ANALYSIS OF GREEN HOUSE HOME PERFORMANCE - Five-Star Quality Rating System - Across Domains - Nursing Home Care

Sep 29, 2026

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Green House (GH) nursing home care, characterized by smaller units, empowered staff, and a resident-directed approach, is linked to culture-change innovation. This analysis connected 53 GH sites to CMS data using the Five-Star Quality Rating System, comparing GH homes with other nursing homes across overall star rating, health inspections, staffing, quality measures, and related indicators. GH sites outperformed national averages in most metrics, including higher staffing and quality measure ratings, while showing fewer low-star results in every domain. Weekend staffing remained notably stronger in GH sites, and GH-only campus sub-analyses indicated even larger differences.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Abstract

Study design and data sources

Comparative performance across CMS domains

Staffing, weekend levels, and quality outcomes

Innovation in Aging, 2025, Vol. 9, No. S2 1159 Abstract citation ID: igaf122.3884 ANALYSIS OF GREEN HOUSE HOME PERFORMANCE ACROSS DOMAINS OF THE CMS NURSING HOME FIVE-STAR QUALITY RATING SYSTEM Dan Andersen1, Marla DeVries2, Margaret Calkins3, Christina Schilstra4, Patrick Miller4, and Susan Ryan5, 1. Explore Digits, Sykesville, Maryland, United States, 2. AgingIN, Linthicum Heights, Maryland, United States, 3. IDEAS Institute, Cleveland Heights, Ohio, United States, 4. Explore Digits, Rockville, Maryland, United States, 5. Center for Innovation, Linthicum, Maryland, United States The Green House (GH) model of nursing home care, characterized by fewer beds per unit, empowered staff, and a resident-directed philosophy, has long been associated with culture change innovation. To evaluate GH performance on national metrics of quality, we linked 53 sites that include GH homes to CMS data sources including the Five-Star Quality Rating System. We compared sites with GH homes to all other nursing homes across multiple domains: overall star rating, health inspections ratings, staffing ratings, quality measure ratings, and individual indicators such as case-mix adjusted staff time and quality measures. Sites with GH homes outperformed the national average across most metrics. For example, 78% of sites with GH homes received a 4- or 5-star rating for staffing compared to 31% nationally; sites with GH homes provided 56% more adjusted nurse aide time than the national average; and 68% of sites with GH homes earned a 4- or 5-star rating for quality measures compared to 49% of non-GH sites. Sites with GH homes also demonstrated fewer low-star ratings across every domain. Weekend staffing levels, a common area of decline in traditional homes, remained significantly higher in sites with GH homes. These differences are even more pronounced in a sub-analysis of GH-only campuses (i.e., sites with no traditional nursing home beds), though this subgroup was not reported separately due to small sample size. These findings suggest that adopting the GH model supports consistently higher quality outcomes, reinforcing its potential as a scalable strategy for improving nursing home care nationwide.

FAQs

What nursing home model is evaluated and what is its defining philosophy?

The Green House (GH) model is evaluated, emphasizing fewer beds per unit, empowered staff, and a resident-directed philosophy.

How was GH performance assessed using CMS metrics?

The study linked 53 GH sites to CMS data sources, including the Five-Star Quality Rating System, then compared GH sites to other nursing homes across multiple quality domains.

What were the main results comparing GH sites with non-GH nursing homes?

GH sites outperformed the national average on most metrics, including higher staffing and quality measure star ratings, more adjusted nurse aide time, and fewer low-star ratings across every domain.

Sep 29, 2026

Upload by Adam