Green House Community Living Center opens soon; revolutionizes long-term care - Milwaukee VA Medical Center
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Milwaukee VA Medical Center


Green House Community Living Center opens soon; revolutionizes long-term care










Fred Kier explains to architect, Christian Braun, the "open eating" concept of the Green House Community Living Center. The first of four Green Houses is projected to open in late 2013.


A skeletal home of bare wooden beams and panels of drywall is visible on the east end of the Milwaukee VA campus.

By the late summer or fall of 2013, that skeleton will transform into a cutting-edge, long-term care facility known as a Green House, according to Fred Kier, the co-division manager of the Rehabilitation and Extended Community Care department.

“It’s very exciting,” said Kier, a geriatric psychologist, as he peered out a window overlooking the construction. “Last week they didn’t have any walls up.”

This Green House, with plans for three more, marks a significant and substantial step forward in the realm of nursing home care, Kier said. These Green Houses will look nothing like traditional nursing homes – and that’s exactly the point.

When they open, Milwaukee will be one of only three VA sites with this concept of nursing home care.

“This takes the institutional setting out of nursing home care, which is something we have been moving toward since 2006,” said Mary Pfeiffer, who also serves as co-divisional manager in RECC, but has a nursing background.

“Our current Community Living Center and the Green Houses will operate at the same time, and both serve a specific need. Because the Green Houses are cozier with private rooms, front porches and sun rooms, it will be much easier for people to adapt to that environment. They’ll offer more quiet and individualized care, which is ideal for those patients who have dementia or those who fare better in a quieter environment.”

Dr. Bill Thomas, a Harvard Medical School graduate, first proposed the idea of the deinstitutionalization of nursing homes when he founded the Eden Alternative in 2003.

Thomas is a self-proclaimed “nursing home Abolitionist,” and he and his wife, Judith Rebig, turned the assisted living model of care on its head when they created the Green House Project later that same year.

The movement focuses on a revolutionary small-house model of long-term care with a particular emphasis on elder vitality, respect, autonomy and dignity. This model of care redefines structural and cultural norms found in virtually all traditional nursing homes, Kier said.

Green Houses are small, self-contained homes that accommodate 12 or fewer residents. They feature private rooms and full bathrooms, along with family-style communal spaces like a hearth, a dining area and a central kitchen.

However, the homes can vary in size, amenities and structure, and may be built on a long-term care campus or in a residential neighborhood.

The houses will also provide patient-accessible patios, porches, walkways and gardens, or “green areas,” and will include many large windows to allow a great amount of natural light into each home.

These homes also make an effort to avoid the inclusion of nurses’ stations, medication carts and public address systems – all of which are common in the traditional hospital setting.

All of these factors combine to make the Green House as home-like as possible, and that is very important to Kier.

“In a hospital, you treat people and then get them back home, but in long-term care (the hospital) is their home,” he said. “Green Houses are homes that people live in where they can get care.”

Moreover, the Green House movement is not solely concerned with reconstructing nursing homes. It is based on a number of guiding principles that, together, represent a culture change in long-term patient care.

These principles include supporting the privacy and security of the residents, offering meaningful activities and promoting maximum functional abilities, according to the organization’s website.

The non-traditional nature of these homes even extends to the staff.

Historically, Certified Nursing Assistants are at the bottom of the care hierarchy, but, in a Green House, they are the ones responsible for meeting the residents’ needs on a daily basis.

CNAs function as a sort of universal worker, managing food preparation, laundry, personal care and patient growth and opportunity. They are always on-site with the residents while physicians, nurses, therapists and other professionals comprise a visiting clinical support team.

Full-time caregivers undergo 200 hours of training in culinary arts, dementia care and habilitation, and will oversee the day-to-day care of veterans while also building personal relationships. 

The Green House project has welcomed elders since 2003, and scientific research conducted within the last five years has detailed the benefits of that home-like environment.

Green house residents were less depressed and better able to perform daily, living activities longer than comparable residents of nursing homes, according to a Minnesota School of Public Health study published in 2007.

In 2009, researchers at the University of Minnesota found that individuals with family members in a Green House were more satisfied with and engaged in their resident’s care.

And two years later, the same group of researchers reported that resident-CNA interactions in a Green House promoted a more caring environment, interdependency and stronger ties compared to the traditional nursing home setting.

In light of all this evidence, Kier, along with Surgeon General Regina Benjamin, believes that the Green House model is the future of long-term care.

“And our veterans deserve the best care we can provide them,” he said.

-- By Steve Martinez, Milwaukee VA Public Affairs


Mary Pfeiffer, architect Christian Braun and Fred Kier

(left to right) look out one of the Green House's future

picture windows onto the main hospital.