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.