What If……

I think it could, and would.

34 years ago I began a process as an architect in graduate school of environment-behavior research-based design at the University of Wisconsin’s Institute on Aging and Environment.  We believed that understanding people’s needs, big and small, and the resources at play, could inform design solutions that play a part in a societal solution or improvement.

This quasi-scientific (I say quasi, because there are too many variables in architectural design to honestly refer to “hard” science) approach has been enlightened over the years, as I watched first my mother’s, then my in-laws’, and recently my father’s last chapter play out in real time before me.  I saw through them their fortune of having a well, incredibly loving and strong partner to lend the helping, dignified and loving hand that they needed 40 times a day.

A few years ago my firm had the good fortune to work with La Plata County, Colorado on a mostly research-based project to understand the challenges and needs of the elders of their county, and how the County could improve their responses to and environments for their elders.  This project included constituent interviews, a county-wide survey, census data analysis, literary research on what helps elders stay well and independent, case studies, and expert interviews.  A few poignant morsels came out of that work that underpin my thoughts here:

1. The number one reason people begin the process of leaving their independent home and move into assisted living is fear of a fall.

Elders either living alone or with a frail partner, who may have diminished balance, mobility, eyesight, cognition or other health condition, worry, and their loved ones worry, that they could fall, be injured, and not be able to render help.

2. The number 2 reason people move into assisted living is a collection of other relatively minor conditions that effect wellness and could snowball when one is living alone and isolated, and could result in an emergent situation.

Including medication management, nutrition, overall hygiene, and confusion.

3. In an overall general sense, the greatest health risks to elders are not physical, but the conditions of loneliness,   isolation, and a sense of lack of purpose.

4. The above represent the so-called tipping point from independence into semi-dependence, (and often Medicaid assisted living), where people are alone and at risk.  While these challenges can accumulate, grow and lead to life threatening situations, these typically do not need the intervention of a highly skilled caregiver.

I’ve been wondering for many years, what would happen if there were safe and well living options for those at the tipping point that were truly community-based, small and simple, and did not rely on licensed, regulated, expensive and sometimes isolating and dependency-born care? 

Could we delay and shorten the length of the average assisted living stay?  Could we greatly reduce the numbers of people entering assisted living at all?

Setting aside for a moment the potential personal improvements in living, real connection, independence, monetary savings and self-worth such options could provide, how much Medicaid reimbursement dollars for assisted living could be saved?  How much of this could be re-apportioned to other under-funded needs such as long-term care?

What I began to believe is that what may be needed to avoid this tipping point, at least initially, is at its essence only three relatively simple things: 1) a ready hand up, but many times a day, 2) someone else present and somewhat capable, to observe, assist and render or call for help when needed.  And 3) A buddy, friend, a partner in arms to do things and venture out with.

For the past few years I’ve spent some time studying and creating designs that may support these kind of small, community-based settings and living arrangements, with the hope of bringing light to and moving forward this discussion.

One such study, Hanai House- a group living arrangement for 4 unrelated elders, was published in this blog a couple years ago.  Another, Ohana House- or a house within a house, will be forthcoming shortly.  Other approaches are “on our boards” but not yet ready for scrutiny.  The focus of all these thus far is developing smaller and more intimate living settings that maintain privacy and dignity yet allow elders to lean on each other or others, knitting a mini community of interdependence and reliance.

At this point I have to pause myself and remember, I’m just an architect, and what I don’t know about the up close and big picture of elder care and Medicaid finance could fill a moving truck.  As such I ask for help, for input, for critical thinking from those of you readers who know and care.  E-mail me, call me, respond to this Blog, lets grab a lunch. We can make this a community effort, as it should be.  Most things worth doing are difficult, include hurtles and stumbling blocks and a certain amount of ego bruising, and more than anything else, creative thinking and will.

But I believe it can be done.

“Never doubt that

a small group of thoughtful, committed citizens

Can change the world”

Margaret Mead

Bill Brummett

Principal

William Brummett Architects

Concerto Consulting

wba@brummettarchitects.com

303.656.6036