August 14, 2007
A Grass-Roots Effort to Grow Old at Home
By JANE GROSS
WASHINGTON -- On a bluff overlooking the Potomac
River, George and Anne Allen, both 82, struggle to
remain in their beloved three-story house and
neighborhood, despite the frailty, danger and
isolation of old age.
Mr. Allen has been hobbled since he fractured his
spine in a fall down the stairs, and he expects to
lose his driver's license when it comes up for
renewal. Mrs. Allen recently broke four ribs
getting out of bed. Neither can climb a ladder to
change a light bulb or crouch under the kitchen
sink to fix a leak. Stores and public
transportation are an uncomfortable hike.
So the Allens have banded together with their
neighbors, who are equally determined to avoid
being forced from their homes by dependence. Along
with more than 100 communities nationwide -- a
dozen of them planned here in Washington and its
suburbs -- their group is part of a movement to
make neighborhoods comfortable places to grow old,
both for elderly men and women in need of help and
for baby boomers anticipating the future.
``We are totally dependent on ourselves,'' Mr.
Allen said. ``But I want to live in a mixed
community, not just with the elderly. And as long
as we can do it here, that's what we want.''
Their group has registered as a nonprofit
corporation, is setting membership dues, and is
lining up providers of transportation, home
repair, companionship, security and other services
to meet their needs at home for as long as
possible.
Urban planners and senior housing experts say this
movement, organized by residents rather than
government agencies or social service providers,
could make ``aging in place'' safe and affordable
for a majority of elderly people. Almost 9 in 10
Americans over the age of 60, according to AARP
polls, share the Allens' wish to live out their
lives in familiar surroundings.
Many of these self-help communities are calling
themselves villages, playing on the notion that it
takes a village to raise a child and also support
the aged in their decline. Some are expected to
open this fall on Capitol Hill; in Cambridge,
Mass.; New Canaan, Conn.; Palo Alto, Calif.; and
Bronxville, N.Y.
``Providers don't always need to do things for the
elderly,'' said Philip McCallion, director of the
Center for Excellence in Aging Services at the
State University of New York at Albany. ``There
are plenty of ideas how to do this within the
aging community.''
Although not a panacea for those with complicated
medical needs, the approach addresses what experts
say can be a premature decision by older people to
give up their homes in response to relatively
minor problems: No way to get to the grocery
store. Tradesmen unwilling to take on small
repairs. The isolation of a snowy winter.
As these small problems mount, sometimes
accompanied by pressure from adult children,
experts say, the elderly homeowner is caught off
guard. Remaining at home without sufficient help
is frightening. But moving to an assisted-living
center is often an overreaction that can be
avoided or postponed.
``A few neighborhood-based, relatively inexpensive
strategies can have an enormous effect,'' Mr.
McCallion said. ``If people don't feel so
overwhelmed, they don't feel pushed into
precipitous decisions that can't always be
reversed.''
For inspiration, the nascent groups looked to
Beacon Hill Village in Boston, which pioneered the
approach six years ago. Beacon Hill's 400 members
pay yearly dues -- $580 for an individual and $780
for a couple, plus à la carte fees -- in exchange
for the security of knowing that a prescreened
carpenter, chef, computer expert or home health
aide is one phone call away.
Experts in aging say the self-help approach
provides a sense of mastery, often lost with the
move to an institution or even an adult child's
spare bedroom. That can-do spirit is attractive to
baby boomers like Alisia Juarrero, 59, who is a
board member of the Allens. group, which spans the
Palisades neighborhood, an enclave of
single-family houses northwest of Georgetown, and
Foxhall, an adjacent area of attached Tudor homes.
Ms. Juarrero is mindful of the future because of
the struggles of her 89-year-old mother and
92-year-old aunt in Coral Gables, Fla. ``This is
where we're all headed,'' she said. ``If I help
set this up, it'll be there when I need it.''
So far, most of the villages are in places where
residents are well connected and skilled in
finance, law, medicine and philanthropy as a
result of their own careers. That raises the
question of whether the model is viable only in
neighborhoods of privilege. But experts point out
that most care for the elderly is already out of
reach for all but the wealthy.
The amenities of an assisted-living center are far
more expensive than a village's membership fee.
