Assisted Living: 10 Great Ideas – To Live with Dignity

Ray Croft zips around the gardens on the grounds of Oatfield Estates in his motorized wheelchair carrying a large watering can.

Before he came to Oatfield, an assisted living community of frame houses in the suburbs of Portland, Ore., he had never tried his hand at gardening. But now Croft, 77, raises prizewinning black-eyed Susans and takes a proprietary interest in the colorful organic flower and vegetable gardens surrounding his new home.

“My daughter found this place for me,” he says, speaking in short bursts like the puffs of smoke coming from his pipe. “I had been in three other places—one horrible, the other bad and the third crummy. This is like heaven.”

It’s not just the beguiling gardens and breathtaking mountain views that delight residents like Croft. It’s the ethos of Oatfield—a place where residents have a say in their own lives, from what’s for dinner to where to go on an outing.

While assisted living residences are one of the most popular options for older people who can no longer live on their own, few think of these facilities as places that foster independence or rejuvenation or hope. But homes like Oatfield Estates are redefining assisted living care. “They listen to you here,” says Croft. “They respect you.”

There is no standard definition of assisted living care from state to state. But unlike nursing homes, these residences tend to be “more like home and less like an institution, and that’s what people want, even people who need extensive medical care,” says Karen Love of the Consumer Consortium on Assisted Living, a national consumer group.

Bill Thomas, M.D., a Harvard-educated gerontologist, has spearheaded the movement known as the Eden Alternative, which seeks to enrich and enliven cold, hospital-like long-term care residences. Today, he says, “the large-scale, institutional care facility is crumbling, and we now have the possibility of real transformation.”

That transformation is already apparent in some exceptional facilities that offer residents more autonomy and more choices.

Whether in Kansas or California, these are residences brimming with life—young children, dogs, cats, birds, plants—and with opportunities. From a Pennsylvania home where residents with Alzheimer’s and their caregivers can walk to a day care center and play horseshoes with the children, to one in Virginia where residents make award-winning wine—these places are catering to the men and women who live there.

The facilities can run the gamut from a room in a family-run home with three residents to a high-rise building with 100 residents. Services can be simple and basic, or they can be upscale and sophisticated, with skilled nursing and even hospice care.

About 1 million Americans live in assisted living residences now, and at least half of them have some form of dementia. In Florida and California more people live in these facilities than in nursing homes. Indeed, assisted living residences are becoming the new nursing homes, and the demand for these facilities is expected to increase.

Burgeoning assisted living care—regulated only by a patchwork of laws that vary from state to state—is uneven: Some places accept people they cannot adequately care for, others are neglectful, even dangerously negligent. Residents have suffered, even died, in some facilities.

But growth has also spurred refreshing innovations that have given rise to some special, creative homes. It’s important for the public to know about these kinds of places, Thomas says. “People hear so much about the worst, their expectations are low. They don’t tend to demand high standards and excellent care—and they should.”

Here then are 10 of the most innovative assisted living homes where residents are well cared for and respected—treated as adults with the right to make choices, take risks and grow—even in the winter of their lives:

1) Making Vintage Wines

In September, when the sun is warm and the sky clear, residents of Marian Manor spend a day in a nearby vineyard, picking big muscadine grapes for the wine they make. Leaning on canes and walkers, they move slowly down the smooth dirt paths between the rows of leafy vines, carefully plucking only the best grapes.

“Before, I was just one to knit and crochet,” says Mary Piedmont, 89, one of the winemakers. “Life is full of surprises.”

Marian Manor, a nondescript three-story brick building on the grounds of St. Gregory the Great Catholic Church in Virginia Beach, Va., looks like hundreds of other elder care facilities. But this 15-year-old residence has a staff and volunteers who work with the 132 residents to create activities that make Marian Manor a standout—from its seasonal winemaking to its chef program that encourages residents to plan and oversee dinner for the entire facility using their favorite recipes.

