PALMYRA, Pa. -- Instead of a nursing station, the focus of activity at Castagna House is a homelike kitchen with double ovens and a long wooden dining room table.
The people who live here aren't called residents or patients, but "elders." Those who care for them are not nurse's assistants or aides; each is called a shahbaz, a Persian word that means "royal falcon." And antiseptic corridors are replaced with short, sunlit passageways leading to private bedrooms, a whirlpool bath, a living room with a fireplace and landscaped outdoor areas.
It doesn't sound like a nursing home, and for good reason. This unusual living arrangement is called a Green House - a progressive new way to care for the elderly in their last years of life. While licensed as nursing homes, Green Houses provide care in a home, not an institutional, setting.
"I've been in different places, and this is the first place I felt like I wasn't in jail. I'm not kidding," said George Hess, 90, who uses a wheelchair to move freely throughout Hostetter House, a neighboring Green House on the campus of Lebanon Valley Brethren Home. "The way they treat me, you would think I'm the only guy here."
Now the concept could be headed to Baltimore. This spring, a Baltimore nonprofit expects to receive approval from the Maryland Health Care Commission to start designing and planning four Green Houses, to be built at Stadium Place in Waverly.
The Green House is the brainchild of Dr. William Thomas, a professor at UMBC's Erickson School. He believes that elderly people who require 24-hour care should live in a homelike environment, where their very basic needs - happiness, privacy, relationships - come first.
New priorities
"That might seem strange for a doctor to say that love comes first, then comes medicine," said Thomas, widely regarded as a leader in the quest to change how nursing homes operate. "But if you really want to make a difference in people's lives, love has to come first."
The first Green Houses opened in 2004 in Tupelo, Miss. Since then, 35 others have opened, and, with funding from the Robert Wood Johnson Foundation, groups are planning additional models in 20 states - including the four in Northeast Baltimore.
Mitch Posner, executive director of Govans Ecumenical Development Corp., the nonprofit organization that plans to open the Baltimore Green Houses by 2011, called the concept "the gold standard" in long-term care.
"It's the most cutting-edge, 21st-century thinking when it comes to providing a housing, service-enriched environment for the frail elderly," Posner said.
Green Houses - so named because of their airy, sunlight-filled atmosphere - don't just feel different. They look different, too.
Many traditional nursing homes are set up like hospital wards, with long corridors of residents' rooms on either side of a nursing station. There are often 20 to 40 people on a ward; residents usually share a room and bathroom with a roommate.
The Green House model calls for no more than 10 elders living in the house. Each elder has a private room and bathroom; the rooms are situated around a large open kitchen, a living room and the dining room.
Eyes and ears
The elders eat together, assemble puzzles together and lounge in the living room together. Staffers who care for them act as housekeepers, cooks and friends. Nurses come in and out, assisting the staff, but not running the house as they do in traditional nursing homes.
As they cook meals or help elders with dressing or bathing, staffers keep a watchful eye and a trained ear for distress calls - or even more mundane needs such as a second cup of coffee or a better book to read.
Another key difference: Elders are not corralled to meals and activities if they choose not to be. If they crave a snack, elders - as well as their children and spouses - are free to grab one from the refrigerator, or from a fruit bowl or muffin tin sitting on a counter.
"You can eat your breakfast whenever you want to," said Leroy Patches, 77, who lives at Hostetter House with his wife, Caroline, in the one adjoining spousal suite each Green House offers.
"Down there," said Caroline Patches, 78, pointing to the traditional nursing home on the Lebanon Valley Brethren Home campus, "they bring it to you at 6:30 a.m." She grimaced at the thought.
Denise Swingholm, a nurse who comes daily to the two Green Houses on the central Pennsylvania campus, said residents are "eating better" and seem happier than they were at the traditional nursing home.
"They smile; they come alive more," she said. "At institutionalized nursing, it's all on a schedule. You can't change it, even if you want to. It's so frustrating."
Oppressive
Betty Schaeffer, a certified nursing assistant who went through additional training to be a shahbaz at the Hostetter House, said the scheduling at traditional nursing homes often is oppressive for the residents, too.
"This lets them be who they are," said Schaeffer. "They don't have to conform to what someone else wants them to do ... like with scheduled mealtimes or bedtimes. Some of them, they worked late shifts, or they've been night owls their whole lives. They're not going to change now, and why should they have to?"
At her Green House, Schaeffer knows which elders like to sleep late; which ones want tomato juice, not orange juice, for breakfast; and which skip the morning meal altogether. She can adjust meals for picky eaters - virtually unheard-of at traditional nursing homes - because there are two staffers on each shift.
Consequently, said Swingholm, "everybody has gained weight."
The fact that Schaeffer, Swingholm and other caregivers know their elders so well is a testament to Green Houses, Thomas said: "One of the great things about the Green House is that you no longer have to live among strangers."
Experts on aging say that the Green Houses - and other similar models, with small resident rosters and private, personal care - represent a new era of thinking for long-term senior care.
"I think what the whole model does is support the growing trend in the industry for people to age in place and age with their unique differences, and not try to impose a structure and an environment on them that limits their personal potential." said Eve Stern, president of SNAPforSeniors, a Seattle-based company that helps caregivers, providers and senior advocates find housing options for seniors.
And, Thomas said, Green Houses cost just about as much to operate as traditional nursing homes. "It isn't more profitable ... but it isn't less profitable either," he said.
Jeff Shireman, president of the Lebanon Valley Brethren Home, said it costs elders about $295 a day to live in one of the Palmyra Green Houses. "That's the same price for a private room in a regular nursing home," he said, adding that about half of the Green House residents receive help from Medicaid.
Although the staff members are paid a little more than nursing assistants, the Green Houses "don't need as many housekeeping aides, dietary aides, activity aides," Shireman said - because the house helpers do it all. "And there are other built-in savings that are hard to quantify."
Stern said the Green House model, though new, has had positive results.
"Studies have shown it reduces their incidence of depression and incontinence," she said. "And it fosters more independence."
In mild weather, seniors in Green Houses have free access to outdoor areas, which are fenced for the protection of those who suffer from Alzheimer's or other dementia-related illnesses.
Getting around
Because of the relatively short distances from their bedrooms to the kitchen and living areas, many seniors can do without wheelchairs and walk through the house, caregivers say.
And unlike at traditional nursing homes, where food is cooked in a distant location and carted in, meals at the Green House are prepared in the main kitchen - in the center of the home - allowing elders to pitch in with chores such as table-setting.
"It is as close as being able to be a home as you can get," said Sam Gearhart, 86, who still tears up when talking about the moment he realized he could no longer care for his wife, Kathleen, 93, now living at a Green House there. "They haven't forgotten a thing. Everything they do is a reminder of home. And memories are all that these people have left."
tanika.white@baltsun.com