Green House homes

Evidence Rating  
Evidence rating: Some Evidence

Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.

Health Factors  
Decision Makers
Date last updated

Green House homes (GH homes) are self-contained, homelike dwellings for 10-12 elderly adults who require nursing home care. Oriented around a central living area, GH homes include private bedrooms and bathrooms, a residential-style kitchen, a communal dining area, and accessible outdoor space. GH homes provide various types of care such as skilled nursing, memory care, and short-term rehabilitation. Certified nursing assistants (CNAs), known as Shahbazim, serve as universal caregivers, conducting clinical, personal, and home care tasks such as preparing food, cleaning, and scheduling. Visiting clinical teams including nurses, doctors, nurse practitioners, physical therapists, and social workers also provide services to residents. GH homes can be part of large, traditional nursing home campuses or standalone facilities incorporated into the broader community1.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Improved quality of life

  • Increased direct care time

Potential Benefits

Our evidence rating is not based on these outcomes, but these benefits may also be possible:

  • Reduced hospital readmissions

  • Reduced preventable hospitalizations

What does the research say about effectiveness?

There is some evidence that Green House homes (GH homes) improve residents’ quality of life2, 3 and increase the amount of direct care time caregivers spend with residents4, 5 compared to traditional nursing homes. Additional evidence is needed to confirm effects.

GH homes may decrease rates of hospital readmission2, 6 and preventable hospitalization6, perhaps due to the amount of time Shahbazim spend with residents and early identification of potential health concerns4, 5. GH homes appear to provide quality of care equal to and, in some cases better than, traditional nursing homes2, 3. GH homes also appear to have greater staff retention than traditional nursing homes4.

The cost to operate GH homes appears to be comparable to traditional nursing homes and may be less in some circumstances7. Some practices core to Green House homes, such as universal caregiving staff and self-managed work teams, can be implemented in traditional nursing homes with little capital investment8

How could this strategy impact health disparities? This strategy is rated no impact on disparities likely.
Implementation Examples

As of Summer 2016, there are 205 Green House homes across 33 states1.

Implementation Resources

GH Project - The Green House (GH) Project. Caring homes for meaningful lives.


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1 GH Project - The Green House (GH) Project. Caring homes for meaningful lives.

2 Afendulis 2016 - Afendulis CC, Caudry DJ, O’Malley AJ, Kemper P, Grabowski DC. Green House adoption and nursing home quality. Health Services Research. 2016;51(S1):454–474.

3 Kane 2007 - Kane RA, Lum TY, Cutler LJ, Degenholtz HB, Yu TC. Resident outcomes in small-house nursing homes: A longitudinal evaluation of the initial Green House program. Journal of the American Geriatrics Society. 2007;55(6):832-9.

4 Brown 2016 - Brown PB, Hudak SL, Horn SD, et al. Workforce characteristics, perceptions, stress, and satisfaction among staff in Green House and other nursing homes. Health Services Research. 2016;51(S1):418–432.

5 Sharkey 2011 - Sharkey SS, Hudak S, Horn SD, James B, Howes J. Frontline caregiver daily practices: A comparison study of traditional nursing homes and the Green House Project sites. Journal of the American Geriatrics Society. 2011;59(1):126–131.

6 Bowers 2016 - Bowers B, Roberts T, Nolet K, Ryther B. Inside the Green House “black box”: Opportunities for high-quality clinical decision making. Health Services Research. 2016;51(S1):378–397.

7 Jenkens 2011 - Jenkens R, Sult T, Lessell N, Hammer D, Ortigara A. Financial implications of the Green House model. Seniors Housing and Care Journal. 2011;19(1):3-22.

8 Elliot 2014 - Elliot A, Cohen LW, Reed D, Nolet K, Zimmerman S. A “recipe” for culture change? Findings from the THRIVE survey of culture change adopters. The Gerontologist. 2014;54(Suppl 1):S17–S24.