The Green House Project

January 5, 2018 4 min read

Did you know that there's a 50 percent chance of you spending a significant amount of time in a nursing home if you reach age 65? For years, the conventional mindset toward nursing homes (there are currently over 15,000 in the U.S.) has been that they are little more than depressing and isolating places where old people go to die. Fortunately, the Robert Wood Johnson Foundation Green House Project is a movement that is changing the concept of skilled care for the elderly.

For over a decade, the foundation has helped support ways to transform the impersonal and institutional feel of traditional nursing homes. Currently, there are close to 300 Green House homes in over 30 states, all of which provide a small environment in which the elderly and the frail can feel safe and nurtured. A reported 1.5 million Americans currently lived in traditional nursing homes as of 2014. According to aging experts, many of them are treated more like patients than residents.

Dr. Bill Thomas, a Harvard Medical School-educated geriatrician, had a part-time job at a nursing home when he was in his 30s (he is now 58) that convinced him there had to be a better way to care for frail older Americans. Deeply moved by the overwhelming depression and sadness that he witnessed among the people who lived there, he was convinced that there was a better way to age. As a result, he wrote "Second Wind: Navigating the Passage to a Slower, Deeper, and More Connected Life." Dr. Thomas recognized that "the medicalization of old age," or the treatment of aging as an incurable disease, is harmful because the impersonal and highly structured lifestyle enforced in nursing homes can lead to accelerated mental and physical decline.

To avoid this type of "counterproductive care," Green House homes are designed to look and feel like a real home. Meals are cooked on the premises; medical equipment is tucked away; residents live in cottages with private rooms and private baths; and meals are eaten in an environment that is more like a homey dining room than an impersonal cafeteria. The homes have a small overall population, and according to a 2010 evaluation report, residents receive more direct care (about a half-hour's worth) than residents in traditional homes. Additionally, Green House residents enjoy four times as much staff engagement above and beyond direct personal care activities.

In addition to the unique design, size, staffing parameters and meal patterns (residents are encouraged to participate in the kitchen), there are staff members with four different support roles in each Green House Project home:

—The Shahbaz: the versatile worker who provides personal care, prepares meals and performs housekeeping, among other duties.

—The Guide: the Shahbaz's supervisor, who is responsible for the operations of the home.

—The Sage: a local elder who volunteers to be a mentor and advises the homes' teams.

—The Clinical Support Team: nurses, therapists, services, activities experts, dietary professionals and others who work with the Shahbaz to provide individual care for each elder.

To read more about The Green House Project, visit or watch the Homes on the Range "The New Pioneers" video on the Media Policy Center website.

Marilyn Murray Willison has had a varied career as a six-time nonfiction author, columnist, motivational speaker and journalist in both the U.K. and the U.S. She is the author of The Self-Empowered Woman blog and the award-winning memoir "One Woman, Four Decades, Eight Wishes." She can be reached at To find out more about Marilyn and read her past columns, please visit the Creators Syndicate webpage at

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