The traditional nursing home model is undergoing a revolutionary transformation through The Green House Project, a groundbreaking approach to elder care that prioritizes dignity, autonomy, and quality of life. This innovative model replaces sterile institutional environments with small, home-like communities where seniors can maintain their independence while receiving the skilled care they need.
At Rubin, Glickman, Steinberg & Gifford, we understand the importance of quality care for seniors and recognize how the Green House Project represents a significant step forward in addressing the shortcomings of conventional nursing home facilities. When families are researching care options for their relatives, understanding this model can help them make informed decisions about the best environment for their situation.
Understanding the Green House Model
The Green House Project emerged in 2003 as a response to the limitations of traditional nursing homes. Created by Dr. William Thomas, the project recognizes that nursing homes were “aging faster than the people living inside them” and aims to replace institutional models with small intentional communities where elders and staff focus on living full and vibrant lives.
Unlike conventional facilities that may house hundreds of residents, Green House homes serve only 10 to 12 elders in residential-style houses located in community neighborhoods. Each resident has a private room and attached bath, while sharing central living spaces with an open kitchen, dining area, and access to outdoor spaces.
The philosophy behind Green House homes centers on three core values: real home, meaningful life, and empowered staff. This approach seeks to eliminate the “enforced dependency” common in traditional nursing homes by creating environments that foster late-life development and growth.
Key Features That Make Green Houses Different
The staffing model in Green House homes differs significantly from traditional nursing facilities. Care is provided by versatile workers called Shahbazim, who handle personal care, meal preparation, and housekeeping duties. They operate within a non-hierarchical structure and are supported by Guides who coach and supervise them, along with clinical staff who visit regularly.
Residents in Green House homes experience unprecedented control over their daily lives. They can decide when to wake up, what to eat, and how to spend their time. The person-centered approach encourages choice and independence, with normalized daily activities like helping with laundry or setting the table for meals.
The physical environment also plays a crucial role in the Green House model. These homes look and feel like typical residential houses, complete with comfortable living areas, open kitchens where meals are prepared fresh, and gardens or outdoor spaces that residents can enjoy freely.
Proven Benefits of the Green House Model
Research has consistently demonstrated the advantages of Green House homes over traditional nursing facilities. Studies show that residents experience increased reports of mobility and social interaction, along with fewer reports of weight loss and depression compared with those living in conventional nursing homes.
A comprehensive evaluation found that Green House elders report improvements across all seven domains of quality of life: privacy, dignity, meaningful activities, relationships, autonomy, food enjoyment, and individuality. Additionally, Green House homes provide 23-31 minutes more direct care per resident per day than traditional facilities and offer more than four times as much staff engagement with elders outside of direct care activities.
Addressing Concerns About Elder Care Quality
While the Green House model shows promise, families should remain vigilant about the quality of care their relatives receive in any long-term care setting. Even in innovative environments, issues such as neglect, inadequate staffing, or substandard medical care may still occur.
When problems arise in nursing facilities, whether traditional or alternative models, residents and their families have legal recourse. The majority of Green House residents pay out of pocket, although most homes accept Medicare for short-term care, and 45% are covered by Medicaid. Regardless of payment method, all facilities must meet established standards of care.
Signs of potential problems include unexplained injuries, falls, medication errors, or significant changes in a resident’s physical or mental condition. Families who notice concerning patterns should document their observations and consider seeking legal guidance.
The Future of Elder Care
Since 2003, nearly 400 Green House homes have opened across the United States in 35 states, with more in development. This expansion demonstrates growing recognition of the need for alternatives to traditional institutional care.
However, challenges remain in making this model more widely available. Construction costs, regulatory requirements, and reimbursement structures can create barriers to developing new Green House communities. Advocates call for increased state and federal investment, along with eliminating regulatory barriers that discourage innovative approaches to long-term care.
The success of Green House homes may influence broader changes in how society approaches elder care, potentially leading to improved standards and practices across all types of facilities.
Rubin, Glickman, Steinberg & Gifford: Protecting Seniors’ Rights
Whether your relative lives in a Green House home or a traditional nursing facility, they deserve compassionate, competent care that respects their dignity and meets their needs. When facilities fall short of these standards, legal action may be necessary to protect residents and prevent future harm. We have represented families across Pennsylvania for over 65 years, and our commitment to justice has earned recognition as a “Best Law Firm” by U.S. News & World Report every year since 2010.
Our attorneys understand the complexities of nursing home regulations and the unique challenges families face when dealing with elder care issues. If you have concerns about the quality of care your relative is receiving, we can help you understand your options and determine the best course of action. Contact us today at (215) 822-7575 or through our online contact form to discuss your situation with our knowledgeable legal team.
Rubin, Glickman, Steinberg & Gifford P.C.
Pennsylvania Attorney's
September 30, 2025
