Residents and staff share meals at a long table beside an open kitchen, with breakfast made to order.
Only 10 resident rooms can be found, with heated floors and individual temperature controls, just steps from a common area with an electric fireplace and reclining chairs.
On Monday afternoons, a bar rolls out for happy hour. There’s a two-drink limit, but that didn’t stop Henry Hintz from beaming when naming his favorite cocktail, an Old Fashioned.
“It’s the spice of life!” said Hintz, 80, who lives at Wisconsin’s only Green House nursing homes, in Oshkosh, touted as a revolution in long-term care.
“It’s quality of life we’re really interested in,” said Andrea Ohman, manager of two 10-bed Green House nursing home buildings at Lutheran Homes of Oshkosh.
Nursing homes, traditionally marked by long, institutional corridors designed to be efficient for staff, are trying to become more “home-like” and “resident-centered,” industry authorities say.
Green Houses — started nine years ago in Tupelo, Miss., with more than 130 open in 21 states today — are a prime example.
“That’s where we want to be,” said Keith VanLanduyt, a vice president of Oakwood Village, which plans to replace or renovate its 100-bed nursing home on Madison’s West Side. “Based on our land and the financial restrictions, how close can we get to that?”
Wisconsin’s two nursing home associations asked the state in March to expand incentives to replace or remodel aging facilities. An existing program that boosts Medicaid payments for approved projects at nursing homes with up to 50 beds isn’t enough, the groups say.
A typical nursing home loses $900,000 a year through Medicaid, the state-federal health plan that pays for two-thirds of the care, so many facilities can’t afford upgrades on their own, they say.
“We want to put nursing homes on a modern pathway,” said John Sauer, president of Leading Age Wisconsin, which represents nonprofit nursing homes. “But it’s not going to happen on a major scale unless the state steps up.”
‘A home in the community’
Beth Kaplan, spokeswoman for the state Department of Health Services, said the agency is working on the proposal with the nursing home groups.
“Together we are looking at ways to support modernization while staying within current budget parameters,” Kaplan said in an email.
Some newer nursing homes in Madison have elements of the Green House model, described by the Arlington, Va.-based Green House Project as “a de-institutionalization effort designed to restore individuals to a home in the community.”
St. Mary’s Care Center, which opened on Madison’s Southwest Side in 2002, has eight “neighborhoods,” each with two “households” of 11 or 12 rooms. Each household has a dining area and kitchen.
Fish tanks, aviaries and libraries can be found in two large atriums, with concerts in the summer near a gazebo. All but 32 of the 184 beds at the nursing home, Dane County’s largest, are private.
“It makes people feel more like they’re at home,” said Barb Bowers, a UW-Madison nursing professor who specializes in long-term care.
Badger Prairie Health Care Center, a 120-bed, county-run nursing home that opened in Verona last year, has all private rooms, private half-baths and 12 small kitchens, with wood floors. The old facility had up to three beds per room.
“It’s more person-centered,” said Kim Marheine, supervisor of the ombudsman program for the Wisconsin Board on Aging and Long Term Care.
Meanwhile, many nursing homes are taking part in quality improvement programs, such as the Wisconsin Clinical Resource Center, to try to reduce falls, bedsores and other problems.
Attic Angel Place in Middleton, for example, lowered its rate of new residents having to be sent back to the hospital from 20 percent in 2010 to 13 percent last year, said administrator Derek Buckley.
Changes in care delivery
Lutheran Homes got $10 more per Medicaid resident per day from the state’s incentive program to open its two Green Houses in Oshkosh in late 2010 and early 2011.
The Craftsman-style buildings, which each cost $1.1 million, were part of a $12 million project that also included a 30-bed rehab center, said Kris Krentz, vice president of health care services for Lutheran Homes.
The complex replaced 50 beds at Bethel Home, a 46-year-old nursing home three miles away. Bethel went from having 200 beds to 150 beds.
Many of the Green House residents came from Bethel Home.
They were screened for many factors, including whether they would do well in a more intimate environment without big group activities, Krentz said.
Several of the Green House residents have chronic diseases or dementia, illness levels “very much the same” as at other nursing homes, said Ohman, the administrator.
The fee, $275 a day, is comparable to other facilities, she said.
One reason Green Houses are affordable is the way care is delivered, Ohman said.
Instead of hiring employees for specific jobs — cooking, housekeeping, doing laundry, giving baths — each Green House is staffed by two certified nursing assistants who perform all of the duties. In Oshkosh, one nurse dispenses medications at both buildings.
The nursing assistants — called “shahbazim,” from a Persian myth about a protective falcon — report directly to Ohman, who is known as a guide.
Since the shahbazim run most aspects of the houses, they get to know each resident well, Ohman said. “The idea is to bring the decisions of the house to the person closest to the elder,” she said.
Green Houses are expected to open next year at the Veterans Affairs medical centers in Milwaukee and Tomah.
Studies cited by the Green House Project say residents have higher satisfaction levels, less physical decline and less depression than those in traditional nursing homes, while receiving more direct care for similar needs.
Choice and flexibility
In Oshkosh, the residents wake up when they want to, Ohman said.
Many feel comfortable using walkers, instead of wheelchairs, to go the short distance from their rooms to the common area, she said.
For breakfast, they can order eggs, pancakes, oatmeal, cereal or other items, said Trina Manns, one of the shahbazim. Sometimes the residents bake together. Lunch and dinner are prepared at the rehab center next door but warmed up in ovens at the Green Houses.
Medical carts are replaced by locked medication cabinets in each room. Puzzles, scrapbooks and art work assembled by residents are on display.
Indoor and outdoor porches offer glimpses of wild turkey and deer. Coat closets inside the front doors give visitors the sense of entering a home.
On a recent day, a CD of Doris Day’s “Sentimental Journey” was wafting through the common area before kindergartners came to color and sing with residents.
Jack Hartman dropped in to see his mother, 100-year-old Viola Marshall. After transferring from Bethel Home to the Green House, she couldn’t be happier, Hartman said.
“There, she didn’t want to come out of her room,” he said. “Here, you can’t keep her in it.”