‘Green House Model’ selected for Buffalo skilled nursing facility

The three residential cottages to be added to the Veterans’ Home in Buffalo, each with space for 12 beds, are designed following the Department of Veterans Affairs’ “small house” model. Within, residents will receive skilled nursing care. (Illustration courtesy of Plan One Architects via The Sheridan Press)

SHERIDAN — Officials say that the Green House model, in which residents are housed in individual rooms with common living areas, could be more resilient to a pandemic than the traditional nursing home setting.

That design has been selected for the new skilled nursing facility in Buffalo at the Veterans’ Home of Wyoming, with a construction timeline starting this summer.

“We are anticipating a mid-August construction start date with a May 2022 completion date,” Ryan Scranton, project manager with the State of Wyoming State Construction Department said.

Design was finished March 15 and presented to the State Building Commission in April. The project went out for bid in May, and the state received eight qualified bids. The design includes three state-of-the-art residential cottages with 12 beds each that will accommodate Wyoming veterans in a home-like setting, according to Plan One Architects of Cody.

After a year of study and debate, the State Legislature approved Buffalo as the location for the skilled nursing facility in early 2019. The Wyoming Veterans’ Home has operated in Buffalo for over 100 years, and in large part because of the potential for continuity of care for veterans already living in the area, legislators voted four-to-one in February to expand services there. The Veterans’ Home was built on the grounds of the former Fort McKinney is located three miles west of Buffalo on U.S. Highway 16.

Perhaps more than anywhere else in the United States, the impact of Covid-19 has been felt in the nation’s nursing homes. According to the New York Times, as of May 21, 37 percent of the nation’s fatalities, or 34,000 deaths at that time, had occurred among residents and staff of long-term care facilities. By July 9, a cluster of 29 cases diagnosed between May 15 and June 4 were tied to the Worland Healthcare and Rehabilitation long-term care facility, and that outbreak had resulted in five deaths, according to a Washakie County situation report.

In all, Wyoming had seen 21 Covid-19 related deaths as of July 10.

The Green House Project is a national a non-profit that creates alternative living environments to traditional nursing home care facilities. Fifteen years ago, its model was used at Green House Living for Sheridan.

According to a May 22 New York Times report, Karl Pillemer, a gerontologist and researcher at Cornell University, said it is time to focus on private rooms in nursing homes. In the Green House model, for example, a dozen residents live in private rooms with homelike common spaces and assigned staff who know them well. This approach has gained ground very slowly, with 268 homes, of more than 15,000 nursing homes nationwide.

“Prior to covid, the VA had moved to this model of small house living that we are modeling and following,” Scranton said.

This spring, the state received an approval letter from the VA that said funding is available for the project, Scranton said.

“While we are still waiting on funding, the VA State Home Construction program has told us that 30 days from when you finish your requirements, they will be back to us with an approval,” Scranton said. “We are still operating under the guise that (funding) will come at some point, and what has come is a letter from the Undersecretary of the U.S. Department of Health that said that funding is available, and where the project sits on the priority list.”

Scranton said that the project will not move forward without federal funding, which will make up 65 percent of the project budget, with a 35 percent state loan match.

“We will move forward as if the federal funding is there, but the contract is subject to the availability of funds,” he said. “The legislation that authorizes this facility offers a state match in the form of a loan to the Department of Health, which they will pay back through the operating of the facility. It is really contingent on federal funds.”

The project cost has not been made public as bids are still out, a contract with a contractor has not been approved nor has the VA approved any amount, Scranton said. Nonetheless, the design of the facility is complete, and focuses on the Green House Project model.

Franz Fuchs, a policy analyst with the WDH, said that hopefully the epidemic will be gone by the time the facility in Buffalo opens, but that everyone hopes the design will be resilient to disease.

“The model for greenhouse living is more of a home-like model with individual rooms, and it is much easier—my understanding is that they are much more resilient than traditional centers to coronavirus,” Fuchs said. “That is a built-in advantage without having to change anything. The design itself will be able to respond to (an) epidemic.”

The facility will probably have 2-3 staff per resident, with 36 beds. Some of those staff, because the state is building on to the existing veterans home, will not be new hires.

“A lot of it comes down to the staff, and the practices that are carried out, like infection control practices,” Fuchs said. “Those really make a difference, so no matter what the design of the building, those care protocols and planning elements matter more than, maybe, the air filters.

“Hopefully the epidemic will be gone by the time we open, which is a few years away,” he continued. “But I think the design itself is really more resilient than an institutionalized layout.”