Why Greenhouse Nursing Homes are Rising in Popularity

No one relishes the thought of putting a loved one in a nursing home. However, often comes the point when the appropriate care cannot be provided at home and a difficult decision must be made. Traditionally, feelings of guilt and despair would accompany the choice. No one wants to put a parent or elderly relative into a place they don’t want to be. Enter the Greenhouse Project.

What Is The Green House Project?

There is an alternative to the traditional nursing home model. It’s beginning to take hold all over the country. It’s called the Green House Project, and it provides nursing home care in facilities that are homelier and more comforting for its residents.

Green House Project homes look like actual homes, with 10 to 12 residents in each. These elders are cared for by compassionate staff who focus on the quality of life for each elder.

The Greenhouse Project is a new way of looking at care for the elderly. It is an evidence-based model for senior living. The project builds on the most natural way to do three things: care, live, and thrive.

Caring in greenhouse nursing homes involves nurturing the residents in a circle of care. There is a deep relationship between elders and caregivers. The model for green house homes reverses the typical institutional, organizational chart.

Caregivers In Greenhouse Homes

Caregivers determine the best way to provide care and work in teams to the benefit of each resident. There are very few layers of management. Care providers work as a team to provide activities that elders want to participate in. The elders have input into the activities that are available.

Living in green house homes is more like living in your own home. Between ten and twelve people live in each Green House Project home. Each person has a private bedroom and bath. There is an open kitchen and a great room.

Greenhouse project homes are designed to harmonize with the surrounding community. They have ample access to the outdoors. Each home meets the state and federal licensing requirements for nursing care facilities.

Thriving in a greenhouse project home is important. It is the result of respect for personal preferences and flexible routines. The homes feature a common dining area. The dining area is where residents gather for meals and socialize. Friends and family of residents are always welcome. The staff encourages the residents to pursue their own interests and passions. In this way, they encourage their personal growth. There is a focus on living, learning, and growing, in contrast to the traditional nursing home.

Green House Project History

The Green House Project began in 2001 by Dr. Bill Thomas and Steve McAlilly. Thomas is a geriatric physician. McAlilly was CEO of Mississippi Methodist Senior Services. The men approached the Robert Wood Johnson Foundation. They had the idea that elders should live in real homes, not in institutions.

They wanted to provide long term care in smaller, more personal setting. The buildings would look and function like a home. The foundation agreed to fund their vision. The Green House Project built its first home in 2003 in Tupelo, Mississippi. Since that time, the organization has built for veterans and low-income seniors. They have also built homes for residents who require short-term rehab services.

Before founding the Green House Project, Dr. Thomas was a co-founder of the Eden Alternative. The Eden Alternative has a similar mission but implements in a different way. Like the Green House Project, the Eden Alternative focuses on person-directed care. It focuses on changing the way care is provided in existing facilities. The Green House Project creates new facilities designed to offer care in this way.

This video explains the history and concept of the Green House project:

How Are The Homes Staffed?

Homes that are part of the Green House Project use a new staffing model. This model is different from that of most long-term care facilities. The basis of the staff is the Shahbaz. A Shahbaz is a direct care provider. They manage the home, work in a team that manages itself, and partner with clinical team members. The Green House Project boasts lower staff turnover and four times more engagement of staff with elders.

The word Shahbaz is ancient Persian word. It means the king’s falcons. The word represents the philosophy of the Green House Project. The philosophy is valuing and empowering the staff. After all, it is the staff who provide the all-important daily care and nurturing to residents. The role of the Shahbaz is to help the elders negotiate old age and find the joy and goodness in their advanced age.

There are several roles occupied by Greenhouse Project staffs, including:

  • Guide – Responsible for supervising the Shabazim
  • Sage – Elder who lives locally and mentors the work teams
  • Clinical Support Team – Comprised of nurses, therapists, and dietitians

The Green House Project Difference

The concept of Green House Project was developed to effect a change in the culture of elder care. Some new approaches include:

Taking a proactive approach. This is to align with the natural rhythms, preferences, and patterns of each elder. The elders are encouraged to keep to their own schedules. They can participate in things they enjoy doing. They do not have to stick to a schedule set by the staff.

