Vacations, even a mini vacation of only four days, can change things.

In this case, a trip to Falmouth on the Cape in September of 2009 became the genesis to a new form of nursing home care that is expected to become a reality in 14 months at Saint Elizabeth Community.

“It was one of the best work days ever,” recalls Sarah Bowater, a certified nurse assistant at Saint Elizabeth, who joined four other staff and six nursing home residents for the trip.

The “vacation” was the suggestion of Steven J. Horowitz, president and CEO of Saint Elizabeth. Doing it required approval from the Department of Health and renting a house in Falmouth. Of course, there was more than renting a house and driving to the Cape. Families of the residents gave their approval, and the husband of one of the residents decided to join the group.

“These pioneers’ ages ranged from 67 to 93,” Horowitz said, “and had medical conditions ranging from arthritis, mild dementia, to congestive heart failure. We needed to get an exception from the health department to take this trip, and the planning addressed every possible detail.”

What happened is what Bowater believes will be replicated with completion of four homes, each providing 12 residents with their own private room and bathroom adjacent to the hilltop site of the Saint Elizabeth 120-bed nursing facility in East Greenwich.

Friendships and relationships were made over meals and just in having time together during that mini vacation. Barbara DiMaio, who is a resident at Saint Elizabeth, was one of the six who made the Falmouth trip. The trip expanded her horizon, and she and Bowater later traveled to Oregon for her granddaughter’s wedding. That trip ended up being longer than expected because of Hurricane Sandy, which delayed their return. DiMaio was delighted with the extended trip.

“It’s the best,” DiMaio said Tuesday following a groundbreaking for the $12.5 million project.

In his comments under a tent alongside a phalanx of giant, yellow, earth-moving machines, Horowitz elaborated on that vacation.

“It took a while for the structure to go away. At first, the ‘pioneers’ wanted decisions made for them, but after a day the staff reported that the residents were making their own decisions, choosing what they wanted to do and when. Walkers were not being used as often and appetites improved. An impromptu trip to Martha’s Vineyard was taken. The general sense of independence and well-being just improved for each resident,” Horowitz said.

He recalled what Matt Trimble, administrator of Saint Elizabeth Home said: “This trip, to me, was much more than a few days on the Cape…it was a taste of how quality of life for nursing home residents could greatly be enhanced through smaller home environments and empowered/cross trained employees.”

While Saint Elizabeth had been exploring options to nursing home care since 2006, it was the experience of “the vacation” that convinced them smaller, more intimate homes was a direction they wanted to pursue. They ended up partnering with The Green House Project, whose founder, Dr. Bill Thomas, launched the program to build smaller nursing homes. To date, The Green House Project has partnered with organizations in 28 states to build 185 houses with 10 to 12 residents in each house. Another 150 homes are in development stages in six states, according to Susan Ryan, senior director of the project.

Ryan said the homes are staffed 24/7, and residents receive more direct care than in a conventional nursing home setting. She said homes are centered on the “hearth area” that serves as the core where residents have meals and join in activities. Residents can bring their own furniture to the homes and even their pets.

Ryan said traditional nursing homes are modeled after hospitals that look to gain efficiencies through volume. But that doesn’t necessarily translate into higher costs with the far smaller homes Saint Elizabeth will build. Ryan points out in The Green House Project model, occupancy rates are higher and the rate of staff turnover is reduced resulting in an improved way of life.

She said the role of The Green House Project is to set standards and to serve as consultants. While prototypes are available complete with construction plans, she said most partners prefer to use their own architects and build projects they believe fit to their community.

SWBR of Rochester, N.Y., is the architect and Calson Construction the builder for Saint Elizabeth. Funding will come from a combination of traditional financing and a capital drive. The Washington Trust Company will finance the project with a tax-exempt bond that was approved Oct. 22 by the Rhode Island Health and Educational Building Corporation.

But there were hurdles to overcome, as Charles Fogarty, director of elderly affairs explained and Horowitz expanded upon. In 1995 the General Assembly enacted a moratorium on additional nursing home beds, which Horowitz said had the “unintended consequence” of stifling innovation in the industry. Legislation introduced by state Rep. Joseph McNamara allowed for the future use of beds that had been removed from the long-term care system, opening up 140 beds.

In 2014 the state Department of Health sent a request for applications to current skilled nursing facilities. The application to utilize some of the pooled beds had to include an innovative or new way of providing long-term care, explained Horowitz.

It was at that point that Saint Elizabeth partnered with The Green House Project and worked with their architects to come up their proposal. It was the only application to gain approval.

As for applications for prospective residents at the Green House Homes, they won’t be posted on the Saint Elizabeth Community website until 2016 as the project nears completion.