RESIDENTS’ BENEFITS FROM TRANSFORMED ENVIRONMENTS NOT AUTOMATIC: STUDY OF SMALL-HOUSE HOMES IN THE U.S.

摘要

In a national study, we identified the universe of small-house nursing homes (S-NHs) i9n the US, including trademarked Green House Nursing Homes (GH-NHs). We described implementation in 48 SH-NH models in which the unit of care are self-contained houses or apartments with under 16 residents; we site visited 10 S-NH projects for in-depth study, The model required simultaneous transformation of physical environments; all staff roles and reporting structure; and philosophy of care—the latter towards individualization and quality of life. In many instances, we observed resident-directed lifestyles that would have been impossible in traditional NHs. Transformed environments were essential but insufficient without supportive staff behavior and organizational policies. Implementation was an arduous process, and conscious effort was needed to avoid regression to institutional models. This presentation is illustrated by photographs, which we find an important adjunct to research, education, quality control, and advocacy.