The people who live here go crabbing on the Chesapeake Bay and take the Marian Manor van to Delaware for a day of gambling. They enjoy an annual formal dance and monthly wine and cheese socials.

Six years ago some residents decided winemaking might be interesting, so administrator Desiree Mitchell scoured the library for information and tracked down an amateur vintner who volunteered to help. Residents have been making small batches of wine ever since—picking the grapes, pressing them by hand, bottling, corking and designing labels for each vintage. While about 45 residents sign up for winemaking each year, others join in to taste the wine as it ages in two five-gallon jugs, sipping from tiny plastic pill cups.

Their Golden Glow and Sunset Sizzle have won medals in international amateur wine competitions.

Now, each New Year’s Eve when they uncork their latest vintage, residents toast the future and dream of a new triumph.

2) Haiku, Sumo and Sushi

When they step through the doors of the sleek glass-and-stone building, the 56 residents of Seattle’s Nikkei Manor enter a special world evocative of Japan: the poignant music of the koto, the pale light of rice paper lanterns. Here residents are cared for by people who speak their language, who know their culture.

Today, more assisted living facilities are specialized residences for people who want to spend their old age with others who share their customs, whether they are Japanese, Chinese or Native Americans.

The first- and second-generation Japanese at Nikkei Manor dine on a mix of Japanese and Western dishes, take classes in haiku (poetry) and ikebana (flower arranging) and watch sumo wrestling beamed from Japan on satellite TV.

Most, though not all, of the residents are of Japanese descent, and most of the staff is bilingual, as are the activities and the Buddhist and Christian religious services.

A number of residents have some form of dementia, and “people with dementia often revert to their primary language,” says Bill Colter, Nikkei Manor’s manager. “That’s a problem for their children who don’t speak Japanese. And we can help with that.”

Colter says the families and the Japanese community strongly support Nikkei Manor, which has a constant stream of volunteers and visitors.

3) Never Too Old to Take Risks

At Meadowlark Hills men and women are allowed to make their own choices, even when the choices are risky. Here, if a diabetic wants to eat a big bowl of ice cream, he can.

“We would advise the resident of the risks,” says Willie Novotny, administrator of the Manhattan, Kan., residence, “but if he still wanted the ice cream, he could have it.”

If the diabetic continued to eat sweets, “we would discuss his behavior with him and his family and then ask them to sign a risk management agreement,” Novotny says. “If the resident understands the risk and doesn’t jeopardize others, we won’t stand in his way.”

Joyce M. Aikin, 73, came temporarily to Meadowlark Hills when she suffered compression fractures in her back. She liked it so much she decided to stay permanently. “There are all kinds of choices here,” she says, “and everyone does everything they can to make you comfortable.”

The community, which began with a nursing home founded by six local churches, added assisted living apartments for 40 people five years ago. The apartments are clustered into households, and the staff handles the arrangements, but the residents plan the menus and activities.

Residents can also add their favorite snacks to the weekly grocery list. And if someone suddenly craves a food that’s not in the “house” or on the menu, staff members can go to the grocery and buy it. “We provide services for our residents on their terms, because this is their home,” Novotny says.

4) Freedom to Roam

Dementia experts from around the world have visited tiny Woodside Place, a gray-shingled building in Oakmont, Pa., that looks like a series of pitched-roofed cottages nestled at the edge of a wood.

Designed to accommodate 36 Alzheimer’s residents, Woodside has been a model for dementia care since it opened in 1991. From its cozy bedrooms and short hallways to the looped garden paths that lead back to the building and never dead-end, never frustrate, Woodside is a comfortable community with plenty of space to wander. Its grounds are secure but the fencing is unobtrusive, blending in with the greenery.

Residents dress as they please, rearrange the furniture on a whim and even curl up for naps in the community room. That is all fine with the staff, which provides care, activities and even food 24 hours a day.

Residents garden, fold laundry, help with meals. They go on outings, often to the staff day care center for activities with the children.

