This good news has generated considerable interest in the Green House model. More than 145 organizations attended a Fund-sponsored Green House workshop in 2006; more than 20 homes are in active development; and four Green House sites have recently opened. In addition, data from Kane's evaluation informed the decision by the Centers for Medicare and Medicaid Services (CMS) to include work related to organizational redesign in the agency's next contract with the Quality Improvement Organizations.⁽³⁾

Because of high real estate costs or other constraints, some nursing home providers may be unable to build Green Houses. But there are other structural improvements that providers can make to improve residents' quality of life. One such improvement is increasing the number of private rooms. Fund-supported research by Margaret Calkins, Ph.D., an architect and gerontologist with the IDEAS Institute, revealed that while construction costs may be higher for single rooms than for double-bedded rooms, enhanced revenue from private rooms quickly offsets these upfront costs.⁽⁴⁾ More important, homes with a high proportion of private rooms are attractive to residents and their families, giving such facilities a competitive edge in the marketplace. Calkins also found unexpected efficiencies related to single-room housing.

Nursing home culture change can be accomplished through channels other than physical reconstruction. The Pioneer Network, an organization that has spearheaded the culture change movement since 1997, is reaching out to providers across the country to offer training, practical tools and resources, and a shared community for those trying to transform their facility. Last year, with Fund support, the group offered "Pioneer Institutes" in Chicago, Denver, New York, and Portland, Ore., to teach providers about resident-centered care.

The Pioneer Network also held a Fund-sponsored symposium in Orlando for frontline nursing home staff—nurse assistants and other staff who provide daily hands-on care. Participants talked about how they have been involved with culture change, shared lessons, and learned how to become agents of change in their own facilities. The Pioneer Network participates in a number of long-term care policymaking advisory groups and is working closely with the Medicare Quality Improvement Organizations.