title: The Green House Model of Nursing Home Care in Design and Implementation.
abstract: OBJECTIVE
  To describe the Green House (GH) model of nursing home (NH) care, and examine how GH homes vary from the model, one another, and their founding (or legacy) NH.
  
  
  METHODS
  Data include primary quantitative and qualitative data and secondary quantitative data, derived from 12 GH/legacy NH organizations February 2012-September 2014.
  
  
  METHODS
  This mixed methods, cross-sectional study used structured interviews to obtain information about presence of, and variation in, GH-relevant structures and processes of care. Qualitative questions explored reasons for variation in model implementation.
  
  
  METHODS
  Interview data were analyzed using related-sample tests, and qualitative data were iteratively analyzed using a directed content approach.
  
  
  RESULTS
  GH homes showed substantial variation in practices to support resident choice and decision making; neither GH nor legacy homes provided complete choice, and all GH homes excluded residents from some key decisions. GH homes were most consistent with the model and one another in elements to create a real home, such as private rooms and baths and open kitchens, and in staff-related elements, such as self-managed work teams and consistent, universal workers.
  
  
  CONCLUSIONS
  Although variation in model implementation complicates evaluation, if expansion is to continue, it is essential to examine GH elements and their outcomes.
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Lauren W
authors.initials: LW
authors.lastname: Cohen
authors.affiliation: Cecil G. Sheps Center for Health Services Research, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: David
authors.initials: D
authors.lastname: Reed
authors.affiliation: ISIS/ICOR, Salt Lake City, UT.
authors.forename: Patrick
authors.initials: P
authors.lastname: Brown
authors.affiliation: School of Nursing, University of Wisconsin-Madison, Madison, WI.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Bowers
authors.affiliation: School of Nursing, University of Wisconsin-Madison, Madison, WI.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Nolet
authors.affiliation: SLH Clinical Consulting, Scottsdale, AZ.
authors.forename: Sandra
authors.initials: S
authors.lastname: Hudak
authors.affiliation: Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Susan
authors.initials: S
authors.lastname: Horn
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006284:Health Plan Implementation / Q000379:methods*; D006707:Homes for the Aged / Q000458:organization & administration; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000458:organization & administration*; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000379:methods
keywords: Culture change; Green House nursing home; nursing home; person-centered care; staff empowerment