The Green House Model, a Nursing Home That Feels Like a Home

What is the Green House model?

The Green House model is an approach to nursing home design that replaces one large institutional building with a cluster of small, home-like houses, each licensed as part of the same certified nursing home and organized around a household of residents rather than a hospital-style unit. It keeps the same skilled nursing, 24-hour supervision, and rehabilitation a traditional nursing home provides 1Ref 1National Institute on Aging (NIH) (2023).Assisted Living and Nursing Homes.Nursing homes provide skilled nursing, 24-hour supervision, and rehabilitation, distinct from assisted living's help with daily activities.; what changes is the physical space and daily routine, not the underlying license or the services covered.

Meals are typically cooked in an open kitchen within each house rather than delivered from a central kitchen, bedrooms are private, and the staff assigned to a house tend to stay consistent from day to day rather than rotating widely across a large building. This kind of small-home nursing model is implemented by individual organizations rather than run as a single national chain, so specific design details vary somewhat from one home to the next. Daily schedules also tend to be built around residents' own preferences rather than a fixed institutional timetable — when someone wakes, eats, or joins an activity looks closer to how it would at home than to a shift-driven facility routine, even though the underlying licensed care being delivered is the same.

Why does the model look this way?

The Green House model responds to a long-running critique of traditional nursing homes: that a large, institutional building with double-occupancy rooms, a central nursing station, and a rotating staff roster can feel more like a hospital than a home, even for someone who will live there for years. Some of that critique lines up with research into the harm caused specifically by involuntary transfers and relocations within nursing-home care, which are associated with measurable adverse outcomes for residents 2Ref 2Montoya A, Park P, Bynum J, Chang CH (2024).Transfer Trauma Among Nursing Home Residents: Development of a Composite Measure.Involuntary transfers and relocations among nursing-home residents are associated with measurable adverse outcomes..

Smaller households, private rooms, and consistent staffing are meant to reduce the kind of disruption and depersonalization a large, rotating institutional environment can produce, even when the clinical care being delivered underneath it is otherwise the same. A resident moving between wings within one large building, or being reassigned to unfamiliar staff after a shift change, is exactly the kind of relocation and inconsistency that a small-household design tries to avoid by keeping both the physical space and the people in it more stable.

Is a Green House home still a regulated nursing home?

Yes. A Green House home operates under the same licensing and certification as a traditional facility, and it is rated the same way, through CMS's Five-Star Quality Rating System, which combines recent health-inspection results, staffing levels, and clinical quality measures into an overall score 3Ref 3Centers for Medicare & Medicaid Services (2026).Five-Star Quality Rating System.The CMS Five-Star system rates each certified nursing home 1-5 stars overall and on three domains: health inspections, staffing, and quality measures.. The home-like design does not exempt it from the inspections, staffing requirements, or public reporting that apply to any certified nursing home.

That is a meaningful reassurance for a family evaluating one: the same public tools used for vetting a nursing home apply here too, including its inspection report, so a Green House home's actual safety and staffing record is checkable rather than something to take on faith just because the building looks different. A home-like design says nothing on its own about whether a specific facility is well run — that is exactly what the public inspection and staffing data are for.

What does it cost compared with a traditional nursing home?

A Green House home is a licensed, certified nursing home rather than a separate, lower-cost category of care, so its costs generally sit in the same range as any other nursing home rather than closer to assisted living. Nationally, a private nursing home room averaged $127,750 a year in 2024, up 9% from the prior year, and a semi-private room averaged $111,325 4Ref 4Genworth Financial / CareScout (2025).Genworth and CareScout Release Cost of Care Survey Results for 2024.2024 national median annual nursing home costs: a semi-private room averaged $111,325 (+7%) and a private room averaged $127,750 (+9%)..

Actual pricing for a specific home depends on the state, the room configuration, and what level of skilled or subacute care is being provided — the same variables that drive cost at any nursing home. Private rooms as a standard feature, rather than an upgrade, can also shift where a specific Green House home lands within that broader cost range compared with a traditional facility offering mostly shared rooms.

How to evaluate a Green House home before choosing one

The same approach to vetting a nursing home applies to a Green House home: check its CMS Care Compare rating and inspection history 5Ref 5Centers for Medicare & Medicaid Services (2025).Finding a Nursing Home.CMS consumer guidance on locating and evaluating a nursing home, including using Care Compare and inspection information., and use the official Medicare nursing home visit checklist covering rooms, activities, safety, staffing, and dementia care during an in-person tour 6Ref 6Centers for Medicare & Medicaid Services (2022).Questions to Ask When You Visit a Nursing Home (Nursing home checklist).The official Medicare nursing home visit checklist covers rooms, activities, safety, staff, and dementia care, and recommends visiting more than once before deciding.. Reading the admission agreement closely still matters here too, just as it does at any nursing home.

Because the Green House model relies heavily on consistent staffing within each small house, it is worth asking specifically how a home handles staff call-outs, turnover, and overnight coverage — the model's benefits depend on that consistency actually holding up day to day, not just on the building's design. Visiting at more than one time of day, including a meal and an evening shift change, tends to reveal whether a home's day-to-day rhythm actually matches its description.

Is the Green House model available everywhere?

Not every nursing home operates this way, and availability depends heavily on location. The model requires a different building design and staffing structure than a traditional nursing home, so a facility has to be purpose-built or substantially renovated to offer it. A family interested in this specific model may need to search more broadly across a region rather than assuming a nearby, generically built nursing home offers it, and confirming directly with the facility is the only reliable way to know. Calling ahead to ask whether a facility identifies as this kind of small-home model, rather than judging from marketing photos alone, is a reasonable first step before scheduling an in-person tour.