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Post-Occupancy Evaluation of a Transformed Nursing Home: The First Four Green House Settings

The Issue

The Green House innovation represents a radical departure from the traditional nursing home setting. These small, self-contained dwellings incorporate physical design changes, like private bedrooms and bathrooms and a residential-style kitchen, while eschewing institutional hallmarks, such as nursing stations and public-address systems. The Green House also transforms organizational and staff roles by giving broader responsibilities to frontline staff.

What the Study Found

In an article in the Journal of Housing for the Elderly, researchers Lois Cutler and Rosalie Kane report on findings from their Commonwealth Fund–supported evaluation of four Green Houses in Tupelo, Mississippi, during which they assessed the physical components of the homes during their first two-and-a-half years of operation to determine how well the environment served residents, staff, and visitors. The authors found that residents and their families appreciated the physical design, including the private rooms and baths and the common spaces—kitchen, dining area, and hearth—which conveyed to them a sense of normal living. Among the staff, it also engendered pride. With the emphasis on creating a residential setting, however, there may have been insufficient attention paid to building an environment that supported care tasks—as evidenced by a lack of storage space for nursing home services.


The evaluation offered many ideas for design improvement, the authors conclude. But the findings also demonstrate that changing the physical environment is not always sufficient. Staff must help residents take advantage of the setting, and they must consciously avoid old institutional habits.

Publication Details



L. J. Cutler and R. A. Kane, "Post-Occupancy Evaluation of a Transformed Nursing Home: The First Four Green House Settings," Journal of Housing for the Elderly, Oct. 2009 23(4):304–34.