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Many people think of nursing homes as grim places where residents often seem bored, lonely and sad. But now, some reformers are experimenting with a new kind of nursing home. Instead of an institutional setting, they want to provide a homelike atmosphere for residents.

Among the leading proponents of this kind of nursing home reform is Dr. William Thomas, who calls his vision the Green House Project. It is based on a simple idea: Older people will thrive in a nursing home if it is built to resemble living in their own home. Others have tried to make existing nursing homes more homelike. The Green House project makes the nursing home over from scratch, the goal being to give residents more privacy and more control over their lives.

At the center of the Green House or House Hold as we will call it, is quality of life, meaning worth and dignity. At the House Hold, these things are at the center of life. Each House Hold, has two nurse aides or shahbazim (elder assistant) that are on duty in each home most of the day. These shahbazim have specialized training and are responsible for running the home, including cooking meals and doing house chores. The shahbazim are a self-managed work team that are coached by an administrator or guide. Registered nurses, doctors, and other medical staff serve a number of House Holds and are available when needed.

Research on the effects of the House Hold concept compared to traditional nursing homes has shown the following:

• Residents reported significantly higher scores on happiness, contentedness, and looking forward to the future.
• Residents also had greater satisfaction with their home as a place to live compared to residents in a traditional nursing home.
• Residents had lower rates of: depression, bed rest, reduced activity, and decline in functional abilities.
• Family members of residents were more satisfied than family members of traditional nursing home residents
• Job satisfaction was higher in house hold nursing homes and turnover rates were significantly lower than the national average for nursing home staff.

In summary, the House Hold concept is clearly challenging traditional views of nursing homes. House Hold homes provide an environment where residents receive the medical care and support they need without it becoming the focus on their existence. By emphasizing resident quality of life and altering the size, interior design, staffing patterns and methods of delivering skilled nursing services to residents, a House Hold home is creating a much needed rethink in the nursing home field.