A feasibility study commissioned by the Osage Health Authority Board concludes that the tribe should build what would be a first in Oklahoma: A “Green House” model assisted living facility that would serve seniors in friendly, cottage-like shared homes rather than providing care in an impersonal institutional setting.
The study, by retired Cherokee Nation Home Health Chief Executive Rick Richards, provides insight into the needs of Osage elders, and says that the Green House model, which consists of homes that house 10-12 seniors living essentially as family, would work best not just for elders but also for the Nation because the smaller homes are easier to staff and less expensive to maintain.
In addition, Richards noted, the smaller homes can be built in clusters or by themselves, which would allow the Nation to build them in various towns – and allow elders to remain in their respective communities: “As a people, the Osage tribe has a very strong sense of community that they wish to maintain.”
Green House homes are praised by experts as a game-changer in elder care, places where seniors blossom and enjoy life rather than wither in loneliness.
The nearest Green House assisted living facilities are in Arkansas and Kansas and the Health Board is scheduled to visit homes in Kansas this week. Most recently, the board toured another small facility operated by the Comanche Nation in Lawton – not a Green House model, but a small facility with just 12 beds.
The data show a need
Richards’ study delves into much detail about the current needs of Osage elders.
Pawhuska is home to the largest number of Osage and Native American elders, with 263 Osages over 55 and a total of 523 Natives. Hominy has 203 Native elders, of whom 95 are Osage, followed by Fairfax with 181 (103 Osage), then Barnsdall with 129 (32 Osage).
Skiatook, which straddles the border between Osage and Tulsa counties, is home to 469 senior Native Americans, of whom 110 are Osage.
In all Osage County communities plus its bordering areas, there are 3,739 Native elders, 808 of whom are Osages, Richards’ study reported.
Among those elders, more than 22 percent need help bathing, one-quarter of them have a disability, and almost a fifth of them live at or below the poverty level. The number living in poverty is likely to rise thanks to the current inflation rate, Richards observed.
Those numbers make the smaller, more intimate model Richards recommends for assisted living viable, although he wrote that services to Osage elders have suffered from labor shortages that hit rural areas particularly hard and were exacerbated by reductions in the number of community health representatives and public health nurses in the past few years.
“The workforce reduction created a lack of community presence and reduced the positive community impact the CHRs and public health nurses have had in the past,” Richards wrote. “This lack of community presence combined with the labor shortage in the home care industry as well as two years of Covid-19 restrictions have greatly increased the need for direct care and support services for elders.”
Residents spring back to life
The “Green House” model was developed in 2001 by Dr. Bill Thomas, a geriatrician at the University of Maryland who fights what he calls “the medicalization of old age,” or treating aging as a disease for which there is no cure, with medical care dispensed in an institutional setting that actually hastens mental and physical decline, as Jane Brody reported in the New York Times.
The first Green House opened in Tupelo, Miss., in 2003.
Brody reports that in that first Green House, the “atmosphere is homelike and the staff, dressed in street clothes, considers the residents to be their bosses — it is commonplace for debilitated elders to, in effect, come back to life.
“Mildred Adams typifies the transformation. Ms. Adams had for several years been cared for in a nursing home where, her family said, she had ‘deteriorated physically and mentally,’ needed help eating and rarely spoke. But within an hour of moving to the alternative environment of the first Green House … Ms. Adams was completely transformed. At her first meal there, she grabbed the spoon from her son, fed herself, raised her glass and started singing ‘Amazing Grace.’”
In 2005, the Robert Wood Johnson Foundation issued a $10 million grant to help building 50 more Green House homes around the country. When Covid hit, it turned out the smaller homes were very effective at preventing the spread of the virus among elders at a time when the disease ripped through traditional nursing homes.
The concept is simple: The small homes house 10-12 seniors in private rooms with private baths. Family style meals are provided based on what the elders want to eat, not an institutionally-planned menu. The homes have no loudspeakers, medical signage, alarms, carts or restraints. Family members and children are welcome to visit, and all are encouraged to cook and engage in other activities such as exercise and entertainment, on their own terms, not in a manner dictated by staffers wielding schedules.
Generally, Green House homes have more staff per resident than a traditional assisted living facility but Richards said that it was doubtful that the sparse population of Osage County would be able to support a 40-bed traditional facility. The 10-12 bed model, on the other hand, would be more attractive to families, residents and staff, which would create the opportunity for more growth down the road, Richards wrote.
Human benefits outweigh cost
Care for those who live in Green House homes (as well as other assisted living facilities) is paid for by Medicare, Medicaid or private insurance or funding. In Oklahoma, the average cost of assisted living is $3,200 a month, according to Richards.
The cost of building a 40-bed institutional facility would run about $7.5 million, and, assuming 95 percent occupancy, would generate almost $2 million in revenue and cost about $1.52 million to operate, including salaries and food but not costs such as insurance, furniture and other fixtures.
A Green House, would run about $1.87 million, generate $525,000 in annual revenue and cost about $495,000 to operate, excluding insurance, furniture and fixtures.
The profits are slimmer at a Green House, but the benefits are immeasurably greater.
Steve McAlilly, the president of Methodist Senior Services in Mississippi which built the first Green House, was out of the country when contacted by the Osage News, but continues to be a huge fan of the system. He told Brody that the transformation of elders has been nothing short of miraculous.
“People who were in wheelchairs are walking again. People who weren’t eating real food are eating again. People who weren’t talking are talking again. People who were losing weight no matter what we did are gaining weight,” he said.
It is of paramount importance, he added, that Green House becomes the standard model for elder care: “It’s almost sinful not to do as much as we can, as fast as we can.”