Affordable Housing Institute : US

By:David A. Smith

 

What do we live for? 

 

Pleasure, happiness, success, new experiences, friends, children, loved ones? 

 

Does anybody really know what time it is?
Does anybody really care (about time)

 

Old age, the silent thief, can imperceptibly steal each of these from us, and as all of us are reluctant pioneers in our senescence, the day may come when we wake and ask ourselves, why am I still doing this? 

 

Viola Baez, the first private inhabitant of a MedCottage, which was designed by a Virginia firm with help from Virginia Tech. It is essentially a portable hospital room.

 

For many elderly, that moment comes when we live alone, surrounded not by friends or loved ones but strangers, and when that happens, we will vehemently resist, as dramatized in this story from the Boston Globe (December 2, 2012):

 

Washington — Viola Baez wouldn’t budge.

 

Her daughter’s family had just invested about $125,000 in a new kind of home for her, a high-tech cottage that might revolutionize the way Americans care for their aging relatives. But Viola wouldn’t even step inside.

 

If you’re over a certain age, that scene is familiar to you:

 

If so I can’t imagine why (Oh no, no)
We’ve all got time enough to cry

For more than 65,000,000 American adults, well more than one in four of us, while we’re ready to help our parents in their declining years, we have discovered that it is a curse to be a caregiver

 

She told her family she would rather continue living in the family’s dining room than move into the shed-size dwelling that had been lowered by crane into the backyard of their Fairfax County, Va., home.

 

While grandmother might prefer living in the dining room, I am sure the family found the whole idea disconcerting, inconvenient, or creepy. 

 

‘‘You’re throwing me out! You’re sending me out to a doghouse! Why not put me in a manicomio?’’ Viola, 88, told them, using the Spanish word for madhouse.

 

Age can steal not only our bodies but also our minds, and as Alzheimer’s takes a person’s mind, it is like peeling an onion in the loss of both memory and emotional stability.  Parents and grandparents become willful, paranoid, angry, and childish.  All their fears surface, and of these the greatest is the fear of disconnection, isolation, abandonment.

 

Don’t know where to go
Don’t know where I am
Can’t see past the next step
Don’t have time to think past the last mile

 

A life not worth living any more

 

As people’s memory becomes fickle, the aging want their relatives immediately at hand, visible and within earshot, to come running when they call, but they also want their privacy, and we want our privacy from them. 

 

Viola’s relatives agonized over the best way to care for Viola only after her ability to care for herself became questionable. Their decision exposed intergenerational friction that worsened after the new dwelling arrived.

 

These desires create family dynamics and market demand, and when that happens, the Law of Economic Pressure produces a new form of physical configuration:

 

 

Many simply know them as ‘‘granny pods,’’ and they have arrived on the market as the nation prepares for a wave of graying baby boomers to retire.

 

To the current economic pressure we have to add the demographic gray wave, which I’ll reference as it’s chock-a-block with hyperlinks:

 

And let there be no doubt – it is a global gray tidal wave that we are facing, as revealed via a terrific new report. Just as our century’s great global-south challenge is urbanization, its great global-north challenge is gerontification – with its implications for public spending and for affordable elderly housing. We know it will hit America, Europe, and Japan, but I had no idea how rapidly the world’s other rapidly emerging nations are also adding, until I found an International Herald Tribune editorial by Richard Jackson, Neil Howe, and Keisuke Nakashima of the Washington-based Center for Strategic and International Studies, authors of a new report (full report in Adobe Acrobat, and overview of results also in pdf) that presents a Global Aging Preparedness (GAP) Index.

 

It’s a gray wave of aging, and we’re all getting there soon enough.

 

They’re living in secret among us

 

In less than 20 years, the number of Americans who are 65 or older will top 72 million, or more than twice the population of older Americans in 2000, and many will need to find living arrangements that balance their need for independence and special care.

‘Found’ is a misnomer that signals our complacency – people’s living arrangements will have to be created, because the configurations suitable for close-at-hand living do not exist in hospitals, nursing homes, or any of the place-based solutions that are now prevalent.  

 

The idea for the MedCottage came from the Rev. Kenneth Dupin, a minister in southwest Virginia who wondered why Americans didn’t take better care of their elders.

 

All the existing health-care modes require the elderly person to be untimely ripped from her home and her support network.  Nor have they evolved in the typical American home, so people are making do:

 

“Cut off his manhood and feed it to the goats”

“There are no goats, half man.”

“Well, make do!“

 

Then the Baez’s air conditioner blew. As temperatures and tempers soared in the main house, Viola’s family coaxed her into the cottage to cool off. Viola stayed the night, then another, and another, until summer had turned to fall.

 

Very swiftly, what had been frightening became familiar.

 

The MedCottage, designed by a Blacksburg, Va., company with help from Virginia Tech, is essentially a portable hospital room.

