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New housing options: Designing for an Aging America

By: Julie Ann Soukoulis
July 6, 2018
Navigating the aging journey

As our nation ages, community development and housing allies work to deliver new choices for seniors. 10,000 people turn 65 in the United States every day, according to Pew Research Center. More than one in five Americans will have crossed that threshold by 2020.  While the national cost of nursing homes tops $200 per day, baby boomers hope to remain at home. Many live in car-centric suburbs, which will leave seniors stranded at home once they can’t drive. Yet social isolation is the real threat. 

Social isolation has been proven a greater risk to life than high blood pressure. Most homes are not actually designed to age in place. Too many stairs and high cupboards are the norm. This nation faces a tsunami of aging without necessary infrastructure to accommodate the population. Folks at the helm of the national Green House Project, like developers and investors are scrambling to design innovative models to accommodate the wave.   

New sources of financing are emerging, catapulted by community development financial institutions, among others. New alliances are also developing between philanthropic, public and private sectors. Hopefully, early efforts will deliver a model for the future.

Putting the “home” back in “nursing home”

It is not news that many directors of nursing for long-term care facilities believe these institutions do not provide healthy settings for residents. Many homes have practices of restraining seniors when they were at risk of harming themselves or others. The intention is always to keep everyone safe, but robs individuals of dignity and respect, as well as causing even more problems as a result.

The institutionalization of the elderly does not work and it is hard to view as humane. Yet the typical model of home care does not always meet many seniors’ needs either. Today’s choices are either cost-prohibitive or socially isolating. As wonderful as home is, we may always need to have long-term care environments available.

The happy medium between home care and long-term care may just be the Green House homes model. Developed by geriatrician Bill Thomas in 2001, the now 200-plus Green House homes are popping up across the country as long-term care facilities designed to resemble normal, inviting houses as closely as possible. 

The Green House Project works with groups — like John Knox Village in Florida — that want to develop or operate a home using the model.

Green House residents enjoy the small yet vital facets of independence that are typically stripped away in nursing homes.

Green House homes serve just 10 to 12 residents. Residents have a private bedroom and bathroom. Each home includes a communal dining table, a cozy living room and a patio. What they don’t have are those long, hospital-like hallways or other institutional signposts. Two staff people on site — or one at night. The staff provide direct care, they coordinate care with nurses and other clinical professionals, and they cook. 

Staff receive extra training to perform these multifaceted roles. In the intimate environment, the staff are expected to build personal relationships with the residents, while becoming closely attuned to their habits and needs. They should be able to recognize immediately when something is off with a client.

Green House residents maintain the small yet vital facets of independence that are typically removed from those in nursing homes. They decide when to wake up, when to eat and what to wear. 

Residents who have been frail for a long time often gain weight after they move into a Green House home, according to representatives. This is because they can smell the food being cooked on site, feel a sense of familiarity at the dining room table, and are not forced to eat breakfast at the crack of dawn — unless they want to. Philosophically, this is their home. The person really has the control and the power to make their own decisions.   

For full-fee Green House residents, the cost is similar to a private room in a traditional nursing home. On average  around $7,000 per month, though most Green House residents say they are willing to pay more than they would at a nursing home. Around half of all Green House homes serve low-income residents. They are supported by Medicaid. Medicaid currently covers more than 60 percent of all nursing home residents, according to the Center on Budget and Policy Priorities.

Medicaid also pays 40 percent of costs for long-term care. Full-fee residents who can no longer pay the entire price are never kicked out. Green House home teams work with people to determine a feasible fee.

Innovative financing models put to work

Developers have used a variety of financing methods to build Green House homes. Most nonprofit developers raise their own capital. Others qualify for federal housing assistance, such as New Markets Tax Credits or US Department of Agriculture loans for rural projects. Some for-profit developers finance Green House homes with private capital.

In 2011, the Robert Wood Johnson Foundation, which has supported the Green House Project since 2002, established a 10-year, $10 million loan fund for Green House homes serving low-income residents.  Capital Impact Partners is a community development financial institution (CDFI) designed to provide capital to markets that traditional lenders are reluctant to enter. CDFI administers the fund, then draws in more investors to leverage RWJF’s commitment.

Capital Impact helped the Green House homes develop and replicate the model nationally. Finally, it was able to operate as a stand-alone organization in 2016.  According to Candice Baldwin, who directs the aging community strategy for Capital Impact, “we’re a unique CDFI in that we do both capacity-building and lending. As a mission-driven nonprofit organization, we have a theory of change about how we think problems can be solved.” They apply that model to help get new facilities off the ground and operating efficiently.

The CDFI more recently launched Age Strong , an investment fund. It partners with AARP, the AARP Foundation and Calvert. This happened in 2015 in order to expand its lending to projects that support low-income older adults in their community. The fund has deployed more than $14 million to date. Investors can earn up to 4 percent returns, according to Baldwin.

What is exciting about the Age Strong fund is that it allows individuals to align their values with their investments. The program opens the door to new opportunities for growth - specifically in the impact investing market - while simultaneously supporting socially conscious CDFI lenders.

End of PART I - next week return for the conclusion that outlines other dominant solutions and funding sources for senior housing and care in today’s national aging population.


Julie Ann Soukoulis is the owner of Home Instead Senior care office in Rohnert Park, mother of two and passionate about healthy living at all ages. Having cared for her own two parents, she understands your struggles and aims, through her website, to educate and encourage seniors & caregivers. Have a caregiving or aging concern? She’d love to hear from you at 586-1516 anytime.