Nursing home alternative challenges traditional system

Jun 24 2008

The Robert Wood Johnson Foundation and Bill Thomas, a former nursing home physician, have been working to overhaul the nation's nursing home system by promoting "smaller, home-like facilities," the Wall Street Journal reports.

RWJF has invested $15 million over five years to encourage the construction of "Green Houses" -- a concept developed by Thomas in which facilities house 10 to 12 residents. There are currently 41 Green Houses in 10 states, and the foundation has set the goal of building Green Houses in all 50 states.

Jane Isaacs Lowe, head of RWJF's Vulnerable Populations portfolio, said, "We want to transform a broken system of care." According to the Journal, "The foundation's undertaking represents the most ambitious effort to date to turn a nice idea into a serious challenger to the nation's system of 16,000 nursing homes."

The Journal reports that to supporters of the Green House model, it is "nothing less than a revolution that could overthrow what they see as the rigid, impersonal, at times degrading life the elderly can experience at large institutions." However, despite funding from RWJF to build more houses, "obstacles remain," according to the Journal. Barriers to constructing more Green Houses include "a thicket of elder-care regulations," the need for "enormous capital" to build new homes, "stiff resistance from many parts of the existing nursing home system" and lower overhead at larger facilities.

Michael Martin -- vice president of Riverside Health System, which owns several traditional nursing homes -- said that Green Houses "will absolutely provide a quality of life unsurpassed," but "they don't work financially."

RWJF "officials acknowledge they don't know whether Green Houses are a viable economic model," but "they've decided not to wait for an answer" and could provide more funding in the future, the Journal reports. Thomas Hamilton, who oversees nursing home quality and regulatory issues for CMS, said, "Robert Wood Johnson is making an important investment to try to make sure there is a sufficient cadre of early adopters of the Green House model -- and research to make sure the model is actually working," adding that CMS is trying to encourage nursing homes to create more "patient-centered" models (Lagnado, Wall Street Journal, 6/24).