Rising Challenger Takes On Elder-Care System
The Wall Street Journal, June 24, 2008
In the spring of 2001, Bill Thomas, dressed in his usual sweat shirt
and Birkenstock sandals, entered the buttoned-down halls of the Robert
Wood Johnson Foundation. His message: Nursing homes need to be taken
out of business. "It's time to turn out the lights," he declared.
Cautious but intrigued, foundation executives handed
Dr. Thomas a modest $300,000 grant several months later. Now the
country's fourth-largest philanthropy is throwing its considerable
weight behind the 48-year-old physician's vision of "Green Houses," an
eight-year-old movement to replace large nursing homes with small,
homelike facilities for 10 to 12 residents. The foundation is hoping
that through its support, Green Houses will soon be erected in all 50
states, up from the 41 Green Houses now in 10 states.
"We want to transform a broken system of care," says
Jane Isaacs Lowe, who oversees the foundation's "Vulnerable Populations
portfolio." "I don't want to be in a wheelchair in a hallway when I am
85."
The foundation's undertaking represents the most
ambitious effort to date to turn a nice idea into a serious challenger
to the nation's system of 16,000 nursing homes. To its proponents,
Green Houses are nothing less than a revolution that could overthrow
what they see as the rigid, impersonal, at times degrading life the
elderly can experience at large institutions.
Susan Feeney, a spokesperson for the American Health
Care Association, which represents thousands of for-profit and
not-for-profit nursing homes, says the criticisms levied against the
industry by Dr. Thomas and his supporters are "overly harsh." She says
many nursing homes are embracing cultural changes to create a more
homelike feel. "While it may not be scrapping a large building...we are
changing," she says.
Green Houses
face a host of hurdles. Many Green House builders say they've
encountered a thicket of elder-care regulations. It takes enormous
capital to build new homes from scratch. Plus, experts say the concept
faces stiff resistance from many parts of the existing nursing-home
system. Traditional nursing homes, many of which care for 100 to 200
patients, are predicated on economies of scale -- the larger the home,
the cheaper it is to care for each individual resident.
Foundation officials acknowledge they don't know
whether Green Houses are a viable economic model. But they've decided
not to wait for an answer. Hewing to its recent strategy of making "big
bets" on ideas to change social norms, Robert Wood Johnson is investing
$15 million over five years -- one of the bigger grants the institution
has handed out to a single entity.
The foundation, which has $10 billion in assets, is
trying to encourage the building of Green Houses and is directing the
cash to NCB Capital Impact, a Washington, D.C.-based not-for-profit
that has been offering consulting, education, architectural and other
help to any party interested in operating a Green House. The foundation
is also studying the viability of Green Houses and says more support
could follow.
"Robert Wood Johnson is making an important investment
to try to make sure there is a sufficient cadre of early adopters of
the Green House model -- and research to make sure the model is
actually working," says Thomas Hamilton, who oversees nursing-home
quality and regulatory issues for the Centers for Medicare &
Medicaid Services. He says his agency is trying to coax nursing homes
into changing their cultures and adopting more humane,
"patient-centered" models such as the Green House.
Read more of this articleAbout Reverse Mortgages: Learn all about reverse mortgages at NewRetirement.com
Annuity Advice for Retirement: Evaluate and compare annuities at NewRetirement.com
NewRetirement Retirement Calculator: Assess your retirement plan with the NewRetirement Retirement Calculator.