“The focus is always on the individual,” says Susan Collins, vice president of assisted living at Woodside Place of Presbyterian SeniorCare. A university study found that Woodside residents, whose average age is 85, are much more social and continue to feed, bathe and dress themselves much longer than Alzheimer’s residents in a nursing home.

“We provide an environment that promotes independence,” Collins continued, “and we adapt to our residents. We don’t make them adapt to us.”

5) Pets, Putting and Art

The Silverado Senior Living Center is home to 90 Alzheimer’s residents who can grow flowers in the garden, play with one of the 11 dogs or four cats that sun themselves on the grounds or practice their putting on a golf green with a hole twice the normal size.

Because the facility in Escondido, Calif., accepts even those deemed “problems” by other homes, half the residents are men. The home works with doctors from the University of San Diego, and 69 percent of residents who come here on psychotropic drugs are soon able to function without them.

Staff members know how to “redirect” the aggression of Alzheimer’s patients, steering them to gizmos on the wall with lights, bells and other whirligigs that distract and calm.

Residents, who are given a great deal of freedom, take part in daily routines like feeding the pets. They can attend exercise, music and art classes. Men have their own activities—gathering to watch baseball games on TV and enjoy a few beers or hanging out in a room decorated like an old garage where they can sand or paint woodworking projects. The enclosed grounds have extensive paths that meander past rabbit hutches and a playground for staff children.

Bath time—often a problem with dementia patients—is a soothing spa experience with Jacuzzi tubs and music.

“There is a lot of life here; it doesn’t stop because of the disease,” says Stephen Winner, a co-founder of Silverado. The center has around-the-clock licensed nursing and even hospice care, so 98 percent of its residents never go to a nursing home.

6) The Price Is Right

Fay Wright, a lively 82-year-old who still takes bus trips around town just to see what’s going on, says she’d be in a nursing home now if it weren’t for the Gardens at Osage Terrace in Bentonville, Ark.

After years of working in a water meter factory, Wright could not afford assisted living, and even though her income and health qualified her for Medicaid to pay for a nursing home, she didn’t want or need that kind of care.

Instead, she moved into the Gardens, where she and the 54 other residents can have pets, decorate their own rooms and receive nursing care—all for less than the cost of a nursing home bed. “I have my own little apartment and all kinds of help,” Wright says. “It’s great.”

The three-year-old facility—an attractive Craftsman-style home with a welcoming front porch—is one of the affordable assisted living residences developed under the Coming Home Program of the Robert Wood Johnson Foundation and NCB Development Corp., a national nonprofit that assists low-income communities.

Coming Home, working with nine states, has helped establish 30 affordable assisted living homes, with 59 more in development. The idea is that other nonprofits will learn from these homes and build more like them.

All the residents—teachers, secretaries, factory workers—have low incomes. “They pay in their Social Security, pension or savings,” says Arletta Wallace, the Gardens administrator.

7) Students Young and Old

The weekly current events class at University Living in Ann Arbor, Mich., crackles with passion and conviction. Bush? Social Security? Iraq? “We bring our newspaper clippings and go at it,” says Richard C. Adelman, the former head of the Institute of Gerontology at the University of Michigan, whose job now is to organize classes and discussion groups for this assisted living residence.

Current events is one of two classes offered each year at University Living, a four-year-old facility where aging men and women can continue to learn along with college students. The yearlong classes have included the ethnic history of the United States and the novels of John Updike.

While a growing number of retirement communities are affiliated with universities, this is one of the few independent assisted living centers that have established ties with one. Each year university students are paired with residents for research projects, and they take classes with them at the facility.

While the 75 apartments in the two-story building are bright and comfortable, it’s the programs residents love.

“The main attraction for me was the fitness program and the classes and discussion groups,” says 92-year-old Irene Skurski, a former legal secretary and Realtor. She helped organize Students and Seniors, the group that arranges faculty lectures on everything from Medicare to the music of Louis Armstrong.

