The Long Run

Model homes

A ‘Green House’ in Chelsea provides skilled or elder care on a family-like site

By Kay Lazar
August 30, 2010

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CHELSEA — The aroma of spaghetti and garlic bread wafts from the kitchen as Marie Burke aims her walker toward the dining room table, where several of her housemates, a couple of them in wheelchairs, already have taken positions.

Lunch is being dished up family style, and the conversation bounces from favorite meals — meatloaf and brisket — to friendly ribbing about who in the house is the real card shark.

Forget the long sterile corridors, antiseptic smells, and assembly-line feel. In this nursing home, elders rule. Residents decide when they want to get up, what they want to eat — and it’s all freshly cooked by specially trained nursing assistants who pull up chairs, fill their own plates, and join in the conversation.

The $34 million Leonard Florence Center for Living in Chelsea, which opened a few months ago, is the first of its kind in Massachusetts, according to the Green House Project, a national group promoting family-like alternatives to traditional institutional care for people needing long-term skilled nursing services. But the cost of building these cutting-edge homes, particularly in a down economy, is impeding their growth nationwide.

The six-story building atop Chelsea’s Admiral Hill has sweeping skyline views and comprises 10 spacious “homes.’’ Each has 10 private bedrooms and bathrooms clustered around an airy and open-style kitchen-dining and living area, complete with a fireplace and balcony.

“I was stunned,’’ said Burke, who is recuperating from a broken hip and, at 66, is one of the younger members of her unit. “It doesn’t seem like a nursing home or rehab facility, and the food is excellent.’’

Unlike traditional facilities that assign staff to patients on a rotating basis, each of the Chelsea “homes’’ has two primary caregivers who routinely tend to the same 10 residents and plan meals with them, help them bathe, groom, and dress, and do their laundry. In addition, nurses, therapists, and other medical professionals care for patients throughout the center.

A project of the Chelsea Jewish Foundation, the center is known as a “Green House,’’ a concept created by Harvard-trained geriatrician Dr. William Thomas, who opened the nation’s first Green Houses in Tupelo, Miss., in 2003 to provide elders with more autonomy, choice, and social interactions. Today, there are 89 Green Houses in 16 states, with an additional 27 in development, according to Anna Ortigara, a Green House Project spokeswoman.

With the average age of the nation’s 16,000 nursing homes approaching 30 years old, Green House supporters say the model for rebuilding skilled nursing centers should be smaller and with more individualized care, an approach more likely to appeal to the legions of aging baby boomers.

“We are woefully behind in conceptualizing and providing the kind of nursing home life that we think our grandparents deserve,’’ said Rosalie A. Kane, a professor of health policy and management at the University of Minnesota. Kane tracked residents in two of the first Green Houses in Mississippi, and compared with two traditional facilities, found higher satisfaction levels and generally fewer health problems, such as depression, in the Green Houses.

“The Green House and small house model seems to be one of the more promising things I have seen in 30 years of working in this field,’’ she said.

Kane’s study was in part funded by the Robert Wood Johnson Foundation, a philanthropic organization that provided $10 million in seed money to the national Green House Project. Other research that compares Green Houses to traditional homes is hard to come by.

Development of Chelsea’s 10 Green Houses was a pricey endeavor, even with foundation help. The 93,000-square-foot project — twice the size of a traditional facility — cost more than twice the price of the average Green House, largely because of its spaciousness, well-equipped kitchens, and high technology in two specialized units for residents with amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease, and multiple sclerosis.

The Chelsea Foundation raised about two-thirds of the cost from private donations, a feat most organizations have been unable to match, said Tom Burke, spokesman for the American Health Care Association, a trade group representing 11,000 nursing homes. Burke said that paltry government funding, which is the primary source for most nursing home construction, and a tight lending market have made it tough for the industry to build new homes.

“We clearly embrace the concept of Green Houses,’’ Burke said. “But cost is the number one impediment.’’

That’s why the AARP, a lobbying group for older Americans, is backing federal legislation that would establish a loan program for the development and construction of small nursing homes that embrace “culture change,’’ a movement, like the Green House projects, that focuses care on each resident’s preferences.

“Living in an institutional-like nursing home is something the AARP has been trying to change for a long time,’’ said Susan Reinhard, the association’s vice president of public policy.

Building costs aside, operational costs for Green Houses should be comparable to those of a traditional home, such as the Chelsea Foundation’s 123-bed nursing home across the city from the Leonard Florence Center, said foundation CEO Barry Berman.

Like other Green Houses, Chelsea’s project does away with traditional hierarchy, such as the higher-paid food and laundry services managers, and instead shifts that money to pay more to each home’s caregivers.

Jill Hreben, president and CEO of Otterbein Homes in Ohio, which operates four traditional facilities and 25 small homes similar to Green Houses, said that in the three years since it opened its first small home, the operating costs have been a wash. That allows the homes to be cost-competitive for consumers.

“We know that in order for this to work, we couldn’t price the rates greater than the rest of the market,’’ Hreben said.

At the Chelsea homes, most residents are covered by Medicaid or Medicare, which pay the home the same rate given to traditional facilities. But the small percentage of patients who pay out of their own pockets are charged about $425 daily, roughly $75 more than the going rate at traditional Massachusetts facilities.

Kay Lazar can be reached at

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