Medicare does not pay for long-term care, and
private help is costly. Only the destitute are
protected in old age because Medicaid pays their
nursing home fees.
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A few villages are cropping up where low-income
families live, such as in the Richmond District of
San Francisco, with its recent wave of Russian
immigrants; Falmouth, Mass., where year-round
residents struggle when the summer crowd is gone;
and in pockets in Westchester County, like
Yonkers, with diverse populations.
In such locations, social service organizations
are likely to organize the project, instead of the
older residents, and they rely on volunteers or
bartered services to keep fees down. One member
fixes another's faucet, banks the time and in
exchange gets a ride to a medical appointment.
Groups also share expertise online and at local
and national conferences, including several this
past spring. Some have access to regional resource
centers that help with matters like hiring an
executive director or buying liability insurance.
In terms of government support, New York State is
at the forefront, with a 20-year-old model known
as a NORC, or naturally occurring retirement
community. Since 1995, the state has financed
social services, including nurses and case
managers, in many apartment buildings with a
concentration of residents over 60. Last year, it
added a few suburban neighborhoods, so-called
horizontal NORCs.
On the federal level, Congress authorized
experiments in aging in place in the 2006 Older
American Act but did not finance them.
The sprawl of suburbia presents challenges to the
elderly once they cannot drive. Amid the rolling
hills of Fairfax County, Va., one group is
grappling with how to serve prospective members in
a place with a single general store and five-acre
lots. Taxi vouchers may be too costly when running
errands can take hours. Recruiting volunteer
drivers from 118 home owners. associations and 17
churches presents liability issues.
.The question is distance and time, and the money
that relates to that,'' said William Cole, 77, the
founder of the group. Mr. Cole anticipates yearly
dues of $1,000, which may be prohibitive for
neighbors who are real estate rich but cash poor.
One likely service, Mr. Cole said, will be advice
about reverse mortgages.
Many of the villages are concerned about whether
they can provide adequate support once the
founding members, who tend to be vigorous
regardless of age, decline either physically or
cognitively. In this regard, the New Canaan group,
with annual dues of $360 and $480, may be less
vulnerable than most. The suburb already has a
home health care agency, an assisted-living center
and a nursing home, thanks to years of advocacy by
a local physician, an 87-year-old board member.
Because of that, ``we have the confidence to live
without these problems getting the best of us,''
said Tom Towers, 69, the board president of the
group, Staying Put in New Canaan. ``And if they
do, we can take care of it right here.''
The first village in the Washington area is
expected to be on Capitol Hill. When it opens for
business on Oct. 1, annual memberships will be
$750 for a couple and $500 for an individual.
Among those eager to join are Marie Spiro, 74, and
Georgine Reed, 78, who share a rambling house that
they insist they will only leave 'feet first'.''
Between them, Ms. Spiro, an emeritus professor of
art history and archaeology, and Ms. Reed, a
retired designer of museum exhibits, have already
endured three knee replacements and an array of
other ailments.
Ms. Spiro describes huffing and puffing while
grocery shopping; Ms. Reed is increasingly
reluctant to visit friends across town. Both
women, who are childless, would already welcome
help with meals, transportation and paperwork. If
they need home care, Capitol Hill Village will be
able to organize that.
``I've never had to rely on other people, and I
never wanted to,'' Ms. Spiro said. ``But I'd
rather pay a fee than have to ask favors.''
Members of all these groups share an independent
streak -- and the willingness to plan for the
future. Those characteristics were on view
recently in a living room in Hollin Hills, a
post-World War II development in Alexandria, Va.,
where a half-dozen neighbors who once organized
baby-sitting co-ops are now organizing for their
final years.
Now, in their 70s and 80s, they still drive, play
tennis and travel the world. None has yet lost a
spouse, but they fear what will happen to the one
left behind.
``The vast majority of people don't have the
capacity to be realistic,'' said Ruth Morduch, 71.
``We don't know what's going to happen in X number
of years, but we know we're going to need help. In
my own home, that's less likely to be humiliating.
And an organization like this gives me a sense
that we're all in this together, our last grand
adventure.''
Copyright 2007 © The New York Times Company
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Katie McCamant and
Chuck Durrett