Small Homes Emerge in a New Senior Housing Era

A few weeks ago this blog featured the story of a man creating an accessory dwelling unit (ADU) to house his mother-in-law on a visit, only to end up using it himself to shelter in place after testing positive for the coronavirus (see Housing for Covid-19). Now that’s starting to look like a harbinger of big things to come.

The reasonably equipped ADU has several things going for it in pandemics: it’s small, it’s safe, it guarantees social distancing by definition, it’s highly suitable for current high-tech communications trends and it’s relatively affordable. But a slam-dunk it isn’t.

By now intelligent readers of this blog, and intelligent new readers as well, understand that small homes for senior living must meet certain requirements. They must be comfortable, easily cleanable and allowing of constant communication regarding the status of the dweller within—are they up and about, are they feeding properly and taking their medications, are they avoiding falls and other mishaps but communicating quickly when disaster happens?

We’ve spoken of the growing technologies supporting this requirement (see Microchips: The Tiny Keys to Senior Independence below), but it’s worth taking special note of the amazing growth and acceptance of telehealth during the pandemic. From being a maybe, to a could be, to a sounds good but…, telehealth visits have evolved as standard care for older people sheltering in place and have become federally financed. This is a major step forward for the small home alternative.

But, as ever, there are precautions to consider. Aside from the usual obstacles, such as single home-based municipal codes, growing construction costs and not-in-my-back-yard community reactions, there are the lifestyle concerns of elderly occupants. Under no circumstances should they be allowed to feel isolated or trappedin these small spaces —out of sight, out of mind.

Nor should they feel any doubt that family and the community support them, care about them and will deliver medications and food as needed.

They should also be helped to avoid feeling bored or “antsy” from living in a small space. A recent report indicated that urban microapartment acceptance was bumping up against growing sentiment by would-be dwellers that they might prefer more space both inside the unit and in surrounding properties.

The needs for openness are understandable and require honest engagement by those who, in so many other ways, see small homes as an important answer for senior living.

Housing for COVID-19

As the austere, isolating environment of the coronavirus closes down all around us, it occurred to me that the ADUs and granny pods we’ve been discussing all this time just might be a workable senior housing solution for this most vulnerable population. I just recently had my speculation confirmed by a story in the most recent edition of the newsletter Accessory Dwellings (see Resources), in which author Martin John Brown describes his own 400 square foot ADU.

It was originally intended, he says, as a place to stay for a visiting mother-in-law. But as the coronavirus scare mounted she cancelled her trip, only to have Brown himself move into to isolate from his family as he developed his own symptoms. “I’m very fortunate to have this place to retreat,” he writes. “It’s nicely done. I can see the leaves emerging and the flowers blooming at nearby houses and the park. I get occasional deliveries of food and supplies on an outside table.”

This would seem to be viable alternative for an isolating senior family member, whether symptomatic or not. It can be safe, comfortable and reasonably close to family without having to close off part of the main house itself.

If properly done.

As we’ve gone on about at some length in this blog, an appropriate small house alternative for seniors requires considerable design and technological adaptation. It should be universally designed, with appliances and appurtenances adjustable to maintain senior independence as disability advances—moveable counters, grippable door handles, barrier-free bathing and the like. And ideally it should be equipped with sensor technology allowing close monitoring and transmitting alerts regarding physical safety, as well as interactive devices providing medication management and voice-activated assistance.

Supportive technology in particular has been showing remarkable development in recent months, as will be detailed in a forthcoming entry. And one aspect of this, telehealth—remote medical visits and examinations via the Internet—has been burgeoning with the enforced isolation imposed by Covid-19.

In short, this disruptive episode in all our lives has at least one bright spot: demonstrating the reality and potential of small houses as a practical alternative.

What will it take?

At first blush the small homes for aging idea makes so much sense it’s a wonder that it’s not more commonplace already. The truth is, there are several obstacles in the way, and removing them will require profound change in several areas:

Zoning: The largest practical obstacle of all at the moment, with the vast majority of municipalities still favoring that post-World War 2 staple of community development, the single-family home. Long held forward as “the American dream,” the single-family home is the bedrock of suburbia and, more and more of late, exurbia (the large rural and semi-rural tracts between cities). And many of the occupants of those structures want nothing that will interfere with their community mores, parking arrangements or taxes.

