EFA Expo Preview: Addressing The Need for Accessible Senior Care

During the EFA Expo, Aug. 28-31, speakers from Erdman will share how an intergenerational model can be one strategy to serve seniors in sparsely populated areas in the U.S.
Published: August 13, 2021

As a preview to their session at the EFA Expo, speakers Isaac Wallace and Rob Pfauth wrote about the need and benefits of an intergenerational housing model for rural communities. For more on their session “Intergenerational Solutions for Affordable Seniors Housing” at the 2021 EFA Expo & Conference, Aug. 28-31 in Chattanooga, Tenn., visit Environmentsforaging.com.

Forty percent of the U.S. population lives in one of 780 cities with 50,000 people or more. In these areas, there are many senior living alternatives available, likely in the same neighborhood or within a few miles of where prospective residents already live. These individuals can move into a senior living community and still shop at the same stores, attend the same places of worship, and stay in close contact with friends and family.

But not all seniors want, or can afford, to reside in urban areas. According to the U.S. Census Bureau, in 2020, about 76 percent of incorporated places in the U.S. had fewer than 5,000 inhabitants; almost 42 percent are home to fewer than 500 people. In such small towns, the available senior housing options are often limited or nonexistent.

Residents of small and rural communities typically live where they do because of family roots, local jobs, or the low cost of living that these communities offer. Such places often experience little to no turnover of the existing housing stock to attract young families, while elders live alone in large older homes that can be a struggle to keep up. Seniors in these areas who have the luxury of retiring to the Sun Belt or who can afford in-home care are generally few.

By contrast, those who need care must often pull up roots to move into government subsidized housing or a nursing home because newer assisted living or other age-restricted housing and care are either unavailable locally or cost-prohibitive. Moreover, the dearth of income-qualified prospective residents generally makes such zones unattractive for development by market-rate owners and operators.

There’s an increasing awareness in the senior living industry of the challenge posed by a growing underserved “middle market,” namely that cohort of older adults whose income exceeds the threshold to qualify for low-income or subsidized housing, yet is insufficient to permit them to move into a market-rate retirement community. This issue takes on additional significance in many rural areas of the country.

Some leading providers are actively exploring new affordable senior housing strategies such as Merrill Gardens’ new Truewood branded properties and Benchmark’s assisted living and memory care brand called The Branches. But here again, chances that such options will soon become available throughout rural America are remote at best.

One concept that could hold a key to addressing the combined challenges of providing local, affordable, and community-based senior living and care services to outlying areas is exurban and rural intergenerational housing. In this model, multiple generations, including working parents and their children along with unrelated older adults, live together under one roof, albeit in separate dwelling units with shared common amenities such as multipurpose meeting and activity space, food preparation facilities, child and/or adult daycare, and a fitness center.

The intergenerational housing and care model goes beyond people of different ages just living together. It also leverages the resources and availability of young families to provide assistance with instrumental activities of daily living (IADLs) to their elderly neighbors. Additionally, seniors can share their wisdom and experiences to mentor young families, as well as supplement childcare and tutoring.

This model is ideally suited to implement in rural communities for several key reasons. First, many small towns struggle to support any form of traditional multifamily housing due to limited demand, low rental rates, and high turnover. Second, childcare in these locales is typically limited to in-home care, resulting in a scarcity of options for working parents in households with young children. And lastly, intergenerational housing arrangements foster the creation of symbiotic relationships, enriching the lives of all generations and reinforcing a sense of home for all members of the community, while offering cost efficiencies found in the duality of functions.

For example, a shared kitchen can be used to prepare meals for both child and senior care functions. Spaces used during the day for childcare can be used in the evening for family gatherings and social events. Additionally, this model could include programs such as community gardens that provide fresh produce for residents while also offering intergenerational education and socialization opportunities with the surrounding community. This solution might look different based on a community’s location or size, but the general idea could be replicated.

One such community is Hope & A Future LLC in Madison, Wis., founded by nurse and executive director Karin Krause. Since 2014, Hope & A Future has operated as a licensed adult family home in a historic farmhouse on 5.5 acres to accommodate four resident elders, as well as live-in staff including Krause herself. Currently, plans are being developed to construct 19 additional housing units with a mix of senior housing and affordable housing for young families, as well as community spaces, guest rooms, daycare services, private counseling rooms, and an office.

Krause dubbed the addition a Therapeutic Interactive Intergenerational Neighborhood (TIIN), focused on reducing the detrimental effects of loneliness and isolation, with the goal to bring people of diverse ages, cultures, and socioeconomic backgrounds together, plus connect residents with the wider neighborhood through shared spaces and programming. The proposed TIIN expansion will operate under the federal government’s Fair Housing Act as “Housing for Older Persons,” allowing for certain resident age restrictions to encourage a desirable balance of older adults and families with young children to foster meaningful intergenerational relationships.

In addressing the disparity that exists between rural and urban locations, plus searching for ways to achieve greater equity in retirement living, reduce costs, and ensure that everyone has a desirable place to age, the industry should consider the intergenerational model as a viable solution to serving seniors in underserved locations.


Isaac Wallace is a design project manager at Erdman. He can be reached at [email protected].

Rob Pfauth is director of planning for senior living at Erdman (Madison, Wis.). He can be reached at [email protected].

Spotlight on EFA Expo
To learn more about the benefits and advantages of intergenerational housing as well as examples of design concepts and community models, check out session “Intergenerational Solutions for Affordable Seniors Housing” at the 2021 EFA Expo & Conference, Aug. 28-31 in Chattanooga, Tenn. For conference details, visit Environmentsforaging.com.

Strategy & Planning Series
Strategy & Planning Series
Strategy & Planning Series
Strategy & Planning Series
Strategy & Planning Series
Strategy & Planning Series