Hollins and her nine housemates are part of two national efforts that some say are the gold standards of care for the nation\u2019s oldest residents. The goal is to delay nursing home care, or even prevent it altogether.<\/p>\n
The first initiative is this Green House<\/a> home \u2014 a communal living arrangement that stresses a home-like environment where relationships flourish. Crucially, they restore decision-making to older residents, such as allowing them to choose what they would like prepared for dinner. They also empower front line staff.<\/p>\n The \u201cpower of normal\u201d<\/p>\n Susan Ryan, CEO of Aging Innovations<\/a>, calls it \u201cthe power of normal.\u201d<\/p>\n By design, Green House homes are small<\/a> \u2014 10 to 12 people, compared with nursing homes, which can house more than 100 residents and employ hundreds of staff.\u00a0<\/p>\n In Detroit, there are two Weinberg Green Houses<\/a>. Unlike others that stand alone as houses, these two Green House homes are on the second and third floors at the Thome Rivertown Neighborhood for older adults.<\/p>\n Rather than ever-present medication carts, nursing stations, and dining hall trays of a nursing home, there are private rooms and an open kitchen. Residents who can help do so \u2014 setting the large dining room table for dinner or folding laundry, for example.<\/p>\n Hollins and her housemates help choose their meals that staff prepare in an open kitchen that invites casual conversation during meal prep. Residents share meals at the dining room table.<\/p>\n In the open shared space, housemate Debra Robinson, 66, is laying out plates and silverware for the smothered chicken and gravy now finishing in the oven. Another housemate, Robert Betty, 77, is letting others know that dinner\u2019s nearly ready.<\/p>\n It\u2019s a communal approach that, compared to the decision-making of a nursing home hierarchy, restores \u201ccontrol, dignity, and a sense of well-being\u201d to residents, or \u201celders,\u201d as they are called, Ryan said.<\/p>\n \u201cIt\u2019s ensuring that elders are allowed to have access to some of the same, same things that the rest of us have access to,\u201d she said. \u201cWe don\u2019t live in institutions. Why would elders live in institutions?\u201d<\/p>\n The weekdays are equally individualized.<\/p>\n One-stop shop\u00a0<\/p>\n Every morning, at about 9 o\u2019clock or so, the elders meet at the front door of their second-floor home in the Thome Rivertown Neighborhood near downtown.<\/p>\n Their destination: a national service called the Program of All Inclusive Care for the Elderly<\/a>, or PACE. This one-stop shop downstairs fills their days with music, dance, exercise and, last week, a 47-piece local orchestra for entertainment.<\/p>\n But it also houses a team of social workers, doctors, podiatrists, dentists and others. Together, they ensure the kind of care that \u2014 when delivered routinely \u2014 will tamp down the odds of these residents and other PACE participants ending up in a hospital and then a nursing home.\u00a0<\/p>\n In this sprawling space, the Green House residents will join about 350 other older Detroit area residents throughout the week. They arrive \u2014 most coming from their own homes and independent- or assisted living homes \u2014\u00a0 on PACE buses.<\/p>\n Each person is eligible<\/a> because they have been deemed medically fragile enough for a nursing home. The idea, though, is to keep them in the community.<\/p>\n \u201cWe want to help them maintain their independence, their dignity,\u201d said Sicily Baker, day center manager.<\/p>\n In addition to two hot meals each day, there are dances, movies, exercise classes and field trips as well as physical therapy and visits to the doctor or social worker \u2014 all in this same collection of rooms.\u00a0<\/p>\n On this particular morning, smooth jazz spills from a speaker in one room, as residents eat breakfast or catch up on their days.\u00a0<\/p>\n Some residents sew or fill in coloring books or crossword puzzles.<\/p>\n Others scroll through phones.<\/p>\n \u201cThey\u2019re in charge,\u201d Baker says.<\/p>\n Savings<\/p>\n Despite the individual care and low staff-client ratio, supporters of PACE and Green House homes say they save tax dollars.<\/p>\n To understand the savings is to first consider a nursing home and its hierarchy of staff and multiple divisions of labor, said Robert Jenkins, a long-term care consultant who helped establish some of the nation\u2019s first Green Houses<\/a> more than 20 years ago.<\/p>\n A certified nursing aide in a nursing home usually has a narrow and prescribed set of duties around personal care. A dietary aide helps with meals. A nurse passes medications. An activities director shepherds engagement.\u00a0<\/p>\n A Green House home \u201cpulls hours back from all of these departments that operate behind walls, away from the residents \u2014 laundry, housekeeping, dietary.\u201d<\/p>\n Instead, one \u201cuniversal worker\u201d \u2014 a familiar face for residents \u2014 also cooks and does light house-cleaning, he said.<\/p>\n Workers like Mesha Dix and Kimnalla Simmons in Detroit.\u00a0<\/p>\n Both previously worked as certified nurses aids in nursing homes. Shifts there were an impossibly long list of tasks that allowed for little interaction with residents \u2014 help with the showering, change linens, and move on to the next resident.<\/p>\n \u201cIt was running from call light to call light and going up and down hallways,\u201d said Simmons, as she and Dix began filling drink glasses for dinner.<\/p>\n Here, Dix and Simmons are each known as a shahbaz<\/a>, part of a small staff who execute those tasks, but also plan meals with the elders or \u2014 just as importantly \u2014 simply sits and talk with residents. Play board games. Reminisce. Make plans.<\/p>\n Upstairs this afternoon, shabhaz Keyon Gordon is chatting with elder Aura Brewer about nothing in particular \u2014 just the day, how she is.