Which points to a related obstacle, called NIMBY, not in my back yard. Years ago I wrote in my book The Big Surprise that it wasn’t unusual for community members to turn out at municipal planning meetings to oppose development of nursing homes and assisted living facilities in their neighborhoods. The thought of changing the nature of a single-family neighborhood, with the supposed impacts on traffic and parking, was intolerable. The same possibly unfriendly reception is true of the small home, be it accessory dwelling unit (ADU), pocket neighborhood or backyard granny pod.

Choice: A big problem is simply availability of information about small home choices. You must find the solution that works best for you in contemplating caring for a loved one at or near the home, but the choices are several. ADUs come in various flavors: attached, detached, upstairs, basement—not to mention sizes varying from, roughly, 300 to 1,500 square feet. Granny pods—temporary backyard structures that can be installed and removed at will and incorporate sophisticated tracking and other supportive technologies—are another option. Somewhat larger practical assisted living (PAL) homes constructed in backyards or nearby are yet another. Understanding these requires significant research and, if possible, input from an informed consultant, if you can find one.

Finance: Two issues here: cost and the availability of capital.

As noted in the previous installment of this blog (“Sticker Shock,” below), the cost of an ADU was found to be irreducible below $180,000 in the “ADU capitol” of the U.S., Portland, Oregon. Granted, the urban northwest is already a relatively high-cost area, but one of the major drivers of that cost is a problem afflicting much of the country: the cost of construction labor. With the loss of much of their skilled labor force during the Great Recession, contractors are scrambling to find, develop and hire the plumbers, electricians and carpenters they need to complete housing developments of all kinds. The inevitable cost of this is a sharp rise in the cost of construction labor. One major Portland contractor I spoke with at a recent ADU conference told me, “This is a growing problem, and I see no end in sight.” Another general problem with contractors is that many just don’t see how they can make sufficient money in the small home market.

Even where costs are not daunting there can still be the problem of raising sufficient money from conventional sources, such as banks and other mortgage lenders. Many financiers are still unfamiliar with the challenge of meeting the needs of the so-called “middle market,” that large and growing group of middle income families who can’t afford sustained facility care running tens of thousands a year, and yet make too much money to qualify for Medicaid assistance. Robert G. Kramer, a founder and strategic advisor for the National Investment Center for Seniors Housing and Care (or NIC, the national organization of seniors housing financiers), says members have been “spoiled” by the relative ease of marketing big-ticket facilities to upscale seniors, but wonder where the return on equity will come from middle market models. He says figuring this out will be seniors housing financiers’ major challenge for the next decade before the full impact of middle income seniors slams into the market.

Technology: As a caring environment, the small house won’t work without supportive technology. These are devices and systems available today that do much of the work a caring staff would do in a formal facility, such as a nursing home or assisted living structure. Residents’ daily activity is monitored closely enough so that any significant slowing down or disruption of that activity will be quickly identified and dealt with. In the small house motion sensors and alarm systems play that role, connecting directly with the main home and its occupants, whether at home or away. Another, not really new, automated device offers medication management, alerting the senior or caregiver when certain drugs must be taken, and tracking serious deviations in drug-taking behavior. More recently voice-activated technology, such as Amazon’s Alexa and Echo Dot, gives the senior communication and environmental control options never before available. (See “New Technology for Small Home Living”, below). Not too far down the road will undoubtedly emerge useful and pleasantly acceptable robots to help seniors with home maintenance and perhaps even provide entertaining company. Also telehealth, with seniors conducting virtual visits online with healthcare providers, is another growing option.

The point for now, though, is that all this emerging technology remains on the cusp of general acceptance, and even existing supportive technologies such as motion sensing can be controversial, perceived by some as an invasion of privacy. The senior care environment has a ways to go to catch up with the smart home revolution currently underway.

