Green House Model Offers Alternative

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.

What do you think? Learn more on Twitter @aginginchicago




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    Bruce -- it appears your blog post is based on several misconceptions. Illinois opened its first Green House Project home last month in Danville -- to great fanfare I might add. Find a roundup of coverage here:

    Also, if you review the extensive research conducted on the Green House model you'll see the capitol costs of building a Green House home are the same or less than a traditional facility. More important, the costs of operating a Green House are no higher than in a traditional facility. Here's the research:

    Perhaps it's true not everyone would want to live with 10 other people. But that remark, as well as your headline, miss the point entirely. The Green House isn't an alternative to a person's private house -- it's the alternative to being placed in a large-scale, institutional nursing home. It's an alternative that provides private rooms and bathrooms, that places all decisions and choices -- such as when to wake up, when to shower, when and what to eat -- in the hands of the elders, rather than the institution. And it provides all this at no additional cost.

    In my opinion, it's only a matter of time before there are Green House homes in every community in Illinois, because once consumers learn about this alternative to institutional nursing homes, they will demand it.

  • In reply to Kavan Peterson:

    Thank you for directing me to the new Green House in Danville. I plan on taking a trip downstate to see the community first hand.
    As a former nursing home operator/owner and consultant, I can say that my remark regarding the hard costs (i.e. land purchase and construction) were higher on a SF basis then the typical nursing home built in Illinois. However, my analysis was based on IDPH interpretations of the life safety code (and OBRA and Illinois Nursing Home Care Act requirements) which may now may now be accommodating the Green House model. Additionally, in my experience with Culture Change initiatives informs my opinion that they also can transform a skilled nursing facility from a traditional top-down management style to a resident-orientated community where the three plagues of living in a nursing home are addressed.
    Never the less, I welcome Green House to Illinois and like you hope that this is the beginning of more choice for older adults. Thank you for your comment!

  • The Green House Project – An Important Choice when Looking for a Real Home

    Bruce asks a great question – why aren’t any of the 117 Green House homes in Illinois? As the Director of The Green House Project, I am happy to say that the Illiana VA in Danville, IL just opened the first of many Green House homes under development throughout the VA system. They are amazing Green House homes meeting the strict requirements for VA nursing homes and implementing the full Green House model (see our blog at or for more information and photographs). And we are ready for more! I encourage any Illinois based organization interested to contact and any Illinois residents interested in advocating for a Green House Project in your community to download our consumer tool kit at

    Bruce also raised an important issue – what defines a home for each of us as individuals? In my many years helping communities create institutional alternatives, especially those serving people with moderate and low incomes, I can say with certainty that every person’s definition of home is different. In fact, you can only assure that you will help someone have the home they want by adding choices to the long-term care options in each community.

    For those of us who want a warm and small home if we need nursing home services, The Green House model is a great choice to have. At our recent 100th home celebration, national leaders share their thoughts on what makes a home and the impact of The Green House model – watch the video here:,, & In addition, a recent article in The Seniors Housing and Care Journal shows that operating Green House homes are delivering on their promise, providing significantly better satisfaction and care outcomes at the same or lower operating costs than traditional nursing home models. Our capital costs, an important factor in creating additional options, are at the low end of culture change models. See for more information on Green House research.

  • Robert,

    Thank you for your thoughtful comments. I hope that Illinois becomes a more hospitable place for the development of more Green House projects located beyond VA campuses.

    Enjoy the holiday! Bruce

  • Robert,
    Thank you for your comment! SNF operators in Illinois, both non-profit and for-profit should reexamine their assumptions regarding the viability of the Green House model in light of the new research. Keep those comments coming! Bruce

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    Bruce Lederman has over 25 years experience in the senior care field as a direct care provider and thought leader. Bruce was CEO and president of his own firm that operated skilled nursing facilities in Illinois. He is a former nursing home administrator and has consulted to numerous elder care providers on planning for strategic growth as well as process improvement. Recently he served as board chair of CJE SeniorLife, a leading non-profit elder care provider in the Chicago area. Bruce is currently employed as chief strategy officer for a company providing skilled nursing services in communities throughout Illinois and Missouri.

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