Skurski has worked with several students in her three years here, including one who took an oral history of her life. “We get to know them, go to lunch with them, enjoy knowing them,” she says. “It’s good for both of us.”

8) Care in an RV Park

Deep in east Texas, on a campground near a piney woods 65 miles north of Houston, stands perhaps the most unusual long-term care facility in the country.

At Rainbow’s End in Livingston, residents live in their own RVs—recreational vehicles—and receive virtually all the care offered by assisted living for $800 a month in a program called CARE (Continuing Assistance for Retired Escapees). The national Escapees RV Club set up the service several years ago for members (dues are $60 a year) who need good care at a good price.

Because residents remain in their own homes, CARE is legally not assisted living and doesn’t claim to be. But once a member parks his RV on one of the lots around the steel-framed CARE building and pays his monthly fee, he can get all his meals, housecleaning, laundry, transportation, activities and nursing through CARE.

“Every morning they have to leave their RV or be helped out of it,” explains Kay Peterson, the 79-year-old former nurse who founded the club, which now has 34,000 member families, and CARE. “They come a few steps to the center where we have our staff give them medications and bathe, groom, dress, even feed them. We also have nurses for health care.”

During the day, CARE residents—some in wheelchairs, others active and ambulatory—can visit with RV travelers camped on the grounds, attend a tai chi exercise or a crafts class at the center or just sit back in one of its big recliners and watch TV. At night when they return to their RVs, there is always someone on call.

“I don’t know what I would do without this place,” says Kitty Haire, 81, who came here when she needed help caring for her husband. “I think everyone here feels that way.”

9) Absolutely Cutting-Edge

There are thousands of long-term care facilities, but Menorah Park Center for Senior Living is one of only 11 in the nation with its own research institute. Care here is not just compassionate, it’s absolutely cutting-edge.

Doctors and psychologists at its Myers Research Institute have pioneered new Alzheimer’s therapies and other geriatric care breakthroughs. They work with residents with dementia who live in Stone Gardens, a building with 116 assisted living apartments that are part of a larger complex that includes independent and nursing home care.

Here, special books with large, bold type encourage dementia patients to read and take part in discussions, while activities—from a comedy club event to a welcome committee that greets all newcomers—give them rewarding social roles.

“If you give people a reason to get out of bed, activities that engage them and allow them to feel successful, they will be at the top of their game, whatever it is,” says Cameron Camp, the psychologist who directs research at the facility.

Not all the residents have dementia, so activities are varied, including adult education classes, lectures and a state-of-the-art indoor swimming pool with a floor that rises to accommodate all kinds of water exercises and therapies.

Residents can volunteer to read or help feed the children at Menorah Park’s day care center for the children of employees. Children’s toys are tucked in the corners of every corridor for visiting grandchildren.

10) Wired and Welcoming

Oatfield Estates—10 attractive two-story houses with large living rooms, country kitchens and colorful gardens—is such a homey place it’s easy to forget that it’s known worldwide for its state-of-the-art computer network that tracks each resident’s movements.

Oatfield, near Portland, Ore., was conceived as a place that would foster freedom. Its technology not only gives staff more information, it gives residents more independence while assuring their well-being.

The only real reminders of the complex system constantly at work here are the small, teardrop-shaped monitors residents wear on a chain or pin. Each monitor communicates with sensors throughout the residence that report to a central computer. The computer records where each resident goes, with whom and for how long, showing how active and social—or not—a resident has been.

If a resident approves, relatives can access all that data through a website, learning where Mom spends her days, whether she is losing weight or tossing and turning at night. Technology also strengthens staff care. It allows managers to track a personal assistant’s response time to a resident’s call for help.

Ray Croft, the gardener who raises black-eyed Susans, put a stop to one daughter’s having access to his data because “she would just call me up and ask about this and that. It wore me out.”

Chris Langford, 44, whose mother recently moved to Oatfield, says the technology “is wonderful. It gives the caregivers the chance to give care, to be interactive instead of taking vital signs all the time.”