Home care knowledge: A major issue right now, and one that continues to evolve, is family knowledge of home care techniques needed to keep senior safe without burning caregivers out. The “right time” to move a frail senior from a normal, day-to-day home environment to facility care has long been contentious. Seniors, for their part, don’t want to leave the home, vowing never to do so even when it’s clearly necessary.

Meanwhile caregivers find themselves becoming ever more deeply involved in senior care—feeding, bathing, dressing, even toileting—as the need grows, often at the cost of their jobs and working hours. The question is, how much can you and others living at home be expected to take on, practically speaking, in the family home? When will transfer to a formal caregiving facility become unavoidable? These questions have highly individualized answers and must be explored early and often.

In view of all this, the path to the small home as a practical alternative may well be long and challenging. But these issues will be worked through over time, based on the accumulated experience of families and homeowners addressing them individually starting now.

ADUs: How affordable?

Affordability: the whole point of this blog from the start has been that accessory dwelling units (ADUs) and other small structures are a far more affordable type of supportive senior housing than assisted living (around $40-50,000 a year) and independent living facilties (monthlies running from $3-5,000 a month, on top of an entry fee not uncommonly of a quarter-million dollars or more).

But there is no getting around the fact that building an ADU from scratch is not cheap. Recently Portland, Oregon-based ADU guru Kol Peterson reviewed the costs carried by developers in that ADU hotbed of activity and found that, among other things, the absolute minimum, irreducible cost of building a detached ADU was $80,000. More typically, though, detached ADU construction averaged more than $180,000,

Average costs weren’t much different for other ADU types, e.g., $185,000 for a basement ADU, $154,000 for an attached ADU (attached to the family home), $142,000 for a garage conversion, and $217,000 for new construction above a garage.

The cost “fly-in-the-ointment” is the expensive fixed costs of development and construction, including labor and material, excavating and pouring a foundation, and concrete formwork, as well as costs involved in permitting, design costs, and utility connection costs.

Many of these costs in the Portland area are offset by so-called “sweat equity,” with owners contributing their own efforts to the design and build. Going even further in individual initiative, these owners are often required to seek financing from sources other than the typical mortgage and building loans available to single-family home developers.

With or without contributing your “sweat equity,” though, it is important to think through the initial costs you will incur with ADU development. The good news is that the expense is upfront and limited, rather than lasting multiple months and years, as is the case with other supportive senior housing. Over the course of time, the savings stand to be substantial.

Still, the small home approach to the “missing middle” talked of so much these days by senior housing financiers, just waking up to the dichotomy between the high-end projects they’re familiar with and the typical alternative of Medicaid-supported facilities, remains frustrating. The concept is new, and many builders and planners just aren’t comfortable with it yet.

Case in point: a recent article on a “pocket neighborhood” of small structures offered as a downsizing alternative to single-family homes in suburban Northern Virginia cites prices of $750,000-800,000 for the 1,500 square feet—hardly within the realm of affordability. While these costs reflect the high-cost environment of single-family homes in this suburb, still, it is clear that traditional senior housing developers have a long way to go toward comprehending the “missing middle.”

Innovation is needed, and there might be some hope, for example, in Bill Thomas’s Minka house concept using offsite prefabrication that can bring construction costs down considerably (see, “Bill Thomas’s Small Home Approach to Dementia”).

But, for now, do your homework and stay patient in venturing into this field.

The ABCs of ADUs

As announced in our previous item on AARP’s involvement in the ADU movement, AARP has just issued its complete, easy-to-read and well-illustrated guide to all aspects of ADU development.

Titled “The ABC’s of ADUs,” it is available for download or phoned requests for hard copies at the site www.aarp.org/ADUs. In it you’ll find the sheer variety of ADU models possible, the design features that might best accommodate your needs—in our case, the “universal design” supportive approach for seniors—and how to address the always tricky issues of building codes and permits.

The Guide’s approach to the latter, by the way, makes it sound clearer and even easier than you might think.

The Guide features real-life examples of each of the models possible and how owners brought them off. It shows the cities and locations that are ADU-friendly and possible courses of action where they are not.

