Small Buildings Put The 'Home' Back in Nursing Homes
The Chicago Tribune Primetime -- Question: If you needed nursing or long-term care, would you rather live in a homelike environment or a place more like a hospital?
In truth, most people would probably prefer to stay in their own homes. But if that weren't possible, a place with a comfortable living area, big open kitchen and other cozy features would probably be a good second choice.
That thinking spurred what's referred to as the Green House or small house movement. Instead of moving the elderly who need extra care into a nursing home, seniors live in a house with only a handful of others. A small staff knows the residents and takes care of all their needs.
"The care is more personal and the small house creates a relaxed atmosphere," says Ray Hemphill, executive vice president at Providence Life Services, a seniors housing and care provider based in suburban Tinley Park. "Anybody would choose the house over a 150-bed nursing home."
Providence Life Services is one of many organizations nationwide building small houses as an alternative to big nursing homes. Providence has a new small house facility under way at Victorian Village, a retirement community in Homer Glen that has independent living apartments and townhomes, along with assisted living units.
The new small house facility is a three building complex. Two buildings will have 10 private bedrooms, each with their own bathroom. The bedrooms circle a common area with a lounge, library and dining area. The third building will have 30 rooms for those who need short-term nursing care after surgery or an illness. Construction is expected to be complete by May and residents will move in by the end of June.
Green House roots
The small house or Green House movement took shape in the early 1990s. The idea originated with Dr. Bill Thomas who thought frail seniors should live in a homelike atmosphere. Today, about 150 official Green Houses exist nationwide. Another 120 projects are in development. In Illinois, Green Houses are open at the Veteran's Administration campuses in Danville and North Chicago.
Other care providers have adopted the model of small scale settings, though not necessarily the official Green House name. Rooms are divided into neighborhoods or clusters that share common areas such as dining and living rooms. Staffers are assigned to certain neighborhoods so they get to know the residents.
Peg Meinhold, 90, lives in a 16-room cottage at Silverado Lake Zurich, which specializes in caring for those with memory loss. Meinhold has Alzheimer's disease and has lived at Silverado full time for the past 12 months. "The community arrangement is ideal for someone like my mother," says Joyce Wagner, Meinhold's daughter, who visits her mother about four times a week. "My mother came from a quiet home."
The small group living arrangements has helped Wagner's mother to flourish. "The socialization and interaction has stimulated my mother," says Wagner, who notes that her mother now initiates conversations whereas previously she could only manage one or two-word answers to questions. Wagner recently spent an afternoon putting together scrapbooks with her mother and other residents. "These residents consider each other friends," she says.
The building design also encourages family members to get to know other residents. Wagner has developed relationships with the residents and even refers to them as her "aunts." She says, "It's nice to sit and hold a hand and talk. I'm part of the group environment."
Silverado Lake Zurich has four buildings or cottages. Residents are grouped according to their abilities. Those with early stage dementia receive a lot of social support and stimulating activities, according to Diana Iacobucci, administrator at Silverado Lake Zurich. Those in the end stages of the disease receive sensory type therapies. "Appropriate programming is available regardless of the resident's abilities," Iacobucci says.
There is no central building, but each building has its own staff. Walking paths connect the buildings and residents can use the paths to visit the other cottages. The layout of each cottage is similar with the resident's rooms circling the common areas. "There are no long hallways," says Iacobucci. Also, residents can choose a private or shared suite.
Each cottage has its own living room, dining room and kitchen. Meals are prepared on site. Residents enjoy the smell of food cooking, says Iacobucci. "It's like walking into a real home."
Small house goes big
The small house concept is also being introduced at large facilities. Big buildings are divided into neighborhoods or so-called households of rooms and residents.
Silverado recently opened a new facility in Naperville — a single building divided into different neighborhoods. Silverado also has buildings in Highland Park and Morton Grove that are divided into neighborhoods in order to provide residents with personal care.
Architect Dan Cinelli — managing partner for 10 years at Perkins Eastman in Chicago, who now works in the company's Washington, D.C. office — helped design a number of Green House and small house projects. The firm evaluated its Green House projects two years after residents moved in and found that no one had tried to leave. "All the residents said the (small house) felt like home," Cinelli says.
Perkins Eastman is currently in the final stages of designing a 23-story high-rise in Manhattan using the small house concept. The new building — a project of the Jewish Home & Hospital LifeCare System — will replace a large institutional-type nursing home with 700 residents. The new building will have only 400 residents. Each floor will have two households or neighborhoods. The elevator lobby on each floor will have two doors on either end leading to a 10-bedroom household. Each household will have its own kitchen, dining room and screened-in porch.
The small house model is also evolving. New prototypes being developed by Perkins Eastman include several rooms that are more secluded from the common areas. In the original Green House concept, the rooms all face the common areas. The new prototype also includes a garage for the building's van to transport residents, and an activity room for residents to work on projects.
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