Skilled nursing facilities have been designed and operated in a hospital-like, institutional style since they proliferated in the 1960s across the United States. But these facilities have been afflicted by quality of care, safety, and infection-control problems for decades. The COVID-19 pandemic spotlighted these challenges, with a disproportionate share of people in the U.S. who died from the virus contracting it while living in a nursing home. Despite an aging population and a growing need for long-term care, nursing home occupancy has fallen since the pandemic, with surveys showing that many people have negative perceptions about nursing homes.

In the 1990s, long-term care experts began thinking about alternative nursing home models that are safer and more satisfying for residents, their families, and staff. One such approach is the Household Model, one of several small-house nursing home models. This approach creates more home-like environments that offer residents greater dignity, autonomy, and infection control, as well as establishes closer, more family-type relationships between residents and staff. The model uses smaller facilities with no more than 20 residents, private bedrooms and bathrooms, home-like communal spaces, and cross-trained staff who are more flexible in serving residents’ needs.

This profile is part of an ongoing Better Care Playbook series, In the Field: Spotlight on Complex Care Interventions, that highlights how organizations are implementing evidence-based and promising innovations to improve care for people with complex health and social needs.

*Author Harris Meyer is a freelance journalist who has been writing about health care policy and delivery since 1986.