The harsh reality today is that, in light of Coronavirus, more people congregated in enclosed spaces is proving to have devastating consequences. What about seniors in assisted living? The solution is simple. Smaller is better. There are many types of assisted living available, but what is the most beneficial for seniors, what do they prefer, and what is best for their health and safety?
Residential assisted living provides seniors care and assistance in a small, home-like environment. Instead of 50 or even 100 seniors in a large facility filled with nurses, care staff, and countless other support staff coming and going, residential assisted living homes primarily have less than a dozen residents with a couple caregivers and a manager. If an outside observer was looking for a solution to keeping seniors safe during this pandemic, the choice would be clear – keep seniors in smaller home-like environments. This is usually where seniors prefer to live anyway.
Covid-19 Primes Senior Living For Rise Of Small-house Models
America finds herself ensnared with the continuing pandemic of COVID-19. When considering what is best for the most vulnerable among us, sensible measures reap great reward. Isn’t smaller better? Smaller what? Smaller housing arrangements. Residential assisted living homes are clearly more ideal for the present condition of public health and affairs in America. These homes are opposite the big-box like facilities so common across this country. Plus, residential assisted living is more ideal to the way seniors prefer to live. For today’s baby boomer, residential assisted living reminds them of growing up as a child. Big families, a house, a yard, neighbors to play with, games and barbecues, especially in the summer. As such, small-house senior living may be well-suited to handle the disruptions of the COVID-19 era. This may help boost the model’s popularity going forward — but the industry will first need to overcome obstacles regarding the way these communities are developed, financed and licensed.
According to Jim Stroud, co-founder of Capital Senior Living, after leaving Capital at the end of 2008, Stroud set out to find the next generation of senior housing models. “Let’s figure out what model we think that the baby boomers will move into,” he said. They aimed to discover a model that is flexible and resilient enough to withstand future change. Stroud told Senior Housing News, “We settled on the small-house concept.” Why the small-house concept? It’s more like home. Stroud’s vision became reality in Sonoma House Assisted Living & Alzheimer’s Care, a community with seven small-house buildings in Carrollton, Texas.
Sonoma House opened its doors in 2013, and in the years following, Stroud Companies spent time honing the community’s operational model. Now, Stroud believes the concept is ready for expansion. It’s only a matter of time before the “big-box” senior living companies embrace the small-house trend, too. “I’ve come from the big company mentality and understand it,” Stroud said. “The big companies are going to recognize this product type, and they’re going to recognize that smaller is better.” There is a sense that small-house senior living may emerge from the current era as a more attractive option, particularly if the model can prove its worth in preventing the spread of COVID-19. Smaller is proving to be better.
There is evidence to suggest that these smaller communities are better equipped to prevent the disease’s spread. How so? For clarity, let’s examine some case studies throughout America to capture the effect.
I. Perhaps the most well-known example of the model is the Green-House Project, a nonprofit that senior living innovator Dr. Bill Thomas founded in the early 2000s as an alternative to traditional long-term care settings. Today, there are 268 active Green House homes in the U.S., about 80% of which are licensed to provide skilled care, and the overwhelming majority of them are nonprofits. Green House properties typically house up to a dozen residents living in homelike facilities with private rooms, and are staffed by “universal workers” who provide a wide range of services and care. Green House operates with the philosophy of:
- autonomy for each resident
- resident controlled care scheduling
- resident driven meal planning
- resident selected activity schedule and activity choice
What is the impact of COVID-19 in Green House Properties?
- 9 out of 245 active Green House Project homes have reported a positive case of Covid-19
- 6 deaths overall, according to Susan Ryan, the organization’s senior director.
The smaller, less congregate nature of small homes is just one piece of the puzzle. The universal worker concept means the communities have fewer workers coming and going, and caregivers are able to develop much closer relationships with residents. This gives them an edge in detecting health issues or behavior that’s out of the ordinary. The intimacy developed in these types of homes gives way to better disease control and early detection of any sort of symptom. There are also numerous other senior living providers that have mirrored the approach in creating their own household models that aren’t officially affiliated with the organization. Though these vary in size and scope, most house no more than one or two dozen residents. With a lower census and the greater capacity to social distance, smaller is better. Some of these small-house senior living homes have reported minimal levels of COVID-19 and have touted the model as key to their success.
II. Another example is Assured Assisted Living – a company headquartered in Castle Rock, Colorado. To date their Covid-19 results are as follows:
- 10 small-home communities in the Centennial State
- 3 positive cases of Covid-19 among its residents
- All 3 were asymptomatic, but were able to be successfully diagnosed
- All 3 have since recovered
Again, Francis LeGasse Jr, President and COO of Assured Assisted Living, credits the smaller model as the reason for such early detection and swift response to the Coronavirus pandemic. And even if COVID-19 does hit one of its buildings hard, LeGasse is confident that having a smaller model puts Assured Assisted Living in a better position to adapt and address the health needs of its residents. In fact, Assured plans to use its COVID-19 success in a new “great things come in small packages” marketing campaign.