The vigorous endorsement by an organization like AARP indicates, for ADUs, an idea whose time has come. Good luck with “The ABC’s of ADUs”!

AARP Pushes the ADU Solution

When an organization representing 38 million older Americans takes a stand, attention must be paid. For nearly two decades the organization, formerly known as the American Association of Retired People, has supported accessory dwelling units (ADUs) as an affordable housing solution for older adults. It started with a model ADU code some 19 years ago, but recent years and months have seen a heightened activism by AARP in this direction.

Heading a relatively new division called AARP’s Livable Communities, Danielle Arigone has advanced a multi-pronged approach to creating such communities for the elderly, including urban planning, transportation and housing. Much of this has involved reaching out to communities throughout the country to encourage age-friendly development. As of now, some 360 communities have been officially designated by AARP as age-friendly.

Last year Livable Communities conducted a survey finding that 75% of older adults wanted to age in their communities, but that in many cases their housing was either oversized for their needs and abilities or too expensive to access, e.g., independent and assisted living institutions. “Communities have come at this in various ways,” she says, “but the most popular has been ADUs.”

Interest has been expressed in all small house models discussed in this blog: attached, detached, backyard granny pods, microapartments, tiny houses on either foundations or wheels. “We’re focusing on getting all the information we can into these people’s hands,” Arigone says.

AARP has developed, for example, a written ADU guide for Louisville, Kentucky and has worked with mayors throughout the Chicago region to conduct ADU workshops.

Last year the organization co-sponsored an exhibit at the National Building Museum called Making Room, which showed various approaches to meeting 21st century housing needs for a changing America: more people living alone or with roommates, extended families, aging in place and, particularly relevant to ADUs, empty- nesters—seniors wishing to move from their long-time family homes to places that, while still safe and comfortable, are more affordable and easier to maintain.

AARP Livable Communities’ specific exhibit for Making Room was an empty-nester-oriented 250 square foot microapartment, featuring many of the ingenious arrangements in furniture design, layout and storage that have been discussed elsewhere in this blog (see below, “Multi-use furniture enabling small spaces”), featuring such “universal” (aging-friendly) design items as motor-operated beds and adjustable countertops.

In early May, Arigone says, AARP Livable Communities will publish a general guide to ADUs for the nation at-large, still another major step toward validation of this alternative. Look for this blog’s report on the guide in a couple weeks.

And keep your eyes open for any AARP initiatives on ADUs in your communities.

The Headaches of Living Small

One of the obvious but seldom discussed aspects of living in a small space is simply getting used to it. A 3 bedroom home or a 1200 square foot apartment it isn’t. 300 square feet or less could seem a little, well, claustrophobic.

Contemplating a granny pod or microapartment, you wonder: Will the walls seem as though they’re closing in? What about those bad or annoying smells from pets, cooking or what have you? Are you afraid that visitors will drop in, take one look, and start a fundraising for you?

That’s pushing it a bit, but there’s no question that moving into a small space will take adjusting.

Here’s where the ingenuity of small home design comes in. Everything should be designed to give you as much clean, well-lit, safe and convenient space as possible. That flexible furniture we discussed elsewhere in this blog—movable, foldable, adjustable in size and height, will be crucial. So will the semi- or non-visible support technologies, such as motion sensors, voice-activated assist devices, medication management tools and more.

Small does not mean simple. It takes every bit of the creative, sensitive design thinking any other successful living space will take.

There’s another consideration: If you’re planning to occupy this as a couple, and at least one of you is built like a linebacker for the Green Bay Packers, this might not be for you.

So be careful when considering your options. Also take care to be as well informed as you can about what those options might be. These are changing and developing all the time—but, in this day of the online search, research should be easy and even fun.

And we’ll try to keep you posted and updated.

Small Homes for Aging: The Next Frontier

Introductory essay published by the National Investment Center for Seniors Housing and Care

The sheer cost of long-term care! Few shocks in modern life can equal that of the average middle-class family seeking safe accommodations for a loved one in need and discovering the price tag of safe housing. Costs run from the mid-30-thousands a year for assisted living and significant home care to $90,000 a year and above for skilled nursing.

