Topics & Your Comments

Aging in Place residences

by in About the project, Aging in Place, Housing January 30, 2020

While many in the community very much wish to have an Aging in Place residence to be able to stay on Bowen as their health status evolves, I am aware that there are questions about what exactly this means to the island, both in terms of benefits and potential challenges. This post is meant to be an FAQ about this topic. Creating and operating intergenerational aging in place has been most of my career’s work. I apologize if I come off as intimidating or over-the-top lengthy in my writing. I am just very passionate about this! If you don’t want to read all this, but would rather be part of an interactive seminar, I will be hosting an event on Saturday April 4, 2-5pm, at The Well on Bowen.

What is Intergenerational Aging in Place?

An Aging in Place residence provides a physically adaptive environment, professional services, and social-recreational programming to allow retirees the peace of mind that regardless of when and how their health evolves, they will never need to leave “home”.

The particular model of Aging in Place that I created is intergenerational living. This is to allow adult children and grandchildren to be an integral party of seniors’ lives. There is a natural age mix that doesn’t categorize, label, isolate and stigmatize seniors. Instead, it empowers older adults to share their wisdom, and at the same time to learn from younger generations, so that people of all ages are meaningfully connected. This is something very new, not just in North America, but also across the world.

In the communities I’ve developed and operated in the past, there are ownership and rental suites in Independent and Supportive Living, and rentals for Licenced Care. Seniors move in when they’re active and well. As they age and experience mild mobility and/or cognitive changes, they can stay in the same suite with support services for scheduled activities of daily living. If at some point, they develop a chronic condition that is moderate to severe and causes unpredictable needs, there is a designated, secured area for Licenced Care, where there is 24/7 Registered Nursing and a holistic health care team to promptly respond to those needs.
About 80% of suites were Independent/Supportive Living, and 20% of units would be Licenced Care.

Throughout the residence, there are programmed social and recreational activities to bring people together: in-house restaurant, lounge, and café; arts and crafts; instructor-led group wellness classes such as dance, yoga, meditation; wellness spa; beauty salon; community garden; games room; library etc etc. There is dedicated programming for Licenced Care residents, tailored to their abilities.

Does such a community increase the burden on emergency services?

In short, I don’t think it does – at least not significantly. This is because:

  1. There are CPR-certified staff 24 hours a day;
  2. With professional nursing staff, there isn’t a default need to call on the ambulance when there is an incident. In fact, Licensed Care likely decreases ambulance service demand, compared to a senior living at home with no professional help;
  3. The intent is for Bowen residents to have first priority. If through the rezoning process, we find that not many Bowen seniors see themselves living in an aging in place community, then it will simply not be part of the Cape. If there are enough Bowen seniors to fill the residence or come close to that, there isn’t a heavier burden on emergency services relative to the current status.

As a side note, I serve on the board of BC & Yukon Heart & Stroke Foundation. Should there be interest and curiosity, I may ask the organization to provide information resources or an education seminar. I have also already asked how we could strengthen services to rural and island communities, and what the limiting factors are.

Would the residence be for the middle class or the wealthy?

This really depends on resident feedback. We will find out from Bowen retirees/seniors’ input whether the majority prefer a more basic physical environment and level of service, or if they want their later years to be the absolute best of their life, even if that means it is more expensive.

To provide some tangible examples:

In my Vancouver project, Independent Living rentals start from around the low $6000s per month. This includes 3 meals a day, 4 hrs/wk of domestic upkeep (could be changing light bulbs, folding laundry, reorganizing closets), group shuttle bus and chauffeured town car.

In Victoria, (which isn’t in construction yet), rentals will start from the high $4000s. This will include 2 meals a day, once a week housekeeping, group shuttle, co-op vehicle, but no chauffeured town car.

There are many factors influencing affordability:
For the overall community, these include the intensity and level of refinement of social and hospitality services, and the extent of amenities to be maintained.

On an individual basis, there are two important drivers: the cost of accommodation (size, quality of finishes), but much more significantly, the actual health needs of the resident, which directly influences the professional hours required to safely accommodate the needs.

The Why

To me, an aging in place community is about serving needs. It is not right that a senior should have to move away from their community because of health care needs. What EVERYONE needs is to stay in the community they love with the friends and family that matter to them, in a home that is physically adapted to increasing challenges, and enriching activities that make them excited to get up every day… And yes, for most elderly, at some point they need support with daily activities, and maybe even nursing care: care aides, LPNs, RNs, recreation managers and therapists etc. These professionals give of themselves and invested into their skills, and they deserve to be paid well. What ultimately makes a safe, secure, supportive environment expensive is professional staff. The accommodation itself doesn’t have to be high end finishing, and it doesn’t have to be large – although many seniors are used to spacious homes and have trouble downsizing and letting go of what they’ve accumulated over decades.

The Independent and Supportive Living stages can offer a whole lot for the spirit. It is scientifically proven that this generally delays the need for nursing care. Independent Living does not necessarily cost a lot. It depends on the size and finishes of the accommodation, and what levels of programmed services, amenities and activities people desire. It is impossible to provide the world, and then not pay the staff fairly. If there is strong and reliable volunteerism, and real community spirit behind that, I believe it is possible that the hospitality and recreation aspects can be within the financial means of most.

What about government-funded aging in place?

Due to the rapidly aging population, the demands on the system are much higher than our tax dollars are able to support. This is going to get worse over the next 2 decades.
I have had experience with government-funded communities. Up until 2005, my father and I, and our team, used to operate funded Licensed Care units within aging in place residences. Unfortunately, the funding was dismal and difficult to attain. It was also completely inadequate to provide a dignifying experience for seniors. Today, it is no better. As an example, currently funding in Licensed Care is only enough to give seniors a bath once a week, and the staff to resident ratio is 1:13.
I don’t know of many communities with Supportive Living that is government-funded. I have a personal example of the amount of funding for home care that the government can afford: two hours a week for someone who had both Parkinson’s and Alzheimers, for 10 years, before a funded care facility had a bed available for him. (Despite his dire state, there were others who were worse off, so he wasn’t high enough on the waitlist to get in earlier.) The funded care facility was three hours away from his wife and son. He sadly passed away within three months of moving into that facility because of the trauma of the move in his fragile state. It hurts to even write this. It is not okay. But the reality is that we don’t have enough trained professionals, and they deserve to be compensated for all that they offer.