These smaller housing models make a big impact

Before Faye Kirbyson, an older adult living with dementia, moved into a Daughter on Call elder care home in Brandon, Man., she was not eating. It was one of the concerns Faye’s family brought to Gail Freeman-Campbell, the organization’s founder and CEO. In those first few days, while the other five residents engaged in grocery planning and shopping, or potato peeling and mashing, Faye declined her seat at the “family” table. At first, instead, she walked non-stop until she was exhausted. After about a year in the home, Faye would sit in front of the TV and staff would bring her food to eat there.

It’s common for people living with dementia to refuse to eat, to be able to sit still long enough to eat, or to eat a balanced diet on their own. What’s unique to each individual, Freeman-Campbell says, is the need that is not being met.

What was Faye’s unmet need?

“Turns out, she used to be extremely physically active,” says Freeman-Campbell. “She had a purpose to move.”

Care providers, who staff the Daughter on Call care home 24/7, began leaving fresh food on the kitchen counter, encouraging Faye to eat as she moved around her home throughout the day.

“We called it ‘Faye’s Perch,’” says Freeman-Campbell. It worked. This simple accommodation empowered Faye to eat and be active on her own terms.

Faye is a resident — and the namesake — of Kirbyson Home, Daughter on Call’s first cooperative elder care home. The 3,000-square-foot bungalow was purpose built in 2017 in a residential community in Brandon. It has six private bedrooms, each with an ensuite bathroom, and a shared kitchen, living room, dining room, fenced yard, garden and hair salon. Kirbyson Home is one of five Daughter on Call elder care homes currently accepting residents, with six more similar bungalows under construction in Manitoba. Freeman-Campbell’s waitlist includes families with immediate needs, those who are anticipating an eventual need, older adults who submit an application pre-emptively on their own behalf and more.

“People want options,” she says. “As long as my phone is ringing, I will keep expanding.”

Small-Scale Living

When we imagine long-term health care for our aging population, we’re more likely to think of a hospital-like setting than a home in a residential neighbourhood. But many care homes are challenging that assumption, including ExquisiCare Senior Living in Edmonton. ExquisiCare has three 10-bedroom estate homes in the Edmonton area, two of which are specifically designed for people living with dementia.

When Dawn Harsch, president and CEO of ExquisiCare, was in nursing school studying to become an RN, she worked in a long-term care ward with six beds to a room, separated by curtains. Harsch remembers thinking, “There’s got to be a better way than this.”

Harsch says care home models like ExquisiCare provide the same high quality of care, safety and innovation as traditional models, accommodating residents at the beginning of their dementia journey to end-of-life, all while keeping seniors in the community.

“I just don’t buy that because someone has health-care needs, they need to be in a large environment,” says Harsch.

In a smaller environment, we are more accountable for one another and our seniors can live more purposefully. At one of her Edmonton homes, Harsch describes a gentleman who carries the groceries in from the driveway, which she discovered is something he had done in his own home for decades. When prospective families arrive to tour the house, he proudly embodies the role of host.

“He clearly feels like it’s his home,” she says.

Rhythm of a Home

Most households have a familiar rhythm. Its cues are much more familiar to us than those of a larger, institutional environment. Small cooperative-living models seek to reinforce these cues and integrate residents into the running of the home to the extent they are interested and capable. Some residents enjoy meal planning and prep, others might fold laundry, garden or, in the case of some Daughter on Call homes, care for the home’s companion dog.

The shared living spaces are open to everyone, but tasks are completely optional. For residents who are further along in their dementia journey, the sensory stimulations in a home-like setting still have therapeutic meaning: the smell of a meal as it is being prepared can increase appetite and the flexibility of a household schedule can allow for more personalized eating, sleeping and activity patterns.

Be Our Guest

The move into full-time care is a vulnerable time for families. Small care homes can remove the friction that visiting a large facility may cause and often allow guests to visit at any time. Often there are no specified visiting hours, and families not only get to know the other residents, but also the other families and caregivers in what can otherwise be an isolating experience.

Global Initiatives

As the proportion of older adults grows in every population around the world, so does society’s motivation to re-imagine senior living. Reigershoeve, in the Netherlands, is a smaller-scale model for people living with dementia, with four group homes of six to seven residents on a small Dutch farm.

In the United States, The Green House Project partners with health-care providers to transform the way we create long-term and post-acute care. Its mission to “eradicate institutional models, destigmatize aging, and humanize care” has inspired care models around the world.

Purposeful Living

Tamar Krebs is the founder and Co-CEO of Group Homes Australia, which has 11 care homes, each with between six and 10 residents and a high carer-to-resident ratio.

The homes are equipped to provide modern medical care, but are designed with period-sensitive decor.

“The visual environment is part of the therapy itself,” says Krebs.

The shared living spaces encourage socialization and allow residents to engage in the day-to-day activities that bring them purpose and meaning. Krebs believes it’s important for seniors to live in an environment based on their common interests and hobbies, rather than just medical needs.

“Yes, their needs are met. But there’s more to their world than just needs,” says Krebs.

Is Small-Scale Living for Everyone?

Breaking our idea of the traditional health-care model can be challenging for some families. Daughter on Call CEO Freeman-Campbell says that some families sometimes still want a medical model, with uniformed staff and routines based on clinical care.

“We’re conditioned to fix, and, when we can’t fix, we think it’s a failure,” says Freeman-Campbell.

Small-scale living can also feel very intimate — while residents have personalized, private bedrooms and bathrooms, the shared living spaces are meant to foster social connectivity and interaction. Freeman-Campbell watches closely for signs that new residents are adjusting, such as taking part in household tasks and activities.

“Then we know they’ve accepted it as a home,” she says.

The Future of Care

Society in general has become less accepting of the institutionalized model of care. In fact, personalized care and home-like settings are increasingly being incorporated into large-scale facilities.

Erik Landriault is the former director of innovation at SE Health in Toronto. SE Health is a national social enterprise providing home care, health solutions and health education. Landriault’s former team, SE Futures, explores the “home-spital” model of care. SE Futures supports health innovations that disrupt the idea that good care must only be equated with a hospital.

“A lot of things that we do in a hospital can be done in a home,” says Landriault. Traditionally, medical care required expensive technologies, and highly trained individuals to operate those technologies. With so many advancements in technology, surgeries and community supports, Landriault says a future where seniors feel empowered to age at home is possible.

“There is an increasing awareness that it benefits everyone to shift power back into the community,” he says.

Community Asset

In Edmonton, one of the most rewarding impacts Harsch has witnessed is how neighbours have embraced care homes in their communities. She expected a small amount of NIMBY-ism (an acronym for “Not in My Back Yard”), but her fear has been assuaged by the positive response in the Edmonton communities. Residents are getting to know their neighbours and are empowered to feel like part of a community, not excluded from it. At Halloween, a favourite time of year in the care home, ExquisiCare residents hand out full-size candy bars to trick-or-treaters.

“Seniors are craving love and respect,” says Harsch, something she feels is uniquely provided in small-scale living. “It allows our seniors to live in and enjoy the communities they worked so hard to create.” [ ]