Born Before COVID-19, $30M Green House Nursing Home Development Takes on Greater Significance

When Renee Lohman, the founder and former CEO of the CareWell Urgent Care chain of clinics in Massachusetts, was seeking a new opportunity in health care, she didn’t have to look far past her own experience with a family member in a skilled nursing facility.

“I was pretty well stunned by the 1970s physical plant,” Lohman said. “But as important was the lack of the feeling of home.”

Lohman — whose Carewell attracted millions in venture capital to back its expansion across the Bay State and into Rhode Island — did some research and found the Green House Project, a non-profit that works with developers and health systems to build “small home”-style nursing complexes.

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Instead of the traditional institutional nursing home model, which can feature hundreds of seniors with shared bedroom and bathroom facilities, the Green House Project focuses on clusters of small buildings that house 10 to 12 people each. The goal, according to the non-profit, is to foster community and a home-like setting for older people who require around-the-clock care.

Inspired by what she’d learned about the program, Lohman founded Navigator Elder Homes of New England in 2018, and soon found the company’s first project: replacing an aging nursing facility at Martha’s Vineyard Hospital in Oak Bluffs, Mass. for regional acute-care heavyweight Partners HealthCare, whose portfolio also includes Massachusetts General Hospital and Brigham and Women’s Hospital.

At the time, Lohman saw an opportunity to reimagine aging services for a small island community looking to keep a range of skilled nursing and long-term care options close to home.

“Two years ago, I said: I want to be part of the change, and I want to see more Green Houses,” she said.

But in the wake of COVID-19, with grim data showing just how easily the virus and other diseases can spread through a traditional nursing facility, the project has taken on a new significance for Navigator Elder Homes.

As the coronavirus death toll in the nation’s nursing facilities approaches 30,000, there have been no COVID-19 fatalities at the 243 of 266 Green House-sanctioned developments that provided data by early May, the New York Times reported earlier this month — and only eight reported having any COVID-19 cases.

“That, to me, says it all,” Lohman said.

The pieces for the new development quickly fell into place. With the backing of local non-profit Healthy Aging Martha’s Vineyard, the parties teamed with architecture firm LWDA Design to draw up a five-building complex that would house the same number of people — 70 — as the on-campus nursing home, Windemere Nursing & Rehabilitation, that it’s designed to replace.

The hospital purchased 15 acres in Edgartown, Mass., for the project, and Navigator Elder Homes developed a target mix of 14 Medicare post-acute units and 56 long-term care units — divided between about 34 private-pay and 22 Medicaid-covered residents.

Construction is set to begin in about a year, with a $30 million to $32 million price tag that accounts for the additional labor and transportation costs that come with any development on Martha’s Vineyard, an island off the southern coast of Massachusetts that’s accessible only by ferry.

The project will feature all the hallmarks of the Green House model, with exclusively private rooms and adjoining bathrooms — as well as shared kitchens that both residents and staff can use any time of day. Residents are generally free to move about their buildings and outdoor areas, with an emphasis on personal autonomy; individual laundry, cooking, and dining spaces for each building reduce the opportunity for mass congregation in tight areas.

Source: Navigator Elder Homes of New England, Courtesy LWDA Design

But as with the construction costs, the campus’s isolated location required creative thinking around staffing. Long a problem for many operators in the post-acute and long-term care space, finding sufficient numbers of nurses and certified nursing assistants (CNAs) is particularly difficult in a small community with limited housing options and seasonal population swings.

So Lohman and Navigator Elder Homes decided to include 60 residential units for staff members — primarily those who work for the nursing facility, as well as Martha’s Vineyard Hospital employees — as part of the project.

“By offering the CNAs and the nurses apartments at a subsidized rate, and by offering them jobs, we believe that we can conquer the expense issue that often accompanies a difficult-to-staff environment like Martha’s Vineyard,” Lohman said.

Based on the current COVID-19 crisis, as well as a legislative push in Massachusetts to implement the small-home model as an industry standard moving forward, Lohman predicted that there’s plenty of room for growth as health care leaders and officials look for ways to prevent future outbreaks.

“I think there’s a hunger now — there’ll be a hunger like never before for more of this model where there’s a definite need,” she said.

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