In discussing the challenges to integrating real, diverse community into supportive living settings, such as senior living, the subject of cost inevitably arises. Financial forces, economy of scale, cost of development, cost of care, cost of land, affordability and access to quality care all gather at the table. Just a tiny bite to take on.
I have been an Architect designing supportive living settings for decades, and have witnessed, and many times been a part of, the following typical cycle – tell me if this sounds familiar:
A Client comes to me with the desire to do high quality assisted living or memory care. Part of their, and my, definition of “high quality” is a “smaller household” model, or a smaller group of residents, maybe 12 or 16 or 20 total. Wonderful. Then financial forces come to play, maybe investors or banks or simply math, and the one household of 16 becomes 2 or 3 households of 16, after all there is an economy of scale in building and care giving at play. Now our initial vision of 16 people on a half acre is now 48 people on 3 acres. Now an investor or other party may say “hey, why don’t you capture all those whose acuity grows beyond assisted living from leaving by providing some skilled nursing. And while we are at that, let’s develop a feeder by including some, or a lot, of senior independent housing too?” Now 16 people and a half acre have grown to 132 people and 20 acres.
Makes sense. Often this scenario is like an all-powerful gravitational pull. But where do you find a reasonably-priced 20 acres? The suburbs is where. Undeveloped parcels. By acreage needed and price/acre budgeted one finds themselves with a site housing only people over 55 (as advertised, but really over 75 and becoming a bit frail as is common) and way, way far away from everything. Access may be easy via the adjacent interstate, but none of those who can drive who live on this campus want to drive it- their eyesight and reflexes aren’t what they used to be, and they aren’t so comfortable going 75 anymore. Residents find themselves stuck on this campus with only others just like themselves, of the same age and with the same challenges, with little connection to anyone else, and with few purposeful things to do.
Where we find the greatest opportunities to give, do, learn, teach, explore, get a little uncomfortable and really live is not amongst a group of people just like us, it is among those who differ from us. I think this is the crux of it. I think this is why I shift uncomfortably in my chair at the notion of a “Dementia Village.”
Clearly, a big portion of the issue is cost. There is little land left at all, even at a very high price, in the city among a larger and diverse community of people and places. But also at issue is type-experience and risk in development. Senior living developers develop senior living. Not other things. And the cost of care is so high, that to make the project work the cost of land must be low. To make a typically conceived senior living project work, that is.
What if we looked at this differently? What if we opened up the notion of who is the developer? What if a collaboration of developers who develop different kinds of places came together to develop a setting that includes supportive living, (perhaps for seniors and others that need supportive setting) but also other things, such as other types of housing, commercial and food service interests, retail, entertainment. The economic equation would change dramatically, the risk shared, the benefits of reaching this huge and relatively affluent market1 shared too.
I could imagine two basic approaches- You develop in the community, or you make a little community in “the country.”
A more urban site would certainly mean a dense mid-rise building. There are many European examples of atrium buildings2, that include a very active open first floor with restaurants, a bar, shops, and upper floors that have a mix of some supportive living and some multi-family living and/or a hotel. In essence, one creates a living room for the city, and a wonderful stage to view and participate. For Denverites like me, think The Brown Palace atrium, or the renovation of Union Station. Who doesn’t want to hang out there?
A larger site further away in “the country” could create its own destination, big or small. If you can’t build in the city, you bring “the city” to you. Such development partnerships could take on many shapes. Maybe one includes a small event venue, or maybe another an actual functioning town hall, perhaps with a library, where a municipality is the partner. Couldn’t new versions of suburban strip malls include a well-designed supportive living, with food and shopping and exercise all easily available?
There is no limit to what engaging uses can be combined with supportive living. None. Granted, these kind of mixed-use developments are not easy. But they are certainly well worth it, and I truly believe the heart of the next generation of supportive living.
To really embrace such a mixed use that includes seniors our culture may need to begin to soften to the realities of frailty, aging, and what is really underneath those words (death), but that’s a subject for another blog. Or two. Or twenty.
WBA- Concerto Consulting
“The powerful play goes on
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1) Emsley, Vaughan (2020). Don’t Underestimate the Market Power of the 50+ Crowd. Harvard Business Review
2) Regnier, Victor, FAIA (2108). Housing Design for an Increasingly Older Population. Wiley