From Nursing Home to Green House

Abstract

This article tracks the changing roles of certified nursing assistants (CNAs) as they transition from a traditional nursing home setting to a “deinstitutionalized” care setting called the Green House. The Green House concept, developed by William Thomas, MD and based on the Eden Alternative paradigm, emphasizes autonomy, dignity, privacy, and reciprocal relationships between residents and staff. This qualitative work focuses on how CNAs (called “shabazim” in the Green House) negotiated the transition from traditional nursing home to the Green House model. Interview, focus group, and participant observation data before and after the transition to the Green Houses reveal that in the traditional nursing home environment, informants report that resident-CNA interactions tend to be rushed, detached, and adversarial, whereas in the Green House care environment, interdependency and stronger ties are promoted. Shabazim report diminished guilt and enhanced sense of empowerment in their new role.