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Small-house nursing homes
When people say "I'd rather die than go to a nursing home," they're picturing a hospital corridor. There is a whole model built as the direct rebuttal: nursing care delivered in an actual house. If nursing-level care is likely in your person's future, knowing this model exists changes the conversation.
What the model is
The Green House model (the best-known small-house design, launched 2003): a real home for 10–12 residents, each with a private room and bathroom, arranged around one open kitchen and hearth where meals are actually cooked; a small, consistent team of cross-trained caregivers runs the whole house — the same faces daily; residents keep their own schedules. It is licensed nursing care — 87% of Green House homes are licensed skilled-nursing facilities — in a building shaped like a life instead of a ward. Nearly 400 homes operate across 35 states; about 82% are nonprofit and roughly 45% accept Medicaid (Center for Innovation / AgingIN — aginginnovation.org, which hosts the national directory and map).
The evidence isn't just aesthetic
During 2020, a peer-reviewed study found Green House and other small nursing homes had significantly fewer COVID-19 cases and deaths than traditional nursing homes — the private rooms, private baths, and small consistent staffing that make the model humane also made it safer (Zimmerman et al., Journal of the American Medical Directors Association, 2021 — pmc.ncbi.nlm.nih.gov). Earlier research consistently reports higher resident and family satisfaction and lower staff turnover than traditional facilities (overview in Health Affairs, 2021).
The practical questions
Because most Green House homes are Medicare-certified skilled nursing facilities, they appear in CMS's rating system — which means you can look them up in our directory like any other nursing home, ratings and inspection records included. Private-pay rates generally track local nursing-home markets. The catch is supply: a few hundred houses nationally means your county may have none — the AgingIN directory answers that in one search, and it's worth checking before a discharge planner is standing over you with a 48-hour deadline.
Who helps you locally — free, and on your side. You do not have to figure this out alone. Your Area Agency on Aging gives free options counseling; reach any of them through the federal Eldercare Locator at 1-800-677-1116 or eldercare.acl.gov (Administration for Community Living). More on the four people who help — and what each one does — on Who helps me locally.
Quick answers
What is a Green House nursing home?
A nursing home built as a real house: 10–12 residents with private rooms and bathrooms around an open kitchen, cared for by a small consistent team, with residents keeping their own daily schedules. 87% are licensed skilled-nursing facilities. Nearly 400 Green House homes operate across 35 states; the national directory is at aginginnovation.org.
Are small nursing homes safer than traditional ones?
On infection outcomes, peer-reviewed evidence says yes: a 2021 JAMDA study found Green House/small nursing homes had significantly fewer COVID-19 cases and deaths than traditional facilities during 2020, attributed to private rooms and baths and small consistent staffing. Research also consistently reports higher resident and family satisfaction and lower staff turnover.
Does Medicaid pay for Green House homes?
About 45% of Green House homes accept Medicaid, and most are Medicare-certified skilled nursing facilities (payable like any SNF for qualifying short stays). Coverage is home-by-home — the AgingIN directory plus a direct call answers it for any specific house.