Not a nursing home, but a nurturing home

"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."

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