Tuesday, June 24, 2008

The Robert Wood Johnson Foundation Makes an Unusual Grant

The Wall Street Journal reports today that the Robert Wood Johnson Foundation made its largest grant to a single entity when it provided $15 million to Dr. Bill Thomas to build "Green Houses" for senior citizens.  The name is misleading on one level --  the "green" refers mostly to Dr. Thomas's idea for revoluntionizing retirement homes, and not so much to environmental concerns.  As reported, Dr. Thomas met with Ms. Jane Lowe, president of the Robert Wood Johnson Foundation and others in 2001 to pitch his idea for "Green" senior citizen homes.  These homes would be 10 to 12 person, smaller homes, that created more of a home-like environment for those seniors needed assisted living.  Dr. Thomas, wearing traditional law professor gear -- birkenstocks and not overly dressy, met with the admittedly stuffy Foundation to pitch his idea for a smaller, more home-like atmosphere and feel of the nursing home.  Below is an excerpt from the story:

In the spring of 2001, Bill Thomas, dressed in his usual sweat shirt and Birkenstock sandals, entered the buttoned-down halls of the Robert Wood Johnson Foundation. His message: Nursing homes need to be taken out of business. "It's time to turn out the lights," he declared.

Cautious but intrigued, foundation executives handed Dr. Thomas a modest $300,000 grant several months later. Now the country's fourth-largest philanthropy is throwing its considerable weight behind the 48-year-old physician's vision of "Green Houses," an eight-year-old movement to replace large nursing homes with small, homelike facilities for 10 to 12 residents. The foundation is hoping that through its support, Green Houses will soon be erected in all 50 states, up from the 41 Green Houses now in 10 states.

We want to transform a broken system of care," says Jane Isaacs Lowe, who oversees the foundation's "Vulnerable Populations portfolio." "I don't want to be in a wheelchair in a hallway when I am 85."

The foundation's undertaking represents the most ambitious effort to date to turn a nice idea into a serious challenger to the nation's system of 16,000 nursing homes. To its proponents, Green Houses are nothing less than a revolution that could overthrow what they see as the rigid, impersonal, at times degrading life the elderly can experience at large institutions.

Susan Feeney, a spokesperson for the American Health Care Association, which represents thousands of for-profit and not-for-profit nursing homes, says the criticisms levied against the industry by Dr. Thomas and his supporters are "overly harsh." She says many nursing homes are embracing cultural changes to create a more homelike feel. "While it may not be scrapping a large building...we are changing," she says.

Green Houses face a host of hurdles. Many Green House builders say they've encountered a thicket of elder-care regulations. It takes enormous capital to build new homes from scratch. Plus, experts say the concept faces stiff resistance from many parts of the existing nursing-home system. Traditional nursing homes, many of which care for 100 to 200 patients, are predicated on economies of scale -- the larger the home, the cheaper it is to care for each individual resident.

Foundation officials acknowledge they don't know whether Green Houses are a viable economic model. But they've decided not to wait for an answer. Hewing to its recent strategy of making "big bets" on ideas to change social norms, Robert Wood Johnson is investing $15 million over five years -- one of the bigger grants the institution has handed out to a single entity.

For the complete story, click here.



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