The Continuum of Care: Housing and Services at James Lenox House

Abstract

At the cusp of the 21st century the dynamic changes affecting family constellations, demographics, and life expectancy influence the much debated health care delivery system. Less often discussed is housing development, housing stock, and the services brought into the homes where people reside. Although this lack of attention to the latter holds true for the entire population, it is of acute concern to the elderly. Nowadays older adults may select from a large variety and bewildering array of residential settings to live out the remainder of their lives. Along with the more familiar apartments, cooperatives and condominiums, a large number of residential complexes and living arrangements are available from which to choose (Table 1). The lengthy list does not include Board and Care Homes, also called Domiciliary Care; sheltered housing or residential care facilities; Congregate Housing (a collective term for various forms of residential care or adult homes); nor facilities/services such as Respite, Adult Day and Hospice Care (Skolnick & Warrick, 1985). In addition, Nursing Homes have been transformed into minimedical facilities, often with added specialty units for Alzheimer's, hospice, and rehabilitation patients, and with subacute care units. The proliferation of residential and custodial care facilities for the older population highlights this group's progression from independence to dependence and from wellness to chronicity which frequently necessitates episodic care for temporary ailments and end-of-life care. The purpose of these relatively new living accommodations (Table 1), with their varied and frequently bewildering nomenclature, is aimed at extending and supporting independence in settings resembling as nearly as possible normal living arrangements. Designed for the specific purpose of delaying or preventing a move to a more protective environment, they are less institutional in mission and structure and are therefore less regulated. The state of the art in assisted living has given rise to many subtle distinctions in the service delivery packages and living arrangements available to the elderly. Public officials worry that market forces in and of themselves may be insufficient to regulate the burgeoning private development of the assisted living industry (Klein, 1998). NEW YORK CITY'S UNIQUENESS Large urban environments such as New York City have for decades attracted individualists. The percentage of those in nontraditional living arrangements and of those who have never married is particularly high, even among present day New York City elders. Some have never kept house, taking advantage instead of the many apartment hotels and single room occupancies (SROs). Many were employed in positions in which room and board were included as part of their remuneration, such as nannies, baby nurses, housekeepers, building superintendents, and support staff in institutional settings. Independent individualists, who are particularly unaccustomed to accepting assistance from anyone, and who become disturbed if increasing frailty prevents them from giving rather than receiving, predominate. Some are survivors of more traditional households whose other members have died, who have left to follow career opportunities elsewhere, or who have sought less costly or perhaps safer neighborhoods in which to raise their families. These, then, are the persons who, when they near the end of life, must be sheltered, protected, and assisted toward a dignified death (United States Bureau of the Census, 1990; Weisel & Joshi, 1994). The purpose of this paper is to describe a not-for-profit organization's successful, commonsense approach to the development of an independent living facility in an urban environment and its subsequent growth. JAMES LENOX HOUSE James Lenox House (JLH), although designed and intended as an independent senior residence, has followed, from its inception, the tradition of a caring community. …