The Green House movement is in the news and I suspect that many are wondering why none of the 117 Green Houses across the country are located in Illinois. Good question!
What is a Green House?
As fully realized, a Green House is a building created around the Eden Alternative model of operating a skilled nursing facility (SNF). It is a radical change, authored by Dr. William Thomas, from the traditional hierarchical method of operating a nursing home where an Administrator (or Director of Nursing) leads from the top of the leadership "pyramid" and authority (and control) dwindles the further one descends down the organizational map, until reaching the certified nurses aide (CNA) who is the resident's care giver. SNF's in the United States are almost exclusively based upon a medical model where, more often then not, the diagnosis's may receive more attention then the person (despite the best intentions of the Federal SNF Regulations).
The Eden Alternative (EA) presents a methodology to fight what it deems are the three plagues of SNF's: loneliness, helplessness and boredom. The corrosive effects of these emotions on the dignity of the resident cannot be underestimated. EA redesigns the top-down organizational structure of a SNF to empower decision making to those closest to the Elder (as resident's are referred to in EA parlance). It is a transformative movement and has provoked a serious discussion in the provider community challenging long held assumptions. The Pioneer Network and "Culture Change" are similar initiatives which are being employed at SNF's across the nation. EA "homes" typically are small scale (10-12 Elders per building) with open kitchens, no long corridors and caregivers who function in a multidisciplinary approach.
Why no EA facilities in Illinois?
There are several reasons. Chiefly, these facilities are expensive to build and operate. I am aware of a couple of non-profit Chicago area SNF's which explored the possibility of constructing an EA type of community but could not make the project financially viable. Additionally, the Illinois regulatory authority (i.e. Illinois Department of Public Health-IDPH) prohibited many of the features of a EA home (e.g. open kitchens, fireplaces, furniture in corridors, etc.). , The recently announced changes by the National Fire Protections Association to their Life Safety Code may create the opportunity for IDPH to permit these features.
It should also be noted that although the EA design sounds very "homey" not everyone wants to live exclusively with 10-12 other people every day. Like living on an island, some may want to be voted off.
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