Re: co-care agreements?
From: Cohousing (
Date: Thu, 26 Jan 2017 10:14:33 -0800 (PST)
Question for Shadowlake Village: Does your multigenerational coho include 
amenities for aging in place such as one level homes and common house with no 
steps, 36” doorways to accommodate wheelchairs, break-away under cabinetry for 
knee space in wheelchair, 5’ area in bathroom to rotate wheelchair, grab bars, 
level walkways without steps, etc? 

One startling thing we at Raleigh Cohousing (senior coho now forming) learned 
when we toured older cohousing communities in the Triangle of NC that were 
built in the 1990s and early 2000s was that they never built in accommodations 
for aging in place and thus their seniors are having to move away. So 
unfortunate that this was not considered in the building phase so that aging 
and disabled residents did not have to leave at all or leave so early in the 
aging process. 

Co-care, neighborly care can cover so many aspects of assisted living. It 
cannot cover 24/7 nursing care like nursing home. In between the two needs 
levels though the PACE program or hired and shared caregivers who can stay in a 
guest room in the common house can delay entrance into a nursing home for many 
months/years and maybe the whole lifetime.

The aging process and reality that we do age needs to be on everyone’s radar 
long before it is needed so it can be planned for in advance. 

Kayelily <> 

> On Jan 25, 2017, at 10:01 PM, Wendy Willbanks Wiesner <wwiesner [at] 
>> wrote:
> Muriel at Shadowlake wrote:
> "At some point, residents with serious physical or cognitive issues should
> expect to sell their house and move to senior
> living/assisted living.  In fact in the last couple of years, four singles
> or couples have done just that, and two more residents are about to leave
> as well because of their increasing age-related physical limitations."
> Muriel, Mary, Dyan, Sharon et al:
> I suggest considering the PACE program as communities put their Aging in
> Place Plan together.  The program is designed to address precisely the
> issues that you highlighted in the above quote, Muriel.  Here are the
> details:
> PACE (Programs of All-Inclusive Care for the Elderly) is a Medicare (and
> Medicaid) program that helps people meet their health care needs in the
> community instead of going to a nursing home or other care facility.
> The program offers a team of health care professionals providing
> coordinated, comprehensive care, including a geriatrician who oversees
> medical care provided by a team of physicians, nurses, therapists and
> social workers.  The program also provides home health workers and sends
> contractors to make a participant's home safer and more accessible.
> *COST*
> If you have Medicare, you pay:
> A monthly premium to cover the long-term care portion of the PACE benefit
> (no premium if you qualify for Medicaid).
> A premium for Medicare Part D drugs.
> No deductible or copayment for any drug, service, or care approved by your
> health care team.
> If you don't have Medicare or Medicaid, you can pay for PACE privately.
> To qualify you must
> 1)  Be 55 or older.
> 2)  Live in the service area of a PACE organization.
> To date, there are 121 programs in 31 states with the program rapidly
> growing.  See the National Pace Association (NPA) at for
> up-to-date information.
> 3)  Currently need, or be "at risk" for needing nursing home-level of care
> (assessment criteria varies by state).  Common criteria include needing
> assistance preparing meals, dressing and/or bathing; chronic medical
> conditions are also considered.  Exemptions may apply.
> AND most relevant to cohousing communities IMHO--
> *4)  Be able to live safely in the community with help from PACE.*
> *The willingness of residents in cohousing to provide mutual support--so
> that residents can "live safely in the community with help from PACE"--will
> influence whether an individual can meet this PACE criteria or not.  *
> What needs to happen next for cohousers wanting to age in place with PACE
> is to work through a few community-level test cases (to my knowledge this
> has not been done in either a coordinated or even an ad hoc way yet).
> I've identified NM as a good test case because the state and its
> vertically-integrated hospital system provider is a recognized pioneer with
> the PACE program, and thus influences others.  This same hospital system
> will be providing health care automation to the State of NC, so NC is an
> interesting possibility as well.  CO is also a sensible and strategic
> choice, given work done with the Director of the Denver Office of Aging and
> the ED of the Colorado Gerontological Society, where together we've all
> been on a housing workgroup focused on Community Wealth Building (cohousing
> being one very impactful way to build Community Wealth).
> *Please let me know if your community is interested in being a test case,
> either in NM, NC, CO or in one of the other 31 PACE program states. *
> *Muriel, there's a PACE program out of Roanoke that may cover Blacksburg.
> Refer to <>. *
> *Dyan, a program out of Holyoke that covers Western MA:
> <>.*
> *Sharon, no PACE currently in DC.*
> Those communities interested in being test cases could clarify PACE
> Qualification Criteria #3 and #4 (above), as they relate specifically to
> cohousing.  Having a range of test cases would give us a better opportunity
> to capture the unique choices that cohousing communities are making today--
> on what we know is actually a continuum of "mutual support".
> Now speaking in general terms, cohousers will need access to the
> comprehensive medical care that PACE provides, but often not need
> transportation/meals on an everyday basis, nor the more extensive
> housekeeping/maintenance/checking up associated with the larg(er),
> traditionally isolated single family home, nor the "social activities" that
> are part of PACE programs.
> *This means potentially reducing the cost/increasing the ease of providing
> care in cohousing, giving PACE providers a clear incentive to work with
> cohousing communities and their residents.  *
> At the very least, if your cohousing community is not currently covered by
> a PACE program, it is possible that your community could participate in a
> development phase PACE program.  Thus cohousing could be considered in the
> program from the get-go.
> Wendy
> Wendy Willbanks Wiesner
> Executive Director
> Partnerships for Affordable Cohousing (PFAC)
> [image: Inline image 1]
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