A Model for Elder Care? Supported Housing

Some hope for the future

Much of what I’ve been writing has been about the dire prospects for elder care when the oldest baby boomers begin reaching their late 80s within a decade. The challenges we will face are exacerbated by the physical design of our communities based on single-family homes scattered around the suburbs. This leads to the isolation of seniors, especially when driving becomes difficult and older adults can become confined to their homes. It can also make it expensive to provide services in their homes as home care workers, visiting nurses, and other providers must travel relatively long distances between the homes of individuals they serve.

Fortunately, there’s an alternative. In my latest Risking Old Age in America podcast, Lizbeth Heyer, President of 2Life Communities in greater Boston, describes their supported housing model for seniors that provides affordable housing with coordination of services that enables residents to continue to live in their communities as their needs increase.

Comprehensive Living Environment

Heyer explains that their model is based first on affordable housing with a full apartment for all residents, including a full kitchen, which allows for independence. In addition, all the units are fully adaptable so that no one has to leave because their physical needs increase.

The communities provide ample programming to keep residents engaged and involved with their neighbors. “Aging in community,” Heyer says, “addresses the epidemic of loneliness and the terribly horrible impacts of loneliness on older adults. There are a lot of studies out there that prove that older adults who are lonely or living alone have radically higher rates of heart disease, diabetes and a greater likelihood of developing dementia and if you do experience dementia you decline much more quickly. We know that loneliness is harmful to physical and emotional health and that community is a tremendous antidote to that by bringing connection and purpose and joy to people’s lives.”

Solving the Cost Problem

Heyer points out that Massachusetts is the state with the highest level of economic insecurity for seniors due to its high cost of both housing and care. It also has the highest rate of nursing home placement in the country, which is related to costs. Often seniors have to go to nursing homes because it’s the only place where they can afford to live with services since it’s covered by MassHealth.

Heyer describes the current system as like a barbell. There are solutions available for extemely low-income seniors and for those who can afford market rate services but nothing for the vast majority of seniors in the middle until they spend down and qualify for MassHealth.

“We have two crises in the home care industry: workforce and costs.” It costs about $35 an hour to pay for home care privately. Often seniors have to buy services in four-hour increments even if they only need a half our of assistance in the morning and evening. In a 2Life community they can simply receive and pay for the help they need.

The communities help solve the workforce problem since fewer care workers can see more people. It also relieves the stress on the workers. Often when they are providing in-home care, they can be the only person the senior sees during a week, adding to their responsibilities. This is not the case if they are working as part of a team in a larger community.

Different from Assisted Living

Heyer distinguishes their apartments from assisted living, where residents often don’t have a full kitchen and must go to a community dining room for all meals, meaning that they lose the agency to cook and live independently. The base cost of assisted living is expensive and typically only covers an hour a day of care. If the resident needs more, they have to pay for it on their own. Often the care becomes unaffordable resulting in residents ultimately have to move to a nursing home.

Each of 2Life’s seven communities has resident services managers that work with individual residents to make sure they receive the services they need. This involves a combination of recognizing the needs of the individual residents and deep knowledge of both the subsidies and services available in Massachusetts, information that families of seniors often struggle to obtain.

But the Need is Great

Unfortunately, 2Life Communities has about 8,000 people on its waiting lists as compared to its 2,000 current residents. But they’re growing. They housed about 1,200 residents a decade ago and expect to have 2,500 by the end of 2026 as several communities in development come on line.

One is Opus in Newton, a fully marketplace community that will open in about a year with 174 apartments. With such a large market for services in one place, they expect to attract a home care agency to work there and sell services in half an hour or one-hour increments.

They are also creating Treehouse at Olmsted Village in Mattapan that will combine senior care, housing for families providing foster care, and housing for young adults aging out of the foster care system. It is modeled after similar program in Easthampton, Massachusetts, that has been very successful in helping the younger people thrive in their transition to adulthood.

Advocacy

2Life is also advocating to expand affordable housing and for policy changes that make it easier to integrate services into the senior community. Heyer says that Massachusetts faces two fundamental problems: lack of supply and lack of alignment. There simply is not enough senior living available across the board. Sixty to 70 percent of seniors in Massachusetts qualify for subsidized housing, but only a small percentage are served.

We need to dramatically increase resources for affordable senior housing, primarily through expansion of rental voucher program and Medicare and Medicaid (MassHealth in Massachusetts) need to coordinate better with housing. Heyer cites Kamala Harris’s proposal to expand Medicare to cover home health care as a potentially significant initiative. It could ultimately save the health care system money because the lack of covered care often resuts in rehospitalization of patients after discharge and longer hospital stays as families struggle to set up systems of care.

Changing Mindsets

This, or course, brings us full circle. It can be difficult to provide care in individual homes. Heyer urges seniors to consider moving from the homes they’ve lived in during their adult lives and for communities to provide alternatives.

We live in a society that defines success as staying in your home as long as possible. “We need to change that narrative. Choosing to age at home often means choosing loneliness. Choosing to move into a community setting is not only a better economic choice. It’s a choice to share life with others, to choose community, to choose wellness through the kinds of social interaction and joy that you can get from all the opportunities that come from sharing your life with other people.”

Topics

00:00 Introduction to 2 Life Communities

00:38 Understanding the Mission and Services

01:22 Addressing Elder Economic Insecurity

03:26 Advocacy and Policy Changes

09:12 Challenges in Home Care

11:10 Innovative Solutions for Affordable Senior Living

21:59 The Opus Middle Market Community

24:49 Future Plans and Expansion

29:32 Recommendations for Policymakers and Seniors

35:53 Conclusion and Final Thoughts