Home Is Where the Hearth Is: New Models for Nursing Homes

David Nolan of Chi Partners

Innovative nursing homes are reinventing themselves with the idea that smaller is better. How do regulations hinder and help this nascent movement?

April 2012

Innovative nursing homes across the nation are aspiring to become less institutional — a move that is saving costs and improving quality of care and quality of life for residents. These "small home" long term care facilities feature private rooms and bathrooms, working kitchens as a focal point for social activity, and consistent staff who administer individualized care.

The slideshow below presents an inside look at one example of the small home approach to nursing facilities.

  • A REAL HOME - Loss of independence negatively impacts seniors who are transitioning from their residential homes into nursing facilities. Small home models, like this Green House home, help residents feel independent and in control.
  • COOKING TOGETHER - Daily decisionmaking can help seniors stay mentally healthy. Residents and caregivers work together to plan and prepare a meal in this Green House home.
  • BREAKING BREAD - When caregivers participate in daily routines, they enjoy their work more and provide better care. Everyone dines together at a common table in this Green House home.
  • THE HEARTH - Socializing helps seniors stay mentally and physically healthy. Mary and Alice, residents and friends, enjoy each other’s company next to the hearth, the social hub of this Green House home.
  • PART OF THE COMMUNITY - This Green House home was built in the style of the surrounding residential community.
  • WE ARE FAMILY - Visits from family members and friends are important to the health and well-being of nursing facility residents.
  • MEAL PREP - It has been shown that involvement with meal preparation can have a positive impact on nursing facility residents. These Green House residents enjoy cooking together.
  • MAKING MUSIC - Continuing the activities that they love and that bring meaning to their lives is important for nursing facility residents.
  • HEALTHY HOBBIES - Having hobbies and caretaking responsibilities has been shown to increase seniors’ sense of well-being.
  • EVERYDAY LIFE - Staying busy and engaged helps keep seniors healthy. The kitchen in this Green House home, like any residential home, is the center of social activity.
  • BLENDING IN - This Green House home was designed to blend into the community.

Regulatory agencies find themselves challenged to keep pace. Some design elements conflict with current regulations, while others conform well. All provide an opportunity for agencies to update regulations to reflect this evolution in how people want to live when they get older.

This issue brief focuses primarily on the Green House model of alternative nursing home design and highlights two facilities in California that are exploring renovations. The report examines the regulatory and licensing challenges faced by skilled nursing providers wishing to transform their institutions, discusses regulatory changes in process in California, and summarizes lessons learned from three states that have successfully implemented these alternative nursing home models.

The complete issue brief is available as a Document Download.