Yes, in my backyard

Many older people want to be with their families when they start to need help with daily living. But disagreements about where to set the thermostat, TV volumes and curfews for teenage grandchildren can make life difficult.

For such families, several companies are developing cottages that either an older adult or an adult child could use as separate living quarters in the other's backyard. Ken Dupin, a minister in Salem, Va., developed so-called MedCottages with help from Virginia Tech researchers after studying family-managed care in other countries.

A MedCottage, which costs about $85,000, has a 12-by-24-foot living area with a handicapped-accessible bathroom, kitchen, hospital bed and living area, and is outfitted so that the person living there can be monitored online.

One of the bigger challenges: getting building permits. Dupin's company, N2Care, and its distributor worked to get a Virginia law passed two years ago that stops local governments from keeping out the structures as long as the family has a doctor's prescription and meets lot requirements, he says. Now, several more states have approved or are considering similar statutes.

Socorrito Baez-Page, a doctor who has spent a number of years caring for her elderly parents in Fairfax County, Va., has been working through the permit process to install a MedCottage for her 86-year-old mother. Her mother has been living in her home since January, but has trouble getting up stairs to bathe.

"Having a cottage in the backyard will help," Dr. Baez-Page says. "There will be a little bit of definition between here and there."


These arrangements, which originated in Denmark decades ago, were designed for anybody interested in living communally. In a cohousing development, residents live in private homes but share a central "common house" with a kitchen and other facilities.

Now, "senior" cohousing is starting to catch on as well, with four such projects already built in the United States and many more expected to follow. (You can find them at By 2020, there should be at least one cohousing community in every metro area, or 235 developments, and about one-third are expected to serve older adults specifically, says Charles Durrett, a Nevada City, Calif., architect who is promoting the concept.

ElderSpirit Community in Abingdon, Va., one such community, was built in 2005 and features 29 cluster homes and apartments with prices in the $160,000 range. Founded by former nuns, it is nestled in a high valley between two mountain ranges and along the Virginia Creeper Trail, a 34-mile-long path that offers a place to walk or bike.

Richard and Linda Brumleve, a retired English teacher and a research analyst, moved in five years ago, drawn by the focus on spirituality and the beautiful scenery. After Brumleve, 73, was diagnosed three years ago with Parkinson's disease, they decided to stay. He can still go fly-fishing along the shore, and he paints in an artist's studio on the common house's second floor, reachable by elevator.

The permanent cruise

A number of years ago, Lindquist of Northwestern met some older travelers on a Caribbean cruise who had essentially retired on water -- even though they shared the same sorts of health problems as her patients living in assisted-living facilities.

That gave her the idea to compare cruise-ship living to assisted living. She concluded in a paper published in an academic journal in 2004 that the costs are about the same, and many of the amenities and services line up as well: dining, escorts to meals, help with medicine and housekeeping.

In between trips, they might stay with family, or in a hotel.

Ralph Ponce de Leon, a 78-year-old retired Motorola executive who lives in Phoenix, spends at least one-third of every year seeing the world aboard Carnival's Holland America line with his wife, Kathie.

On their first cruise with the company, he says, he was surprised to see a number of passengers in their 90s, including a 92-year-old from the United Kingdom who told him she had taken 18 world cruises, which can last as long as four months.

One big advantage on a cruise ship: "You have a 24/7 physician and nurses," while doctors aren't always on-site at an assisted-living facility, Lindquist says.

It isn't clear how many people already are living on cruise ships full time, but more than 400 people reached out to Lindquist after reading her paper, she says, many of whom planned to attempt it. The costs of the two choices have remained roughly the same since, she says.

Spa living

Portnoy of Miami Beach isn't the only person who used a spa instead of an assisted-living facility. Melinda Minton, the executive director of the Spa Association in Fort Collins, Colo., says others are beginning to connect the dots.

One reason: Spa resorts increasingly are trying to expand into residential communities, "so you have people typically your age and in the same phase of life as you are," she says.

Meanwhile, Portnoy says, a friend's mother recently moved into Canyon Ranch, and he has talked to more people who live at the resort part time, or have vacationed there, and are considering similar arrangements with their own parents.

For other adult children considering such a move, he cautions that there were times when he felt he was in over his head, particularly in hiring nursing aides. But Canyon Ranch's medical and wellness teams "couldn't have been more supportive," he says. "They embraced me in what I was trying to do."

Of his mother, Portnoy says, "I think she lived much longer than she would have if she'd been in an institution."

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