Revolutionizing Eldercare in Mississippi

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There’s a unique experiment in housing in Tupelo, Mississippi, that is reimagining what life can be like for elderly Americans.

Ten single-story houses line a lakeside driveway, each with up to 12 residents who each get their own bathroom and bedroom. In the center of each home there’s a living room with couches around a fireplace, along with an open kitchen, laundry room, and a dining area for home-cooked meals every evening.

It sounds like a larger-than-average house for college roommates, except for a few key differences. Every resident is retired — the average age is 80 and there is a full-time, paid staff to look after them. The houses are a few minutes away from major hospitals, and various doctors’ offices are around the corner. There are no beeping monitors, long hallways with patients pushed around in wheelchairs, or shared spaces for sleeping. Contrary to the rules at most Mississippi nursing homes, some of the houses also have dogs, cats, and birds as pets.

The Traceway Retirement Community, part of a larger retirement campus that also includes assisted living apartments and a rehabilitation center, became home to the first "Green House" in the country 17 years ago. The concept is shorthand for an effort to deinstitutionalize eldercare to allow those in the last stages of life to live in a homelike atmosphere, away from the needles, constant nursing-staff visits, and hospital-like feel of many nursing homes, as well as the social isolation of in-home care.

Most of the nation’s Green Houses — now numbering in the hundreds — are nonprofits run by women, as is the Maryland-based Green House Project organization that certifies them. 

“I’ve never seen anything like this before, and I’ve worked in elderly care for 15 years,” said Traceway administrator Kasie Wood, who took on her position three years ago. “The whole point here is to make people feel like they are living in their own space in comfort. Some even bring in their own recliners and furniture.” 

According to the National Center for Health Statistics, there are 1.6 million Americans living in the 17,000 nursing homes that operate in the country today. The industry has grown tremendously since Medicare and Medicaid were created in the 1960s. The average nursing home has 107 beds. Many are several stories high or spread out over large campuses, and about a quarter are nonprofits.

"The whole point here is to make people feel like they are living in their own space in comfort. Some even bring in their own recliners and furniture."

The Green House concept, which was founded in 2003 by Mississippi Methodist Senior Services CEO Steve McAlilly and geriatrician Bill Thomas, aims to reduce what organizers have described as the “enforced dependency” that traditional nursing homes tend to foster.

Today, the Linthicum, Maryland-based Green House Project nonprofit certifies and provides guidelines for around 300 houses.

“Greenhouse, one word, is a way to create the optimal environment to produce the best growth in plants,” said Susan Ryan, the senior director of the Green House Project and a former director of nursing. “Green House, two words, is a way to produce the best environment for the best growth in people who work and live there. It’s shifting the paradigm of long-term care.”

Reclaiming the End of Life

Like traditional nursing homes, Green Houses have certified nursing assistants on staff, though they go by a different name: shahbazim. The Persian word, plural for shahbaz, refers to a guardian, and the workers at Green Houses are trained to do housekeeping, laundry, and cook meals, as well as provide emotional support and friendship to residents. 

Candi Cann, a Baylor University associate professor of religion whose research focuses on rituals around death and dying, said the houses fit into a trend of people more positively reclaiming the end of life.

“People think of a nursing home as a place you go to die,” said Cann. “It seems the Green Houses are reclaiming them as a way to live your life. It’s valuable at a time when a lot of people are getting shut away and dismissed by society or no longer seen as necessary.”

While many Green Houses cost more to build and maintain than the average nursing home because of their smaller size and more personal staffing, others are equal in cost for elders and their families. In Tupelo, Traceway charges about $7,000 a month per resident. That’s around the same cost as the average private room in a nursing home, according to government data.

"People think of a nursing home as a place you go to die. It seems the Green Houses are reclaiming them as a way to live your life. It’s valuable at a time when a lot of people are getting shut away."

Ryan said Green Houses are an attempt to reframe the views of nursing homes, of which “the public generally does not have a good perception — especially during the coronavirus pandemic.”

Residents and staff of eldercare homes have accounted for around 40% of the more than 200,000 deaths linked to COVID-19. Green Houses haven’t avoided the virus entirely, though their smaller size has made outbreaks less widespread. According to a recent study, around 95% of Green Houses have had no cases.

In Tupelo, Wood said restrictions due to the pandemic are still in place, which have put a damper on the homelike community she usually works hard to sustain.

“None of the families can come visit residents right now; they can just make visits through a window. That’s a state regulation,” she said. “But when it’s safe to come visit again, we want to make this space feel like home more than ever.”

Tags: Social Justice

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JD Turner

JD Turner is a writer and puppy parent based in Los Angeles. See Full Bio

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