 

A bedroom-triptych

 

As the schematic above displays, the MedCottage is a bedroom writ large.  Everything radiates outward from the bed as from a throne, flanked by sitting chairs for guests (relatives).  The bedroom is in turn flanked by a smart-device-laden bathroom that doubles as a medical diagnostic station, and a user-friendly heat-and-eat kitchen.  Movement is minimized because the resident is very likely to have limited mobility.

 

The MedCottage in Fairfax is about 12 by 24 feet, the size of a typical master bedroom. With its beige aluminum siding — and cosmetic touches such as green shutters — the cottage looks a little like an elaborate dollhouse.

 

But it’s a very smart dollhouse, with nifty features.

 

Tech everywhere

 

Note the enhanced tech:

 

Rev. Dupin created N2Care, a company that designed the MedCottage with help from the Virginia Tech Corporate Research Center.

They stuffed its steel shell with the latest in biometric and communications technology, and crafted its features using universal design principles to accommodate people of all ages and people with disabilities.

 

Video and computer monitors provide remote access to the real-time situation.  That’s the kind of privacy most people would allow only a family member.  The computer prompter (‘virtual companion’), pressurized ventilation, lift and lighting are all designed with an octogenarian in mind.

 

Shannon Page, 28, monitors her grandmother’s activity and the temperature in her room on a computer screen in a living room nook that doubles as an electronic command center. The family agonized over the best way to care for Viola only after her ability to care for herself became questionable.

 

The interior, painted gray and white, seems so airy and comfortable that Soc jokes about reusing the dwelling someday as a mountain cabin.

 

The MedCottage brings the health care into the housing, and moreover, as the housing is modular, it brings the housing to the household.

 

Viola Baez getting oxygen … and uploading biomedical repots into the system.

 

Viola’s family understood this. Her daughter, Socorrito Baez-Page, 56, who goes by Soc, and her son-in-law, David Page, 59 — both of whom are doctors — began planning her care well before Viola’s husband, Luis, died of cancer last February.

 

Sad to relate, death is a sexist, taking more men than women, so by far the most common elderly person is a widow.

 

They explored many options and had firsthand experience with several. Soc and David had taken care of or arranged various types of care, including assisted living and hospice, for other parents.

 

Viola and Luis disliked nursing homes, and Soc’s property was not well suited for an addition. Then Soc read about the MedCottage, which Luis endorsed before his death.

 

5. Baez-Page, right, sits in the kitchen while her mother, Viola, sits in the living room of her MedCottage. The MedCottage retails for about $85,000, but with delivery, installation and hookup, the family has spent closer to $125,000.

 

I’m sure that was a crucial step in moving the family, and Viola, toward moving; to be told that the new home will be safe by the one who lives with you and who will die before you.

 

If so I can’t imagine why (Oh no, no)
We’ve all got time enough to die

 

The enormous future demand for a compatible, nurturing close-at-hand living environment is leading many companies into the market:

 

Several firms have entered the market for auxiliary dwelling units, or ADUs, as they’re known in the building industry. These include FabCab, a Seattle-based company that makes ADUs and full-size homes.

 

More a micro-apartment than a nurturing cottage

 

FabCab’s unit is much more like a simple independent apartment at small scale; the MedCottage has been technologically enhanced to create a smart-house living environment. 

 

Practical Assisted Living Solutions, or PALS, a firm based in Meriden, Conn., makes freestanding modules.

 

A PALS ADU snuggling up against its host house

 

The Home Store, which is headquartered in Whately, Mass., sells modular ‘‘in-law’’ additions called ‘‘Elder Cottage Housing Opportunity’’ additions.

 

Modular kitchen in the ECHO unit

 

All these home constructions have been given cutesy monikers, all designed, I think, to make them sound friendly and unthreatening.

 

Aren’t I unthreatening?

 

Being unthreatening and small-scale is also critical to marketplace acceptance, including tolerant or accommodating zoning.

 

HomeStore’s ECHO home being dropped in alongside an existing house

 

Virginia state law, which recognized the dwellings a few years ago, classifies them as ‘‘temporary family health-care structures.’’

 

That classification is sui generis – unique to the pods – and it’s obviously a stretch to accommodate the form without being bound by zoning’s straitjacket. 

 

Everybody’s working (I don’t) I don’t care (About time)
About time (Oh no, no) I don’t care

 

And there is a further generation looming in our future, one the sf writers have been exploring for decades.  As people live longer into their dotage, as computers become smarter and as bandwidth goes to infinity, it will be robots who care for us – and as they become more human, as they care for us we will come to care for them.

 

Hath not a robot eyes?  Hath not a robot hands?

 

Why do we keep on living?  As long as we think and love, that is enough.

 

Will you be Frank with me, robot?

 

As the first private inhabitant of a MedCottage, Viola is a reluctant pioneer in the search for alternatives to nursing homes for aging Americans.

 

All of us are reluctant pioneers in our old senescence.

 

Viola combs her hair under a futuristic-looking light in the living room of her MedCottage. Her daughter and son-in-law began planning her care well before her husband died of cancer in February.

 

Viola Baez, the Alan Shepard of elder care.

 

Welcome home, pioneer