he concept of patient-centered care—care delivered in accordance with the needs and desires of patients—is starting to gain traction in health care, including the field of long-term care. When Congress passed the Omnibus Budget and Reconciliation Act of 1987, new standards for nursing home quality were put in place, giving resident-centered care a statutory basis and stimulating a handful of providers and long-term care professionals to think creatively about how nursing homes could be transformed.
From these beginnings, efforts to move the culture of nursing homes from an institutional model to one centered on residents have attracted the attention of providers, consumer advocacy groups, and government agencies. The Picker/Commonwealth Program on Quality of Care for Frail Elders is deeply involved in these efforts. The projects it supports seek improvement in nursing home quality by testing and evaluating emergent models of resident-centered care and promoting nursing home "culture change" among stakeholder groups.
One of the most revolutionary ideas for what nursing homes should be comes from William Thomas, M.D. He argues that if nursing homes function as residents' homes, they should be built on a residential scale. Thomas has developed a model for small group homes, which he calls Green Houses, and a system for providing care that borrows from home care rather than the acute care practices that have shaped the industry.
With Fund support, the University of Minnesota's Rosalie Kane, M.D., has evaluated the first four Green Houses, which were built in Tupelo, Miss. Kane has found that, compared with their counterparts at older facilities, Green House residents, staff, and families are more satisfied and residents function at higher levels. Kane is now analyzing the business case for the Green House model, and the Robert Wood Johnson Foundation is supporting its replication.
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