A daily community meeting. This engages elders in making decisions that affect the house and the way it is managed.

Care planning is a collaborative practice. It takes place between the Shahbazim, the elder, and their family. The planning focuses on forming deep and knowledgeable relationships.

There is a focus on attaining the highest practicable level of wellness of each elder in the home. This includes physical, social, and mental wellness.

Elders are encouraged to bring personal effects and treasures. They should decorate their rooms as they would like. This helps provide a feeling that is more like home. It also helps the staff and other residents get to know one another.

For Green House Project adopters, the language used reflects the philosophy. Instead of the facility, they say “community” or “home.” Individual is a term used in place of “resident” or “patient.” What others call ‘activities’ are termed ‘meaningful engagement.’

All these ways challenge the existing paradigm of nursing home care. They are making the vision of the Green House Project a successful reality.

The Impact On Healthcare Costs

A 2012 study compared the differences in Medicare and Medicaid costs. It looked at the cost of care in traditional nursing homes and Green House homes. The study looked at 13 sites, 9 of which were Green House sites, and 4 of which were traditional nursing homes.

The study looked at 255 residents. 97 were from Green House homes and 158 from traditional nursing homes. When they were admitted, the residents had comparable conditions. They needed comparable amounts of care. The study collected data from June 2004 until September 2009.

The study looked at the 12-month hospitalization rate. It was seven percentage points higher for nursing home residents. Also, those in Green House homes had better functioning during the period of the study. This led to lower Medicaid expenditures. The total cost savings over 12 months for a Green House resident was estimated at $1,300 to $2,300. This was compared to the cost for a resident in a traditional nursing home.

The Centers for Medicare and Medicaid Services, or CMS, recently updated their regulations. The new regulations support the values of the Green House Project. These regulations are regarding the quality of life and care. In these new regulations, CMS changes some of their languages. It has made it more focused on the elder as opposed to their condition. This is like the language used by the Green House Project.

Medicare and Medicaid reimburse Green House Project homes. Reimbursement is the same as it is in a traditional nursing home. For private pay residents, the homes set their own rates. They do this in accordance with the supply and demand in the local market.

Level Of Care

A Green House Project home can provide the same level of care as a traditional nursing home. Home regulations are just like all other skilled nursing facilities. They must meet all the requirements. The difference is that the Green House Project home looks like an actual home. It does not look like an institution.

Green House Project homes accept Medicare and Medicaid. Reimbursement works in the same manner as traditional nursing homes. Residents in Green House Project homes have lower costs due to the greater personal and social contact they receive.


As of May 2017, there are over 200 Green House Project homes in more than 30 states.

Many more homes are under development. There are Green House homes for low-income elders, veterans, and short-term rehab patients.

Green House Project homes appear in both suburban and urban areas. There are homes in low- moderate- and upper-income areas. The homes blend into the surrounding neighborhood. This makes residents feel as though they are part of the larger community.

The founders of the Green House Project feel that this model is the future of nursing care.


The Greenhouse Project is aiming to put a different spin on traditional assisted living for seniors. This alternative option has been good for many elders in need of care who are seeking something different than a common nursing facility. Do you have a loved one who has lived or is currently residing in a Greenhouse Project facility? We encourage you to share below in the comments section!

Photo of author

Stevie Compango, CNSC, CPT

Stevie is Certified Nutrition Specialist and Certified Personal Trainer for the past 10 years. He specializes in mobility and chronic pain management. His methods have helped thousands of clients improve the quality of their life through movement.

Recommended Articles


  • The transformation of institutional long-term and post-acute care, https://thegreenhouseproject.org/

  • See It and Believe It, https://thegreenhouseproject.org/find-a-home/tour-green-house/

  • See It and Believe It, https://thegreenhouseproject.org/find-a-home/tour-green-house/
  • Green House Blog, https://blog.thegreenhouseproject.org/
  • Regulation and Guidance, https://www.cms.gov/regulations-and-guidance/regulations-and-guidance
  • The transformation of institutional long-term and post-acute care, The Green House Project, https://thegreenhouseproject.org/

    • The transformation of institutional long-term and post-acute care, The Green House Project, https://thegreenhouseproject.org/