COVID Incidence, Mortality Rates Are Lower in Small-House Nursing Homes

March 23, 2021

Non-traditional and “small-house” nursing homes (NHs), the Green House model being the best known of these, have attracted great interest in the wake of the novel coronavirus; and with good reason. A study published in the March issue of JAMDA showed that COVID incidence and mortality rates are less in Green House/small house NH models than in traditional NHs.

In Nontraditional Small House Nursing Homes Have Fewer COVID-19 Cases and Deaths, data from 43 Green House/small NH organizations showed that they had significantly lower rates of COVID-19 cases, admissions, and mortality than traditional NHs, both those with 50 or fewer beds and those with more than 50 beds. Even outlier rates for these small house NHs are markedly lower than those in other NHs.

The Green House model has 300 NHs across 32 states. These homes have components that may be critical for infection prevention and control, including they each house only 10-12 residents, they have consistent and universal staff assignments, and they have private rooms/bathrooms, smaller overall space, and a central entry. Research on Green House NHs has found their benefits include better resident quality of life, fewer hospital readmissions, better quality indicators, reduced Medicare spending, and possibly less staff turnover.

“More than half of Americans who survive to age 65 will require long-term care, yet a majority would rather die than live in a NH,” said lead author Sheryl Zimmerman, PhD. She concluded, “Non-traditional Green House/small NHs have better outcomes than traditional NHs in numerous areas. As such, they are an especially promising model as NHs are reinvented post-COVID.”

This study was conducted by researchers at the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill; School of Social Work, University of North Carolina at Chapel Hill; Gillings School of Global Public Health, University of North Carolina at Chapel Hill; and The Green House Project, Linthicum, MD.

Click here for more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email



JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.