III. Shepherd Premier, a McHenry, Illinois-based senior housing provider with five small homes, has not yet seen a case of COVID-19 among its residents or workers, according to CEO Brandon Schwab. Like LeGasse, Schwab believes the small-house model is much more amenable to infection control.
“When a home is 10 to 15 beds compared to 150 to 200, you can control the spread of anything drastically easier,” says Schwab. “I feel that this type of home is going to be the Uber of this particular industry.” In essence, Schwab is alluding to significant market disruption. The small-house model will revolutionize senior living much in the same way Uber did the taxi cab industry and Amazon the big-box mall.
IV. Boise, Idaho-based BeeHive Homes has:
- 216 small-home senior living franchises across the U.S.
- a small number of positive Covid-19 cases among staff
- 1 case among its residents
- 0 deaths reported thus far.
The model’s flexibility, coupled with its more intimate nature, helps with infection control measures, according to BeeHive co-owner Dennis Toland. It is becoming blatantly clear – the smaller residential assisted living home model works for more than agreeable housing. It is safer.
Solution Vs. Problems
Among architects and even some developers, there is a sense that many senior living residents will take note of the small-house model’s success after the pandemic. Demand for residential assisted living homes will rise. However, the small-house or residential assisted living home model is not a “cookie cutter” model. This concept is diverse. The small-house communities of tomorrow may resemble single-family homes, as many small-home communities do today. This is far from the only option, according to Dan Cinelli, a principal at Perkins Eastman. This concept of senior living fits anywhere in America.
Truthfully, it is America. “It can be rural, it can be suburban, it could be a single-family home that’s detached, or it could be a vertical model,” Cinelli says, referring specifically to the Green House Project model. Residential assisted living homes are found in commercial zones as well as residential. They fit wherever they are needed. For instance, the vertical model may hold the most promise for shaking up the formula. Instead of arranging bedrooms throughout a single-story residence as many designers of small-house buildings do, architects of tomorrow may instead place them in buildings with multiple floors, with appropriate access like elevators, etc. Two projects Perkins Eastman shared as an example of this design.
- a three-story small-house building at the Rochester Jewish Home in Rochester, New York
- a four-story small-house building at the Goodwin House in Alexandria, Virginia.
In both examples, residents live in spaces with private rooms and bathrooms, decentralized dining and other features that could help with infection control. COVID-19 conscience construction is crucial in the present day and will continue to be beneficial long into the future. The vertical model in particular could prove popular among senior living developers, according to Joe Hassel, principal and co-leader of senior living at global architecture firm Perkins Eastman. He says, “the vertical model is much more cost-effective in the sense of land utilization and acquisition costs.” With lower construction costs, the opportunity for investors becomes even more financially attractive. Two other projects in Dallas may also offer a blueprint for the way forward, according to David Dillard, principal with D2 Architecture.
- The Vistas at CC Young, a nine-story assisted living building
- Ventana by Buckner, a 12-story continuing care retirement community (CCRC)
While neither fits the definition of a traditional small-house community, they do include many of the model’s core household-centric principles. Dillard says, “The small-house model was a solution waiting for a problem, and the problem is COVID.” The model is not perfect. It has its issues and challenges. For instance:
- Affordability of small-house communities
- More of a boutique-style arrangement means boutique pricing.
- Planning for small-house construction projects can be challenging.
- Resident rooms are spread farther apart requiring more creative land uses and design considerations.
- Small-house communities can be harder to license for senior living services.
- Regulators don’t always understand the product type as well as assisted living or memory care.
- Stroud finds this the biggest challenge in growing the model – regulatory agencies.
“When you go to someone that has not dealt with a small house before, then you have to educate them,” Stroud said. But that doesn’t mean the model can’t adapt as challenges arise. Like the architects at Perkins Eastman and D2, Stroud believes a vertical small-house model could help bring about the product type’s next evolution. The broader campus model may be the most expensive and is the least feasible in urban areas. Therefore, towers with the neighborhood concept per floor are more ideal.
Assisted living providers will navigate the post-COVID world in a manner similar to how assisted living and memory care providers hammered out their model in the early 1990s. Larger senior living companies will embrace the trend eventually. What remains to be seen is whether they will forge ahead with stand-alone small-house models, or whether they will instead integrate those buildings and concepts into their existing campuses. Only time will tell. Meanwhile, smaller residential assisted living homes continue to thrive.
Do Good And Do Well
Smaller is proving on a daily basis to be better. Care is better. Engagement is better. Above all else, safety is logically more feasible in these smaller settings.