Redefining elderly care: elegant suburban homes are more hotel than hospital

The Green House Project seeks to offer older people autonomy, with nurses providing care in buildings nearly indistinguishable from neighbors houses

You could almost mistake it for a student house-share.

Ten bedrooms, a gaggle of residents hanging out in the living room, exotic smells coming from the kitchen and pullout couches for people to stay the night.

But the fridges are stocked with fruit juice instead of cheap beer; the only drugs on offer are prescription meds. And the average age of the tenant is over 80.

Is this the future of elderly care? Four elegant homes on a tree-lined suburban block in West Orange, New Jersey, personalised schedules, care plans and mealtimes, adaptable care workers and a vibe that is more hotel than hospital.

The model, developed by a group called the Green House Project, likes to say it puts the elders at the center of the programme, giving them as much autonomy and independence as possible within the confines of a space that still has skilled nurses on hand to work with the retirees.

Susan Ryan, the Green House Projects senior director, said the model upends the traditional organizational structure in a care home to give older people the power to make the decisions, regardless of their physical condition.

We really place value on who that person is and the rich life that person has lived, Ryan said. The world is looking: how do we solve the problem of global ageing?

It certainly is. The number of people worldwide over 60 is expected to more than double over the next 30 years to around two billion by 2050. All across the world, according to the UNs 2012 report on global ageing, people are caring for their ageing relatives at home less and relying more and more on facilities to house older relatives in the final stages of life.

But the alarms have sounded on the quality of this care and people are working to improve the treatment offered to people in their final stages of life. The Green House Project has been pioneering a new approach, and has over the past 10 years expanded to a network of 204 homes in 29 states.

The company has fielded calls from all over the world, including Germany, the UK and Australia, and Ryan recently gave a Chinese businessman a tour of one of the Green House facilities.

Ryan said she was a director of nursing for long-term care when she realized the elderly care system was broken.

Our best practices were not really enabling elders to live any type of quality of life, Ryan said. And even what we were doing in terms of trying to bring the best quality of care fell way short of what I felt in my heart was good.

She moved to home care, but that is exclusive to people who can afford its steep price tag. And she found that it was an incredibly isolating experience for residents. It felt like there was still something missing, Ryan said.

At Green Hill in West Orange, the answer is that the residents are in charge. If a resident worked night shifts her whole life and wants to continue that nocturnal lifestyle, its permitted. Residents get to choose their breakfasts, which are prepared by aides, and lunch menus are customized to match their preferences.

Green Hill, the West Orange Green House facility Photograph: Amanda Holpuch for the Guardian

Josephine DeLillo, who has lived in a Green House home for one year, said she has an arrangement so she can skip lunch, after her hearty breakfast of toast and oatmeal, and save the meal as a late-night snack. Whatever you need, they are ready to get it for you, DeLillo said.

She said she had control over all aspects of her care, from the social activities to the pictures in her room. Thats the way I like it and thats the way it is, she said.

Green Hills executive director, Toni Lynn Davis, said that to create an environment where older people are comfortable asking for these things, and workers are comfortable giving them, she must unteach peoples understanding of hierarchy, which is a bad word at the Green House Project.

Davis described herself as a servant-leader and said this lack of a hierarchy ensured workers and residents were empowered to make the best environment and communicate when something falls apart. This structure is also reflected in the design Davis does not hold keys to any of the homes and must ring the doorbell to get in. If she shows up unannounced, she is just as likely to be chided for the violation of protocol as a part-time worker.

Each Green House home is designed to look like other homes in the communities they are based in whether it is a townhouse in New York City, a lodge in Alaska or a suburban home in West Orange. The four houses there sit alongside a tree-lined, winding road that runs through the neighborhood, just like in the surrounding communities. It is not obvious that this is a fenced-off property and that the residents are locked in their homes. At night, deer walk through the area.

The home setup is a bit like a communal house that university students would live in there is plenty of seating, reading material and art on the walls. The living rooms have enough space for exercise and plenty of couches that can pull out as beds for family members who may want to stay the night or aides who cant get home because of bad weather.

Medication is dispensed from a locker in each persons room, instead of a medication cart trolling the halls, and medical equipment is hidden in administration offices and in storage areas. Two people brought their own bedroom furniture and one residents family covered her wall with medical conference ribbons she had earned during her long career as a doctor.

The design is meant to treat what the Green House Projects calls the three plagues: loneliness, helplessness and boredom.

Many times I hear people come in because they got tired of eating alone thats the one reason above care, above need, above anything else I just got tired of eating alone, Davis said.

So she teaches workers at every level to speak with residents whenever they get the chance and, if someone seems unhappy, to ask about it. She said that sort of day-to-day contact is more valuable than scheduled activities and happens when staff feel empowered to do it as part of their job.

We all need and crave intentional community, and the family has been that community for us, said Ryan. But now we have people living much longer than it was ever envisioned. We need to figure out a dignified system that can help support people into those late years.

This piece is part of our Half-full series. If you have suggestions of stories, trends, innovations and people that youd like to see included in this series, please share them in the form below.

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