It’s difficult to discuss design and person-centered environments these days without the topic of small-house or Green House design coming up in the conversation. Such was the case during the 2019 EFA Expo & Conference in Salt Lake City in April, where several presentations included mention of person-centered design and more than a handful covered the topics of neighborhoods and households.

The Green House model, pioneered by nonprofit The Green House Project (GHP) more than 15 years ago, features a small-house, person-centered design that is universal-design friendly and includes open kitchens, all-private rooms with bathrooms and access to outdoor spaces. GHP has more than 285 nursing and assisted living Green House homes in 32 states, and the success and proficiency of this model has been a driving force behind much of the innovation and disruption in senior living design since its inception in 2003.

These achievements prompted GHP to launch a new endeavor, known as Green House 2.0, in early 2019 that leverages the success of the Green House model by, among other things, expanding the scope of the organization’s work to improve the lives of elders. Green House 2.0 will give senior services providers the opportunity to implement GHP’s innovative principles and practices into their existing models.

One key element of this new endeavor is Cultural Transformation, an initiative that offers GHP consultation to providers of traditional skilled nursing and assisted living communities to help them implement substantive culture change via education, leadership development, and physical changes such as remodeling and/or repurposing spaces.

For example, a skilled nursing home in New England is implementing the initiative to educate its staff and “unpack” hierarchical frameworks that often come with traditional settings. While the community is planning to break ground on a new building soon, it wanted to invest in people by creating empowered staff and involve everyone in the decision making to create better quality of life and quality of care for everyone. Others are using GHP insights on design, space, and architecture. A life plan community in Florida utilized the approach as a reference and resource for the legacy redesign of a skilled nursing unit, including the repositioning of elevator banks away from the living room and the creation of front doors for each neighborhood to support a more person-centered, homelike environment.

Another aspect of Green House 2.0 is the organization’s expansion of short-term rehab Green House homes, which are excellent environments for rehabilitation services. Because each Green House home is built according to standards that include non-institutional open kitchens and bathrooms, a living room with a hearth in the center, and homelike laundry rooms and machines, residents can more easily undergo therapy that reflects the experiences they have in their home environments. This enables them to return to their own homes better equipped to navigate their familiar environments.

The model also allows providers to diversify their payer mixes by adding Medicare short-term rehabilitation services. The Woodlands at John Knox Village in Pompano Beach, Fla, created one of the first short-term rehab Green House homes in the country and has seen positive outcomes, including lower costs per episode of care ($12,348 in Green House home versus $13,470 in traditional short-term rehab facility) and decreased lengths of stay (20 days in Green House versus 28 days for other facilities).

In short, Green House 2.0 seeks to propel the organization’s leadership in small-house design to the broader community to further advance efforts to eradicate institutional models, destigmatize aging, and humanize care for all people.

Debbie Wiegand is director of operations for The Green House Project (Linthicum, Md.). She can be reached at