Think about a time you have felt truly lonely. It probably wasn't when you were home alone, but when you felt anonymous in the midst of a big crowd of people. We are creatures of relationship, and except for the greatest extroverts among us, we are off-kilter with people who aren't in some relationship with us, be it intimate or somewhat casual. Yet our institutions don't reflect this.

K-12 schools began addressing the disconnect after research showed improved learning with smaller classrooms. In colleges, with the decline in the Greek system, dorms are now sometimes configured into smaller "residences" of students who live together all four years, often with some teaching staff.

Now, we are seeing this concept emerge in senior care housing. The model featuring corridors of up to 40-50 people per floor and scores of residents dining together does offer variety -- better odds that residents will find people who are compatible and share interests. For some, this is ideal, but many studying this model conclude that for others, it can create a profound sense of alienation.

The need for relationship that goes beyond exchanging niceties begs for our attention. L. Bradford Perkins, who heads up a senior home architectural firm said it well: “Older people’s greatest fear is having to share the most vulnerable time of their lives with a stranger." Seniors may have lost much of their family to death or geographical distance. The question the Residential Model poses is, to what extent can senior care centers compensate by introducing new people who become much more than just strangers sharing a common schedule?

To provide a family feel, Residential Homes typically house 6 -12 people in a physical environment that includes private bedrooms and bathrooms, but shared living, cooking and dining areas, as well as atria, sun rooms and outdoor areas. Rather than fit people into institutional timetables for rising in the morning and eating meals, flexibility is extended. Everyday activities like gardening and cooking together invite opportunities for organic involvement and more natural living patterns. But deciding on how to group people together is not straightforward. Options include:

  • By age group or life expectancy
  • By physical or mental capacity
  • By similarities in education and interests
  • By gender (mixed or not?)
  • By preferences for more or less independence

Reconciling the formation of appropriate groups with the reality of an unpredictable stream of new residents poses yet another challenge.

Then there is the fact that when you create a smaller family feel, resident turnover due to death or a move to skilled nursing may have a more powerful impact. The saying goes, "You can't pick your relatives." Yet you love them through all their quirks and annoying habits. In creating something resembling a family, losses are bound to be more poignantly felt. The average length of residence in independent and assisted living ranges somewhere between 1.8 years and 3 years, with only about 15 percent of residents staying over five years. Can a family model sustain such a frequent reshuffling of the deck?

Few would argue that these concerns outweigh the benefits of the more intimate, natural and active living opportunity the Residential Home model invites. We will watch with interest as the different designs and approaches to resident groupings are put to the test. No doubt we will learn more as certain approaches lead the pack in life extension, avoidance or deferral of higher skilled nursing costs and, most importantly, resident and family gratification.

In our next post, we will look at the cultural elements and staff support that underpin the Residential Home model.

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