The coronavirus pandemic shined a spotlight on nursing homes in Massachusetts, with more than 5,500 residents dying of COVID-19 (down from 6,722 after the state revised how it reports deaths in long-term facilities). The deaths underscored the risks for residents who live in a communal setting, especially for those who share a room. A design developed decades ago for hospital-like efficiency, the shared room can contribute to substandard care and a dehumanizing, undignified end of life. It must disappear.
This will require investment in new models that support seniors’ right to thrive in life-enhancing environments that are far superior to conventional institutional living. This funding initiative must motivate the developers and owners of nursing homes to create private living spaces for residents. It must also motivate them to include an invitation to “community-centered living” in their nursing home redesign of common space.
Private rooms alone will not modernize the outdated eldercare housing model. To avoid opening a building that is obsolete on day one, each developer should envision the senior-living residence as community-centered, a gathering place for neighbors of all ages.
It is crucial to incorporate into senior housing common spaces that invite neighbors of all ages to join each other and create a life-enhancing sense of connectedness and purpose. Age does not erase a person’s individuality and ability to grow and thrive. Community-centered living, a dynamic in which people of all ages and backgrounds interact, breaks down walls of separation. It promotes vibrant interconnectedness. This is the objective of community-centered living: to integrate residents into the wider population and to welcome everyone into this life-enhancing assembly.
The Scandinavian Charitable Society of Greater Boston successfully brought community-centered living to the Scandinavian Living Center in Newton. The physical and social design of the Scandinavian Living Center model challenged the all too common “out of sight, out of mind” attitude that many people hold about elders. The center was able to integrate the lives of its residents and their neighbors in the wider community. Before the pandemic, more than 2,000 neighbors from Greater Boston (not counting family and friends of the residents) came through the door every month to participate in communal activities, including lectures, movies, community club meetings, and art exhibits. Members of more than 40 organizations discovered the advantage of making this elder community their gathering place and headquarters. The opportunity to meet neighbors every day filled residents’ need for human connections.
Of course, COVID shut down these opportunities, at least for a time. Yet in doing so, it only reinforced the importance for community-centered living in our lives, and the urgency to fund the necessary space.
Government and business leaders should support the construction and renovation of community-centered senior housing environments — and begin to think about nursing homes in the same way we consider schools: as a public trust. The best schools and best senior housing will lead to the best communities.
There should also be a review of the Hill-Burton Act. Passed in 1946, this legislation provided funding for an eldercare infrastructure considered advanced at the time. Seventy-five years later, elected officials need to envision the outcomes that can be achieved by updating the act so that funding creates a landscape that brings neighbors of all ages together in a welcoming, community-centered living setting.
At all levels of government, citizens raise money to erect and maintain needed physical infrastructure such as military installations and government buildings. A funding source must be created that supports the full spectrum of nursing home developers and owners.
The benefits of funding senior residences that are committed to community-centered living are twofold. First, the need for stand-alone communal gathering space in towns and cities decreases. Second, the need to overregulate institutional-style senior living environments diminishes; visitors provide oversight and accountability.
Over time, the construction of community-centered senior housing residences will become a society-wide money saver. Why? Because the construction of community-centered living decreases duplication of capital and effort. When specific senior housing owners and developers refuse to accept Hill-Burton style funding, the market interest in their outdated facilities will decrease. Their institutional-style buildings will close from lack of demand by a community that insists on a better way.
This straightforward way to fund supportive elder housing is a win-win proposition for developer/owners and consumer/residents. And the operational isolation that leads to strict regulation, lonely living, and poor care decreases significantly overnight.
Society must offer all residents the dignity of private personal living. However, if developers renovate solely to create a private room for every resident, each new nursing home will be outdated the hour it opens. They must also include common spaces that meet the need for intergenerational, multicultural connection between and among residents and their neighbors. Imagine the day when skilled nursing residences in every American city and town become a life-enhancing destination.
Joseph Carella is executive director of the Scandinavian Living Center.