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Skilled nursing facilities continue to face challenges in the midst of the pandemic, but a new report shows SNFs could learn from the Green House model. Learn how the Green House model may have helped limit the spread of COVID-19 in senior living communities.

COVID Business Operations

SNFs Using Green House Model May Fare Better During Pandemic

  • Emily Buswell
  • 9/9/2020

Key insights

  • COVID-19 has amplified the challenge for SNFs to recruit and retain direct care staff.
  • Alternative operating styles, like the Green House model, could provide potential solutions for traditional SNFs.
  • Green House models appeared to help contain staff infections and prevent the spread to patients more effectively than the traditional model does.
  • CLA has a wealth of resources to help SNFs get through these trying times.

We recently discussed how difficult it is for skilled nursing facilities (SNFs) to recruit and retain direct care staff. The worldwide pandemic has only amplified those problems. Aside from low pay, inadequate benefits, and tough work, direct care employees put their own and their families’ safety at risk as they combat COVID-19 in senior living facilities. Many direct care workers have decided it just isn’t worth it, making employee retention that much more difficult.

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The article noted above explores the Eden Alternative and Green House models as potential solutions to the staffing problems in the senior living arena, but new research suggests that one style may also help limit the spread of coronavirus infections. Learn how the Green House model appears to fare better against COVID-19 than other models do.

The Green House model

Residents live in small homes of up to a dozen people with a shared living room, kitchen, dining room, and outdoor space. They have private rooms and restrooms, and residents can decorate their space as they wish. Children and pets are allowed as visitors. The typical nursing station is replaced by a private medicine cabinet in each individual’s room, and an adjustable track and roll-in shower allows residents to bring themselves to the restroom.

Certified nursing assistants (CNAs), called Shahbazim under the Green House model, are trained to provide more services than those offered in a traditional facility, which includes cooking, cleaning, and laundry. Employees work with a small group throughout the day and have the opportunity to develop close bonds with residents. Shahbazim and residents participate together in daily meetings, where residents have the power to make their own decisions and schedule for the day.

Green House homes may fare better against COVID-19

In partnership with the University of North Carolina, the Green House Project is conducting research to determine COVID-19’s impact on Green House model facilities versus traditional homes. The research will be ongoing through at least December. In the meantime, the researchers have issued an initial report with their findings from a study via an emailed questionnaire of 68 organizations, including 298 Green House homes. The data covered February through May 2020.

The average traditional facility had 62 resident cases of COVID-19, which resulted in 27.5 deaths. The average Green House, comparatively, had 13 cases and less than one death. Traditional homes averaged 39.5 staff cases and 0.5 staff deaths compared to 27.6 staff cases and 0.41 staff deaths at Green House facilities. Remarkably, 95% of Green House homes surveyed were free of COVID-19.

The difference between the number of patient cases in the two models is much larger than the difference between the number of staff cases in the two models. Green House models were somehow able to contain staff infections and prevent the spread to patients much more effectively than traditional homes.

Potential reasons why COVID-19 spread was contained

The physical design of a Green House facility may be more conducive to isolating the virus. Residents are grouped together in a small home with personal medicine cabinets and restrooms, which may prevent the spread of germs. Small staff groups work with the same cohort of residents, which potentially limits exposure.

Furthermore, the direct care employees have more one-on-one interaction with residents at a Green House home, so changes in condition could be noticed and addressed sooner. For the few Green House residents that did contract the virus, caregivers were likely able to identify symptoms early.

Green House home staff also report high job satisfaction. Many traditional homes struggled to maintain adequate staffing during the pandemic and were forced to outsource caregivers. It’s possible staff in Green House homes had less turnover and fewer new faces within their facilities.

How we can help

SNFs continue to face many challenges beyond staffing and infection control in the midst of the pandemic. Operating costs have increased significantly due to the need for continuous testing, personal protective equipment, and shortages on supplies. CLA has a wealth of resources to help you navigate through these trying times. Reach out to speak to one of our teammates, or visit our COVID-19 page for more information.

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