title: The effects of the Green House nursing home model on ADL function trajectory: A retrospective longitudinal study.
abstract: BACKGROUND
  Growing attention in the past few decades has focused on improving care quality and quality of life for nursing home residents. Many traditional nursing homes have attempted to transform themselves to become more homelike emphasizing individualized care. This trend is referred to as nursing home culture change in the U.S. A promising culture change nursing home model, the Green House nursing home model, has shown positive psychological outcomes. However, little is known about whether the Green House nursing home model has positive effects on physical function compared to traditional nursing homes.
  
  
  OBJECTIVE
  To examine the longitudinal effects of the Green House nursing home model by comparing change patterns of activities of daily living function over time between Green House home residents and traditional nursing home residents.
  
  
  METHODS
  A retrospective longitudinal study.
  
  
  METHODS
  Four Green House organizations (nine Green House units and four traditional units).
  
  
  METHODS
  A total of 242 residents (93 Green House residents and 149 traditional home residents) who had stayed in the nursing home at least 6 months from admission.
  
  
  METHODS
  The outcome was activities of daily living function, and the main independent variable was the facility type in which the resident stayed: a Green House or traditional unit. Age, gender, comorbidity score, cognitive function, and depressive symptoms at baseline were controlled. All of these measures were from a minimum dataset. Growth curve modeling and growth mixture modeling were employed in this study for longitudinal analyses.
  
  
  RESULTS
  The mean activities of daily living function showed deterioration over time, and the rates of deterioration between Green House and traditional home residents were not different over time. Four different activities of daily living function trajectories were identified for 18 months, but there was no statistical difference in the likelihood of being in one of the four trajectory classes between the two groups.
  
  
  CONCLUSIONS
  Although Green House nursing homes are considered to represent an innovative model changing the nursing home environment into more person-centered, this study did not demonstrate significant differences in activities of daily living function changes for residents in the Green House nursing homes compared to traditional nursing homes. Given that the Green House model continues to evolve as it is being implemented and variations within and across Green House homes are identified, large-scale longitudinal studies are needed to provide further relevant information on the effects of the Green House model.
authors.affiliation: School of Nursing, University of Wisconsin-Madison, Signe Skott Cooper Hall 3117, 701 Highland Avenue, Madison, WI 534792-2455, USA. Electronic address: yoon26@wisc.edu.
authors.forename: Ju Young
authors.initials: JY
authors.lastname: Yoon
authors.affiliation: School of Nursing, University of Wisconsin-Madison, Signe Skott Cooper Hall 4187, 701 Highland Avenue, Madison, WI 534792-2455, USA. Electronic address: rlbrown3@wisc.edu.
authors.forename: Roger L
authors.initials: RL
authors.lastname: Brown
authors.affiliation: School of Nursing, University of Wisconsin-Madison, Signe Skott Cooper Hall 5113, 701 Highland Avenue, Madison, WI 534792-2455, USA. Electronic address: bjbowers@wisc.edu.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Bowers
authors.affiliation: Health Management Strategies, 9600 Escarpment Blvd, Suite 745-21, Austin, TX 78749, USA. Electronic address: ssharkey@hmstrat.com.
authors.forename: Siobhan S
authors.initials: SS
authors.lastname: Sharkey
authors.affiliation: International Severity Information Systems/Institute for Clinical Outcomes Research, 699 East South Temple, Suite 300, Salt Lake City, UT 84102-1282, USA. Electronic address: shorn@isisicor.com.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Horn
mesh_terms: D000203:Activities of Daily Living; D008137:Longitudinal Studies; D009735:Nursing Homes / Q000592:standards*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies
keywords: ADL; Culture change; Growth curve modeling; Nursing home; Outcome; Person-centered care