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Architecture plays a key role in reimagining care solutions

A simple yet innovative concept combines stable housing, intergenerational care, social integration, and neighborhood revitalization.

Globe staff illustration/Carehaus
Adobe/Globe Staff

Even before the coronavirus pandemic, older adults and people with disabilities were already beginning to feel the start of the nation’s imminent care crisis. The problem is two-fold: On the one hand, the high cost of care is financially out of reach for 80 percent of the middle class and altogether inaccessible to lower-income families; on the other hand, there are not enough caregivers to meet the existing demand of aging baby boomers.

Without the daily help of caregivers, older adults and those with disabilities suffer preventable injuries or missed medication. These care deficits result in costly hospital visits paid for by patients, their insurance companies, or taxpayers. In an interview, Ai-jen Poo, director of the National Domestic Workers Alliance, painted a picture of the urgency for new solutions: “Every single family could be in a state of crisis by the year 2050 when 27 million of us are going to need some form of long-term care just to meet our basic daily needs. It’s a situation that will impact the entire economy and shake up every family unless we do something drastically different.”

Two root causes contributing to this care deficit can be addressed through both policy and how we design our cities and homes. First, because caregiving has been historically and structurally devalued, today’s caregiving industry is characterized by low wages and high turnover. With an income averaging $20,000 or less a year, caregivers face acute economic and housing precarity. Second, isolation is a top challenge for older adults as they lose mobility, leading to a rapid decline in physical and mental health. So too, caregivers working in individual homes face disproportionate health risks from tasks like lifting an older adult out of bed.


In response to the growing need for care solutions, we joined forces with real estate developer and urban planner Ernst Valery and health care and finance expert Ellen Itskovitz to establish Carehaus, the nation’s first care-based co-housing project.


As a new type of residential building for older adults and those with disabilities, along with caregivers and their families, Carehaus is a simple yet innovative concept that combines stable housing, intergenerational care, social integration, and neighborhood revitalization.

Carehaus Baltimore is designed around a shared courtyard allowing ground level access from both street and alley. Architect: Rafi Segal A+U with collaborating artist Marisa Morán JahnCarehaus

Architecture plays a key role: All residents would live in independent units clustered around common spaces that support shared meals, child care, and activities such as art workshops, fitness, physical therapy, financial literacy courses, and gardening. Carehaus’s design for clustered or “congregate” care would make caregiving more efficient and safer: Carehaus’s design for both independent living and clustered or “congregate” care would make caregiving more efficient and safer: Caregivers could take turns keeping an eye on both elders and children in common spaces while also having their own private apartments.

In exchange for their labor, caregivers would receive good wages along with subsidized meals and housing for their families, child care, and other benefits. As a co-living community, Carehaus would be able to pass on cost savings — resulting from lower energy consumption, shared meals, care, and housekeeping — to residents in the form of consistent quality care and good wages for caregivers.

Founded on the belief that art and storytelling enable us to live our fullest, stimulate the senses, and should be accessible at each stage of life, Carehaus will integrate the arts into its DNA — in its arts programming offered to all residents young and old, in its interiors, where art narrates specific histories, and its exterior design, which inspires us to re-value aging and care.


Carehaus Baltimore is a newly constructed care-based co-housing building in Baltimore’s Johnston Square neighborhood. Architect: Rafi Segal A+U with collaborating artist Marisa Morán JahnCarehaus

We are building the first Carehaus in a historically underserved neighborhood of Baltimore. As we look at other sites and cities where this model of intergenerational care-based co-housing would thrive, we would adapt Carehaus size and form to meet local needs, challenges, and opportunities. Given Greater Boston’s world-class medical facilities, strong leadership among domestic workers and care advocates, and a growing population of older adults, Carehauses throughout Massachusetts could harness the power of architecture and art to inspire new ways of how we live and care for one another.

More broadly, as we rebuild our nation’s care infrastructure in this moment of economic recovery, we need to consider how the design of our cities and homes can enable the active participation of caregivers, elders, and people with disabilities in our democracy.

Marisa Morán Jahn is an artist/filmmaker who teaches at The New School and MIT. Rafi Segal is an architect, associate professor of architecture and urbanism at MIT, and director of Future Urban Collectives.