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More than a million Americans live in nursing homes. And for many of them, that means following rigid schedules, sharing a room with strangers and sitting slumped in a wheelchair all day. Well, there's an effort to change that, and it's called the Green House Project. The idea is to shift from large institutional nursing homes to small and more friendly ones.

In the past 10 years, more than 140 of these alternative, nonprofit nursing homes have been built in 24 states. NPR's Ina Jaffe covers aging for us, and she visited a Green House home in Baltimore.

INA JAFFE, BYLINE: No one needs to announce that it's time for lunch.

(SOUNDBITE OF SIZZLING)

JAFFE: You can hear the sounds and smell the aromas coming from an open kitchen that looks like it belongs in a big suburban home.

TUMARKA WILSON: We're having chicken parmesan, broccoli cuts and egg noodles.

JAFFE: That's Tumarka Wilson. She's making lunch, but she's not the cook. She's a nursing assistant. At the Green House homes, nursing assistants are trained to do a bit of everything. Wilson says it wasn't like that at the nursing home where she used to work.

WILSON: We cook for them. We do daily activities with them. We spend a lot of quality time with our elders.

JAFFE: One of the reasons Wilson and the other nursing assistants can spend quality time with the elders, as they're called here, is that there are no more than 12 living in any one Green House Home. Every resident has a private room and bath close to the common areas: the kitchen, the living room and a communal dining table with more than enough seating for residents and staff to eat together.

Eighty-eight-year-old Lawson Suber was seated at the table in his wheelchair. About a year ago, his kids insisted he move here.

LAWSON SUBER: I blanked out. I don't know what happened. I just blanked out.

JAFFE: Did you have a stroke?

SUBER: I don't think so. I don't know what - the cause of it. And I've been here ever since.

JAFFE: He says he can walk but not much. Staff members here help him out when he needs it to get out of bed or take a bath, but he says he's still pretty independent.

(LAUGHTER)

SUBER: I'd been that way all my life.

JAFFE: So when he hears this place referred to as a nursing home, it surprises him a bit.

SUBER: I guess it's somewhat like a nursing home. I guess it is.

DR. BILL THOMAS: The Green House is based on, really, a radical idea: Let's abolish the nursing home.

JAFFE: That's Dr. Bill Thomas, a geriatrician from Upstate New York, who came up with the idea for Green House homes in the 1990s. He had patients who lived in nursing homes then and he realized...

THOMAS: That the medicines I was prescribing were not treating the true source of suffering, which was loneliness.

JAFFE: He also realized that traditional nursing homes were going to have to be replaced soon anyway.

THOMAS: Most of them were built in the 1960s and '70s and, you know, their time is done. So I got to asking the question: What comes next?

JAFFE: What came next were the first Green House homes, which opened in Tupelo, Mississippi in 2004. Now, with 148 Green House homes nationwide, there's enough research to get an idea of how they're working. And the answer is: pretty well. Studies show that residents are happier and stay healthier longer.

David Farrell, director of the national Green House Project, explains that those private rooms aren't a luxury. They're safer than a traditional nursing home where two or even three people might share a room and then share a bathroom with the two or three people in the room next door.

DAVID FARRELL: So now you're talking about six people sharing the toilet and the washbasin, which, of course, just further increases the spread of infection for all the elders living there.

JAFFE: Research also shows that Green House residents maintain their independence longer than residents of traditional nursing homes, where hallways are long and schedules are tight.

FARRELL: So people really are kind of relegated to a wheelchair in order to efficiently move them around, and they quickly lose their ability to walk.

JAFFE: There are no strict schedules at Green House homes. So while many of the residents gather at the table for lunch, 72-year-old Charles Tyler stays in his recliner in the living room, blanket up to his chin. He's not in the mood for lunch right now, but he's not worried about missing a meal.

CHARLES TYLER: Anytime, I get ready. Just press the button, and they'll bring me a raisin bread sandwich. That's my favorite.

JAFFE: Raisin bread and what?

TYLER: A piece of lunch meat or just two pieces of raisin bread. I love raisin bread.

JAFFE: Personal service, private rooms, it all sounds expensive. But Green House home costs are about the median for nursing homes nationally. In fact, in Baltimore, the Green House homes serve mostly low-income people on Medicaid. So all Charles Tyler has to do is focus on keeping his strength up.

TYLER: No pressure on you. All you have to do, ask them what needs to be done and what is my part in it, and try. That's all.

JAFFE: There are now about 150 more Green House homes in development where residents will be able to enjoy the privacy of their own rooms or the company of the communal table. It'll be their choice. Ina Jaffe, NPR News.

(SOUNDBITE OF MUSIC)

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