home-cooked meals are prepared.

Following more Green House clusters in Mississippi, the next Green Homes opened in Lincoln, NE. In August 2006, the project added its third national location--a pair of Green Houses at Presbyterian Villages of Michigan (PVM), a nonprofit, multisite resident campus located in Redford. Each residence cost about $1 million to build.

"It has really exceeded our expectations on what we imagined it was going to be," says Roger Myers, PVM's president and CEO. The transformation to a higher quality of life affected not only the residents, but also the staff, he adds.

LEADING THE WAY

Even though PVM is not the first-ever Green House, it readily takes a mentor role to other facilities considering a transformation. "It's still very early, but we've had dozens and dozens of inquiries from other communities. We're happy to [respond]; it s one of our obligations and commitments to the national Green House project" says Myers.

"We're actively engaged with the Mississippi campus, and with every new development, you're learning from each other. For Mississippi, the good news for them was they were the first, and the bad news was they were the first, but either way, they got a lot of kinks out," says Mariellen Davis, a regional vice president at PVM.

"Plus, there are the national project managers that help support this, so we are already a kind of educational house," she adds. "The questions we get are often about how the union works, how the employees are chosen, and if there has been a division in terms of staff. But I don't think there's been anyone who said this isn't a good thing to do."

ART AND NURSING CAN MIRROR LIFE

Designwise, the Michigan Green Houses built upon what the Mississippi and Nebraska houses had started, according to Daniel Cinelli, managing principal at the Chicago offices of architecture firm Perkins Eastman. It wanted the Green House to truly reflect what people were leaving--their single-family homes.

The Michigan residences have a living space and courtyard in the back to mirror real housing, he says. "We wanted to add a garage to each one to bring in a van or ambulance. There is enough room on the side to be able to get a lift so that the person can get in the vehicle in a heated environment."

The Green Houses in Michigan were converted from existing continuing care retirement communities (CCRC) on an underutilized part of the Presbyterian Villages campus. Their design ideas flowed even before construction began, with architects researching the houses around the area and deciding to face the Green Houses outward toward the other single-family homes on the street, mirroring their look and position.

"Each Green House is about 7,000 sq ft, and a lot of the houses around there are 2,500 sq ft and one story," Cinelli explains. "We try to make each house look like two mini-houses. Each has a totally different exterior, color, siding, and type of entrance on each side."

INTERIOR ENHANCEMENTS BRING RESIDENT COMFORT

Inside the house, the focus is on more subtle touches.

"We moved some appliances, such as the dishwasher, out of the kitchen proper and into the dining area so the residents can help with chores," Cinelli says. "We put the buffet counter in the dining room, so when the staff cook, they can put it on the buffet and residents can come get their own food, if they want."

State-of-the-art bathing facilities allow the resident to maintain privacy while allowing for assistance. "This is a no-lift home, and each bathroom has a ceiling-rail system," says Cinelli. "Where two bi-fold doors open up, you can go past the watercloset into the roll-in shower and get ready for the day."

Myers often gets questions about the financials, he says, and the Green House is certainly an expensive investment. PVM maintains a separate budget for each individual Green House and will be reporting its separate financial statements for the first time this month. Myers plans to share the data on each house's financial performance with the staff and families of residents--staying true to the Green House's community culture.

"We don't yet have enough experience to say that this works 100% and here's been our experience with it" Myers offers. "But we expect to be able to say that a year from now."

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The Robert Wood Johnson Foundation, which provided smaller grants for the earliest Green Houses[R], is behind a $10 million grant to establish Green Houses in all 50 states over five years. The Green House Replication Initiative is a joint venture of the Green House Project Team and NCB Capital Impact, the latter with a team headed up by Robert Jenkens.

"The Robert Wood Johnson Foundation recognized there were such positive results coming so quickly that a model made sense," Jenkens explained. "We're also working under the grant to develop a whole variety of tools to assist organizations in creating Green House financial models, design models, and policies and procedures manuals"

The Green House concept is spreading far and wide, with projects in various stages of completion in Birmingham, AL; Bentonville, AR; Youngtown, AZ; Miami, FL; Columbus, GA; Hutchinson, KS; Chelsea, MA; Grand Rapids, Holland, and Powers, MI; Southern Pines, NC; Troy, NY; Bluffton, OH; Mechanicsburg and Palmyra, PA; San Angelo, TX; and Twisp, WA.---Chad Berndtson

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"Shahbaz," a Persian word for "royal falcon," was the term Green House creator Dr. William H. Thomas used for a nursing assistant in a Green House[R], intended to differ from the standard "certified nursing assistant" nomenclature.

And the Shahbazim definitely have different experiences. "A great byproduct is the growth you see in your employees, and the fact that families actually come in," says Mariellen Davis, a regional vice president at Presbyterian Villages of Michigan (PVM).

"The question I get is 'Does it work?' "says PVM Administrator Lisa Maxwell. "And absolutely, it does work. I heard from one Shahbaz [on Thanksgiving], and she said, 'You know, it was just like home. The doorbell was ringing all day.'"

The turnover rate for Shahbazim hovers around 10%--one of the most dramatic differences between Green Houses and traditional skilled nursing facilities. According to Steve McAllily, president and CEO of Mississippi Methodist Senior Services, Inc., (home to the first Green Houses in Tupelo), that's just one form of cost savings.

McAllily spoke on several of the cost benefits at the National Investment Center for Seniors Housing and Care Industry's fall 2006 conference in Chicago. He discussed reduced dependency on food supplements, less need for incontinence products, and being able to use the same staff to fulfill housekeeping and dietary services duties as ways Green Houses save money.--Chad Berndtson

Adrienne Trivers contributed reporting to this article.