How to Avoid a Nursing Home

"Aging in place" communities help seniors stay in their own home and avoid assisted living.

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If it takes a village to raise a child, it may also take a village for seniors to age safely in their own homes. Repairs, meal preparation, and transportation to and from doctor's appointments can sometimes be too much for a frail senior to handle alone.

But pricey nursing homes and assisted living are solutions that few elders aspire to use. Enter "aging in place" communities: nonprofit associations of seniors who pool their resources to stay safely in their homes longer. Although each individual community is unique in the services provided to members and pricing, here is a taste of a few popular offerings:

Transportation. Although she can still drive, retired clerical worker Caroline Sator, 87, avoids traffic and parking by taking advantage of door-to-door transportation offered to members of Sunset Neighborhood in New Hartford, N.Y., to get to her doctor's appointments. Fees range from $450 to $725 annually based on the services selected, some of which are a la carte. Rides that are over 10 miles round trip cost an extra 50 cents a mile.

Transportation may also be provided by other members for shopping, errands, religious services, restaurants, and group activities. Maryana Preston, 84, who lives alone in Palo Alto, Calif., has been to the symphony, ballet, beach, and lectures by Stanford University professors with other members of Avenidas Village, a 340-member group for people 50 and over that charges $750 for singles and $900 per couple. "I don't drive," she says. "They pick me up, and they bring me home."

Home maintenance. "Home maintenance is the second-biggest category of request, after transportation," says Gail Kohn, executive director of Capitol Hill Village in Washington, D.C. One member, Ed Missiaen, 66, a retired economist, is a bit of a handyman. He has helped other members change ceiling light bulbs when they're afraid or not steady enough to get up on a ladder, checked a backyard sewer that wasn't draining properly after a heavy rain, evaluated electrical wiring for a woman whose vacuum cleaner set off a spark, helped move furniture, and even taken out the garbage for people who can't navigate the stairs to get outside.

But Missiaen isn't much of a computer guy. "We had a person who works with computer stuff [come] over here when I had a vexing computer problem that I couldn't figure out," he says. If a single call to Capitol Hill Village doesn't result in a volunteer who can solve your home maintenance problem, the group, which charges $500 for individuals and $750 for households annually (but gives discounts to low-income residents), will connect you to vetted vendors and often negotiate a discount.

Meals. Sunset Neighborhood will do grocery shopping for members every three weeks. Other communities will connect members to vendors who deliver prepared meals to their homes. And most groups feature regular lunch and dinner gatherings for members to interact. "We had a member who fractured an arm, and when she came home, we had another member provide dinner that night who stayed and had some wine," says Kohn of Capitol Hill Village.

Health assistance. Many communities offer a daily check-in phone call to members who want one. "If you live alone like I do—and my children do not live nearby—it's kind of reassuring to know someone is looking out after you," says Sator of her daily phone call from Sunset Neighborhood.

The group also helps members coordinate their medical care. "You get a care manager who is a registered nurse who will accompany you to the doctor and will be another pair of ears to hear what the doctor says. They will write it down and maybe send it to your family," says Carol Jubenville, founder of Sunset Neighborhood. "If the diagnosis is, say, Parkinson's disease, we will help you find support groups, find physical therapy that treats it, and start a plan for care."

The prototype for aging-in-place communities, Beacon Hill Village in Boston, is a member-driven concierge service that provides or negotiates reduced rates on everything from high-end health services like personal trainers and massage therapists to more essential geriatric care managers and home hospice care. "It is totally consumer-driven," says director Judy Willett about the high level of services offered by the 50-plus community. Beacon Hill has annual dues of $600 for individuals and $850 for households, with discounts available.