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William Thomas: Prevailing seniors housing concept lacks any true sense of community

Geriatrician William H. Thomas is one of the nation's better-known proponents of change in the seniors housing industry. As president of the nonprofit Eden Alternative, whose goal is to improve seniors housing by reconnecting residences with a sense of community, Thomas is outspoken in saying seniors housing all too often fails its residents. The current model, he says, doesn't address their deeper needs.

Thomas also serves as a professor at the University of Maryland's Erickson School of Aging Studies. More than merely advocating change, Thomas is actively seeking it through his Green House residences, a housing concept he devised that is designed to foster community among the elderly.

The concept — the first of which opened in Tupelo, Miss., and was developed by Mississippi Methodist Senior Services — features private rooms for six to 10 seniors situated around an open kitchen and dining area, a hearth-like approach. The Green House looks and feels like a home, containing few medical signposts.

The goal is to provide a place where the elderly can receive clinical care and daily support without the assistance and care becoming the sole focus of their existence. NREI spoke with Thomas about this emerging concept.

NREI: How will seniors housing change in the coming years?

Thomas: The whole continuum of care is going to go away. That concept is going to be archaic. Continuum of care essentially offers the customer a down escalator. Instead of continuum of care, the emphasis will be on continuum of service. In that model, units are rich in community, but also embedded in a sophisticated service delivery network that helps people stay in a dwelling, no matter what their condition becomes.

The old model — and it's going to be the old model after a lengthy transitional period — requires the customer to fit into the property type of independent living, assisted living, and so forth. In the new era, what we build will have to conform to the customer.

NREI: How will developers accomplish that goal?

Thomas: What housing providers have to do is create opportunities for the enthusiasm and energy of the seniors themselves to do most of the community-building in partnership with the housing providers. In the future, seniors housing is going to be subordinate to creating communities, and the design of the housing will be to support the community. Right now, it's mostly the other way around. We build the housing, and then hope the community takes root.

NREI: In what ways will the housing reflect that trend?

Thomas: When you're living in a community, the web of your relationships form an important source of your well-being. Take the example of a 90-year-old widow who lives alone in an apartment. All her friends have moved or passed away, and she's afraid to go out, so her only social contact might be the Meals on Wheels volunteer.

What is aging in community? That's the same 90-year-old widow who, as a result of how and where she lives, is involved in a relatively large number of social relationships. Some of the time, that person is helping others. Other times, she's receiving help from them. The bricks-and-mortar will be important in the future to the degree that they foster these social relationships, not as ends in themselves.

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