PEABODY - Nestled in a neighborhood of neatly kept houses, four frail seniors are pioneering an alternative to nursing homes.
They live together in a ranch-style house with a live-in aide who cooks and launders, helps them with bathing and dressing, and reminds them to take their pills. Nurses visit the house as needed. The residents relish the companionship that group living offers, but also the independence the setting allows.
"Isn't it a lovely home?" asked Maxine Davis, 88, as she welcomed a visitor recently, gesturing around the spacious living room and pointing out the large yard.
"Here, we can do anything we want," she added. "We stay up very late watching the Red Sox if we want. And we're going to have a garden out there."
Private elder service agencies in Massachusetts, which bought and retrofitted the house, hope to open dozens more such group homes over the next five years, starting on the North Shore, in the Leominster area, and in Greater Boston.
"We're creating a new niche with a more intimate form of care," and one that helps seniors maintain neighborhood ties, said Al Norman, executive director of Mass Home Care, an association of nonprofit agencies that launched the initiative.
The model is similar to group homes for the mentally ill and mentally retarded that helped thousands move out of institutions. In this case, it is designed to serve seniors too frail or disabled to live safely on their own or in assisted living, but who don't need - or want - the round-the-clock nursing of a large facility.
It is part of a nationwide movement to give seniors more choices, driven by baby boomer advocacy for their parents and by new laws, including one Massachusetts passed last year, requiring government to allow disabled seniors to choose the "least restrictive" environment to obtain taxpayer-supported services. Prior to these laws, many states directed nearly all money for senior care to nursing homes. Now, states are paying for more home-based services for low-income seniors who would otherwise be in a nursing home.
"We're going to see more and more of these innovations, with emphasis on small houses, because that's what people really want," said Jane Isaacs Lowe, a senior program officer for the Robert Wood Johnson Foundation, which is helping fund development of small home-like nursing facilities called Green Houses, including one in Chelsea.
Unlike most of the Green Houses, which are being built in clusters or on the same campus as a traditional nursing home, the group homes are taking shape in existing houses in residential neighborhoods. In addition, the group homes are smaller and allow more flexibility because they are free of nursing home regulations.
The Massachusetts initiative, called Going Home, is similar to one in Oregon, where thousands of seniors live in small-group foster care. Massachusetts has a similar, little-used program that pays family members and strangers to take in a senior or two. Other models include shared housing organized by families in Illinois and small assisted living houses in Maryland.
Residents moved into the West Peabody house about two months ago, staying up late the first night getting acquainted. Neighbors brought over cake and home-grown tomatoes.
Maxine Davis and her twin sister, Irene O'Sullivan, are thrilled with the house, even though they have to share a bedroom for the first time in their adult lives. The other residents, a man and a woman, have their own rooms.
The twins had shared an apartment in a more urban section of Peabody for nearly 30 years, but Davis's osteoporosis was making movement difficult, and memory problems led O'Sullivan to leave the stove on accidentally and forget to take medicines. Their health suffered because they didn't always eat well.
Now, both are thriving. O'Sullivan's daughter says she no longer worries about her mother's safety. O'Sullivan loves being able to stroll outside and watch the birds. Many of her plants brighten the hallway to the patio.
Davis has gotten the whole house to become Red Sox fans. And she says, "We have a wonderful person taking care of us," - Edith Kabugo, a home health aide who lives there for half the week, until another aide comes to stay.
The other residents, Thomas Patrick Donagher and Barbara McNutt, particularly like the family-style meals around what McNutt calls "the laughing table," because of all the shared good times.
Besides being homier, the houses may be less costly than nursing homes or private home healthcare - both for the state and the seniors.
In West Peabody, the seniors are paying about $800 a month each for room, board, television, and phone, according to Paul Lanzikos, executive director of North Shore Elder Services, which is screening potential residents and coordinating services. Rent could be less expensive in other locales, including Boston, where a group home is being developed in a Hyde Park residence owned by the Boston Housing Authority.
Services cost another $3,600 to $4,000 per person a month at West Peabody, covered through the Medicaid and Medicare programs, because the residents have medical and physical conditions that would otherwise qualify them for government-paid nursing home care. The total cost per day is less than the $187 average state payment for nursing home care, but more than the state pays for the least-ill nursing home residents.
"It's not for people who just want a smaller house or need limited assistance," said Norman.
The houses, however, will be open to residents who want to use their own funds or long-term-care insurance to pay for the services.
Because the houses are not subject to state regulation like nursing homes, some question whether residents would be adequately protected. There have been occasional abuses in state-funded homes for the mentally ill.
Organizers say there are multiple checks and balances in the way the houses are run. One of the regular duties of the elder service agencies is to investigate abuse and neglect for the state. The agencies' staff monitors the care provided in the houses. And other professionals, obligated to report abuse, are regular visitors.
"It builds in oversight," said Rosalie Kane, a University of Minnesota professor who studies long-term-care options. "It doesn't sound especially risky to me."
Alice Dembner can be reached at firstname.lastname@example.org.
For more details about the West Peabody house, go to elderhomeoptions.com/ or call North Shore Elder Services at 978-750-4540. For information about the Going Home initiative, call 413-773-5555, ext. 295.