Residents gather at the table ahead of dinner at the Weinberg Green House at Thome Rivertown Neighborhood in Detroit. A Green House home is small compared to the large, institutional feel of some nursing homes. Other programs available for seniors in the Rivertown neighborhood include PACE, which provides medical care. (Emily Elconin for Bridge Michigan)

Editors note: This story was originally published by Bridge Michigan, a nonprofit and nonpartisan news organization. Visit the newsroom online: bridgemi.com.

DETROIT — Afternoon sunshine floods into the large window of her private bedroom, making even more clear at this moment Tanya Hollins’ incredibly good fortune.

Hollins could easily be one of the some 35,000 residents in a Michigan nursing home.

Instead, she’s here this day, showing a visitor a collection of photos taped to her wall: herself grinning in a cowboy hat, another as she stands with Santa Claus.

The 69-year old pushes her walker a few inches, reaching now for a tiny jewelry box.

“I painted it myself — I did,” she says, smiling. “It’s a pretty color, don’t you think?

Does she ever get bored?

She explodes into laughter.

“They keep us busy here, busy all the time.” She shakes her head as though it was the silliest question she’s ever heard.

“This is home. This is better than home. I love it.”

Hollins and her nine housemates are lucky. Despite complicated health conditions and advanced age, they likely will be able to avoid time at a nursing home — facilities that in best cases can feel institutional, and in worst cases, can be places of frequent short-staffing and neglect. Hollins and her nine housemates are part of two national efforts that some say are the gold standards of care for the nation’s oldest residents. The goal is to delay nursing home care, or even prevent it altogether.

The first initiative is this Green House home — a communal living arrangement that stresses a home-like environment where relationships flourish. Crucially, they restore decision-making to older residents, such as allowing them to choose what they would like prepared for dinner. They also empower front line staff.

Susan Ryan, CEO of Aging Innovations, calls it “the power of normal.” By design, Green House homes are small — 10 to 12 people, compared with nursing homes, which can house more than 100 residents and employ hundreds of staff. In Detroit, there are two Weinberg Green Houses. Unlike others that stand alone as houses, these two Green House homes are on the second and third floors at the Thome Rivertown Neighborhood for older adults.

Rather than ever-present medication carts, nursing stations, and dining hall trays of a nursing home, there are private rooms and an open kitchen. Residents who can help do so — setting the large dining room table for dinner or folding laundry, for example. In the open shared space, housemate Debra Robinson, 66, is laying out plates and silverware for the smothered chicken and gravy now finishing in the oven. Another housemate, Robert Betty, 77, is letting others know that dinner’s nearly ready.

It’s a communal approach that, compared to the decision-making of a nursing home hierarchy, restores “control, dignity, and a sense of well-being” to residents, or “elders,” as they are called, Ryan said. “It’s ensuring that elders are allowed to have access to some of the same, same things that the rest of us have access to,” she said. “We don’t live in institutions. Why would elders live in institutions?”

Every morning, at about 9 o’clock or so, the elders meet at the front door of their second-floor home in the Thome Rivertown Neighborhood near downtown. Their destination: a national service called the Program of All Inclusive Care for the Elderly, or PACE. This one-stop shop downstairs fills their days with music, dance, exercise and, last week, a 47-piece local orchestra for entertainment.

But it also houses a team of social workers, doctors, podiatrists, dentists and others. Together, they ensure the kind of care that — when delivered routinely — will tamp down the odds of these residents and other PACE participants ending up in a hospital and then a nursing home.

In this sprawling space, the Green House residents will join about 350 other older Detroit area residents throughout the week. They arrive — most coming from their own homes and independent- or assisted living homes — on PACE buses. Each person is eligible because they have been deemed medically fragile enough for a nursing home. The idea, though, is to keep them in the community.

“We want to help them maintain their independence, their dignity,” said Sicily Baker, day center manager. In addition to two hot meals each day, there are dances, movies, exercise classes and field trips as well as physical therapy and visits to the doctor or social worker — all in this same collection of rooms.

Despite the individual care and low staff-client ratio, supporters of PACE and Green House homes say they save tax dollars. To understand the savings is to first consider a nursing home and its hierarchy of staff and multiple divisions of labor, said Robert Jenkins, a long-term care consultant who helped establish some of the nation’s first Green Houses more than 20 years ago.

A certified nursing aide in a nursing home usually has a narrow and prescribed set of duties around personal care. A dietary aide helps with meals. A nurse passes medications. An activities director shepherds engagement. Headshot of Robert Jenkins.The purpose of Green House living is “to get away from more of the assembly line structure of institutional healthcare settings,” said Robert Jenkins, who helped develop some of the nation’s first sites.

A Green House home “pulls hours back from all of these departments that operate behind walls, away from the residents — laundry, housekeeping, dietary.” Instead, one “universal worker” — a familiar face for residents — also cooks and does light house-cleaning, he said. Workers like Mesha Dix and Kimnalla Simmons in Detroit.

Both previously worked as certified nurses aids in nursing homes. Shifts there were an impossibly long list of tasks that allowed for little interaction with residents — help with the showering, change linens, and move on to the next resident.

“It was running from call light to call light and going up and down hallways,” said Simmons, as she and Dix began filling drink glasses for dinner. Here, Dix and Simmons are each known as a shahbaz, part of a small staff who execute those tasks, but also plan meals with the elders or — just as importantly — simply sits and talk with residents. Play board games. Reminisce. Make plans.

Upstairs this afternoon, shabhaz Keyon Gordon is chatting with elder Aura Brewer about nothing in particular — just the day, how she is.

Green House homes also can save money — at least in the long run, say advocates for older adults. In Detroit, the monthly cost for the twenty Green House residents is $7,067.40 each. In comparison, the average cost for a semi-private nursing home room was $10,570 in 2024, or $11,574 for a private room, according to life insurance company Genworth, which operates Care Scout, a website that allows consumers to compare long-term care costs.

“The Green House is to try to get away from more of the assembly line structure of institutional health-care settings and put it back into what is a real home environment,” said Jenkins, the consultant. “You’re both empowering the direct care staff so that they have input and control and management, but you’re also making that a more efficient process.”

Michigan now has 14 PACE programs. That’s significantly more than just about any other state. Only California, with 38 sites, and Pennsylvania, with 18 sites have more.