February 17, 2019
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Navigating the aging journey

Julie Ann Soukoulis
Developers eye elder housing
July 13, 2018

Investors and community development advocates are not the only ones trying to deliver more appropriate senior support and housing. In Mesa, Arizona, there are developers preparing to build new innovative styles to meet the need for new senior housing as well. Arizona seniors will live in a series of “cottages.” These 6,200-square-foot buildings have 16 bedrooms and a common kitchen. They also include a dining room and living area. Each cottage caters to a specific population, like memory care needs or those with high physical needs.

Each has its own staff administrator. Care and activities will be customized for the population. This site has a medical office building leased to a group of third-party physicians. Like the Green House homes, they feel like custom houses. Cottages sport vaulted ceilings, open floor plans and single and double bedrooms off to the side. These cottages will service both full-fee and Medicaid-supported residents. Full-fee residents will typically pay less than most area competitors - averaging $4,500 per month. The smaller size and flexibility of cottage models allows them to be nimbler. This means lower overhead costs without giving up quality.

The big buildings can’t even open until they have 120 residents, yet the cottage model opens with just 20. This also makes it easier to adapt care plans, while tailoring the marketing to baby boomers. There is no need to move when care needs change. This fact makes it much easier to work on things like obesity or high blood pressure. You can cater food or other requirements for them as needed. Private-pay residents deliver operating margins between 20 and 35 percent. Medicaid residents deliver 15 to 20 percent. As comparison, margins on standard apartment buildings without senior services is 40 to 45 percent. Margins are lower for senior care obviously due to operating costs.

While many private developers dive into senior living markets with amenity-filled buildings that look like the rest of their portfolio, clearly aiming for a higher margin, this approach is shortsighted. Developers who fail to give thought to seniors’ unique circumstances - are in for a reality check. Some developers also think many builders are over estimating the number of baby boomers with healthy savings accounts. Right now developers are building to pencil out at $6,000 rent per month. Unfortunately, the bigger segment will be the $2,500-$3,500 per month group. At this time, a typical American who has put aside money for retirement has saved $60,000 . This covers less than one year at $6,000 per month. A full half of all Americans have put no money aside at all.

Services and support from home

Most couples have no desire to abandon established community supporting routines, or leave the home they have lived in for 20 plus years. Most children will be hovering within reasonable commute distances. This means grand and even great-grandchildren live in the area which keep elder’s busy and feeling needed and valued.

Once one of the elder’s gets a diagnosis such as lymphedema, a chronic condition that causes incapacitating swelling in both legs, it can change everything. This disease requires someone to get down on the floor each day to wrap the legs in compression stockings. Without this help - the elder can’t live on their own.

Enter in-home support services

For most elders who are on Social Security, there is that little niche where it’s too expensive to do it on their own because they do not qualify for financial aid of any kind.  SASH, or Support and Services at Home sends wellness nurses and care coordinators to visit Medicare recipients at home. This provides basic care and health coaching there, plus coordinating connections to social service agencies and health and housing providers as needed.

SASH can be found throughout Vermont at 140 affordable senior housing complexes and single-family homes in surrounding neighborhoods. The aim is to provide basic assistance to help seniors “age in place” healthfully and cost-effectively. Affordable housing nonprofit Cathedral Square manages SASH. It is operated by regional housing organizations and authorities. All of these organizations work in partnership with hospitals and health and housing agencies. Cathedral Square CEO Nancy Eldridge developed the idea in 2009 after repeatedly watching seniors move out of their homes prematurely due to easily solved problems.

As the former associate director of primary care at the University of Vermont’s College of Medicine, Eldridge knew how unprepared communities are to handle the impending growth of the elderly population. She had also watched her father wither away in a nursing home even though he didn’t have significant medical needs, but simply could no longer manage his medication.

“Absolutely, in my mind, that could have been dealt with,” According to Eldridge “there are numerous triggers that send a person to a nursing home for the rest of their life, often at a young age. That’s just unethical.” SASH is Eldridge’s response for creating a scalable model —one that leverages existing community resources — while providing inexpensive care for an entire aging population. The plans are tailored to meet each member’s needs. For most - it’s exactly enough to keep them safely home. An early study shows the program’s attentive care and small solutions reduce Medicare expenditures by an average of $1,536 annually per participant.

As creative models for long-term care and assisted living continue to emerge, innovative aging-in-place programs also offer important alternatives. The variety of options ensure seniors with different levels of capability and dependence can live very safely where ever they want to.

More cross-sector responses

As our current baby boomers enter their 70s and 80s, Susan Ryan of the Green House Project said, “there will be a consumer demand for innovative models and buildings. The same old, same old is just not going to cut it.” To develop and then expand new innovations will take significant intention. It requires mission-minded community development organizations willing to partner - and step up. “If we get our heads together and figure out what pieces each of us play and how we create these alliances or partnerships maybe we can solve what I believe could be a rather significant societal crisis.”  About a year ago, Ryan found herself fielding phone calls from economic developers and organizations. They felt inspired by her effort to build healthy places for aging community members. This interest from diverse stakeholders gave her much needed hope.

The success of SASH has taught us that cross-sector collaboration is critical. “If we treat this as a community problem with a community solution, we can do so much more. It’s wrong to leave families on their own to figure it out.”

At some point, most families are faced with heart-wrenching choices. Do you move a parent or relative out of their long-time home? Do you drain savings to hire a caregiver? Do you take time off from your job to care for mom? These decisions will become all too real for many Americans in the coming decade.

And while new and supportive homes are helpful - the trauma and setbacks triggered by moving elder’s over 80 - remain critically significant.

Seeking options to and looking for creative solutions is a task best undertaken when not in crisis. Explore your options!  We at Home Instead Senior Care can help you navigate this. Call us and let’s have a discussion on what options are available for you or your loved one. Let us connect you with some of our Expert Care Partnerships we have built over our 20 years in business here in Sonoma -County. 707-586-1516. 


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.