Then comes the shock of learning that virtually none of this is covered by government or, in particular, Medicare. And the government coverage that does apply, Medicaid, only comes in when the family member becomes legally impoverished.

This is the “big surprise” I alluded to in publishing a small book on that theme several years ago (“The Big Surprise,” XLibris Publishing, 2012). Families are experiencing it every day in growing numbers—a growth soon to burgeon, as the oldest Baby Boomers move into their 70s.

It’s questionable how, or whether, society will respond to this challenge, but one thing is becoming increasingly clear: a form of safe and affordable housing is evolving that may meet much of this need.

Small homes are just starting to penetrate the national consciousness. These include, but are not limited to, tiny houses—around 500 square feet, often on wheels—that have gained some trendy attention in news media and entertainment venues (a character in the Netflix series Grace and Frankie lives in one). But small homes are also defined by the term accessory dwelling units (ADUs).

ADUs come in several flavors—additional dwelling space in a family home, small detached homes of varying heights, so-called “granny pods” (small, independent units installed in back yards), and microapartments of 300 square feet or less. They are attached or detached, urban or suburban, freestanding or offered as small communities, such as pocket neighborhoods or tiny villages.

Usually (though not always) these come at relatively affordable prices, a one-time expense of roughly $45-120,000. So their affordability is already a selling point for the senior housing field.

But beyond this are the design advances and new technologies that have evolved only recently to make small home viable for seniors seeking safe, affordable housing.

Some design innovations include adjustable-height counters, beds and tables that fold into walls when not needed, ingenious arrangements of furniture and storage space allowing for maximum mobility and avoidance of claustrophobia, and pleasant finishes worthy of any home.

Technologically there is the microchip, and all the supportive equipment that this enables—motion sensors; personal emergency response; voice-enabled “servants” providing schedule reminders, entertainment and home security; and medication management. Advances in artificial intelligence (AI) point to the imminent arrival of helpful robots performing needed chores and errands.

Coming as well is telemedicine, allowing physician offices to connect directly with patients in their dwellings, providing surveillance and advice, as well as needed examinations.

All of these technologies are working together to create a new alternative for senior housing.

Needless to say, none of this is commonplace as yet—this development can be fairly characterized as “bleeding edge.” Supportive technologies have a way to go to secure seniors’ trust and adoption, not to mention basic understanding (although a surge of voice-enabled devices, such as Alexa and her sisters, seems to be in full swing). Intense focus on the elderly is not quite there yet in Silicon Valley, and AI has a long way to go to become domestically useful.

An even bigger current obstacle is the slow advance of municipal housing codes to make way for the development of small homes of various types. Most codes are very conservatively single family home-oriented. Northwestern cities such as Portland, Oregon and Vancouver, British Columbia are currently leading the way in opening the door to smaller spaces, and recently Minneapolis, Minnesota became the first city in America to end single-family zoning throughout the city. Meanwhile Virginia became a “granny pod” pioneer only a few years ago in allowing development of backyard MedCottages.

Last year long-term care innovator Dr. Bill Thomas laid the groundwork for his so-called Minka small home communities in the state of Indiana and has initiated construction.

In general, though, municipalities and states have been leery of small home developments for fear of uncontrolled spread and severe diminishment of property values, and this appears to be a challenge slow to resolve.

Or maybe not.

In any event, all elements are present for a true revolution in senior housing—an affordability salvation for many families, a step toward safe independent living for elderly no longer able to live in the family home, and a rich opportunity for imaginative real estate developers who see what’s coming in only a few years.

To that end I have established the blog smallhomesforaging.com to track these developments, educate decision-makers, and perhaps even entertain.

Richard L. Peck is former Editor-in-Chief of the magazines Long-Term Living (formerly Nursing Homes Magazine) and Healthcare Design, of which he is founding editor. He also began the DESIGN series of annuals (now known as Environments for Aging) showcasing advanced design for long-term care facilities. Previously he spent nearly 10 years editing Geriatrics, a clinical magazine aimed at primary care physicians.