<\/p>\n Nothing rushed.<\/p>\n He, too, used to work in a nursing home. In addition to those personal care duties at the Green House, he makes dinners and bakes cakes for the elders.<\/p>\n \u201cHere, it\u2019s about relationships, too,\u201d he said.<\/p>\n It\u2019s another hallmark of a Green House \u2014 empowered staff \u2014 and it\u2019s critical to that feeling of home \u2014 along with plants and pets and welcoming living spaces, Rani Snyder, president of The John A. Hartford Foundation, told Bridge. The nonpartisan philanthropy works to improve care for older adults.<\/p>\n Green House homes are about \u201cresident autonomy and choice and dignity,\u201d she said. \u201cThey emphasize meaningful interactions.\u201d<\/p>\n Green House homes also can save money \u2014 at least in the long run, say advocates for older adults.<\/p>\n In Detroit, the monthly cost for the twenty Green House residents is $7,067.40 each. In comparison, the average cost for a semi-private nursing home room was $10,570 in 2024, or $11,574 for a private room, according to life insurance company Genworth, which operates Care Scout<\/a>, a website that allows consumers to compare long-term care costs.\u00a0<\/p>\n \u201cThe Green House is to try to get away from more of the assembly line structure of institutional health-care settings and put it back into what is a real home environment,\u201d said Jenkins, the consultant. \u201cYou\u2019re both empowering the direct care staff so that they have input and control and management, but you\u2019re also making that a more efficient process.\u201d<\/p>\n In short, he said, \u201cyou have fewer middle managers that you\u2019re working through.\u201d<\/p>\n Moreover, empowered staff are less likely to leave \u2014 a cost savings in an industry racked by high turnover of staff and the high costs of recruiting and training replacements.<\/p>\n At the height of the pandemic, Green House homes reported substantially lower turnover rates \u2014 33.5% for shahbazim, according to Aging Innovations, which runs the Green House Project. In comparison, nursing homes reported more than 100% turnover rates for certified nursing assistants in some areas, according to research<\/a> published in the peer-reviewed journal Health Affairs.<\/p>\n Why aren\u2019t there more?<\/p>\n Michigan now has 14 PACE programs<\/a>. That\u2019s significantly more than just about any other state. Only California, with 38 sites, and Pennsylvania, with 18 sites have more.\u00a0<\/p>\n It has twelve Green House homes<\/a> at six sites, including the two homes in Detroit\u2019s Rivertown neighborhood.<\/p>\n Both the PACE and Green House homes serve just a sliver of older Michiganders, compared to the more than 35,000<\/a> nursing home residents.<\/p>\n Michigan AARP and others have renewed calls<\/a> for small homes such as Green House sites, especially since COVID, which proved particularly deadly for nursing home residents.<\/p>\n The biggest hurdles to expanding both programs are start-up costs.<\/p>\n \u201cYou have to build out a building. You have to fully equip it \u2014 build out a clinic and have staff hired and trained and on site before you can enroll one participant, said Christine Vanlandingham, CEO of Region IV Area Agency on Aging in St. Joseph.<\/p>\n There, it took $6 million to get a PACE program up and running, she said. Today, about 250 older area residents arrive at the program, some choosing to come five days a week and others just a few times a month.<\/p>\n Expanding the programs can happen with nonprofit help, fundraising, and local tax dollars, but it will take state investment, too, said Paula Cunningham, of Michigan AARP.\u00a0<\/p>\n It\u2019s not easy, she acknowledges.<\/p>\n \u201cWe can figure this out together. We can all be at the table, sit down and figure out: How do you restructure what you currently have? Are there dollars for that?\u201d she said. \u201cI don\u2019t have all the answers, but the answers are out there.\u201d<\/p>\n \n\tRelated\n<\/p>\n Thank you to our Michigan Health Watch Sponsors<\/p>\n Bridge Michigan Health Watch is made possible by generous financial support from our sponsors. Sponsorship supports our independent journalism mission but does not constitute sponsor endorsement of individual articles or editorial content. Bridge Michigan journalism remains fact- and data-driven and independent at all times.<\/p>\n Please visit the\u00a0About<\/a>\u00a0page for more information and to\u00a0subscribe<\/a>\u00a0to Health Watch. Interested in becoming a sponsor?\u00a0Contact Emma Carr<\/a>.<\/p>\n Republish This Story<\/p>\n![\"Green](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/02\/02272026_green_house_home_EE-24.jpg\")
Green House resident Deborah Robinson puts waters on the table ahead of dinner for residents at the Thome Rivertown Senior Apartments. The Rivertown neighborhood offers programs including PACE, providing medical care and support services for residents.(Emily Elconin for Bridge Michigan)<\/p>\n![\"Physical](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/02\/02272026_green_house_home_EE-36.jpg\")
Physical therapy in nursing homes and elsewhere may be limited by insurance \u2014 to two weeks or while there\u2019s improvement, for example. But at the PACE program in Detroit, it continues indefinitely, helping participants to maintain their strength in an effort to help them avoid nursing homes. (Emily Elconin for Bridge Michigan)<\/p>\n![\"Headshot](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/02\/robert_jenkins_courtesy.jpg\")
The purpose of Green House living is \u201cto get away from more of the assembly line structure of institutional healthcare settings,\u201d said Robert Jenkins, who helped develop some of the nation\u2019s first sites.<\/p>\n
![\"Creative](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/08\/1754973788_72_cc-by-nd-4.0.png\"\/)
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