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Senior Managing Director | The Opes Group LLC

The Household Model: Person-Centered Care

Are you happy with the assisted living facility or nursing home in which you have placed your family member? Can you think of anyone who is? We are in the midst of a proliferation of senior care concepts and yet almost no one is happy with the choice made for an elderly relative. Why? The homes are clinical, bland and bereft of life. Most senior homes aren’t intended to be a continuation of life. Rather they are simply a place for your relative to sleep and be medicated until they move on. Senior care is focused on ‘push medicine’ rather than common sense thoughts on how societies should care for elders in a humane manner given healthcare improvements that allow us to live longer. How should we leverage the experiences of our elders while ‘doing unto others as you would have them do unto you’?

We are not the only ones asking this question. Established foundations such as the Robert Wood Johnson Foundation and the Commonwealth Fund have been pursuing health care reform in the United States for several years and they have both sponsored organizations that promote the ‘household’ model of senior care. How does this model differ from traditional senior homes?


Traditional nursing homes, and even many assisted living facilities, are designed in an institutional manner. They are based on a 1950’s era hospital setting with long hallways and centralized nursing stations from which caregivers often cannot see all the patients at once. Such settings are befitting of temporary care but people are not meant to live in that manner long-term. It has been shown that assisted living facilities that are designed more like a house reduces hospitalization rates in the elderly by as much as 90% and increases longevity. In these homes seniors often have their own private bedrooms and in-suite bathrooms with either a private living/dining room setting or a shared arrangement with no more than 10-15 neighbors per unit. People are happier in a ‘homelike’ setting as this feels more like a natural continuation of their lives and their improved medical results reflect this mindset.


The manner of care is also significantly different in the ‘household’ model. To begin, the elderly retain a certain level of self-determination by having a say in what activities they do and when they do them. They are not necessarily forced to follow a strict schedule that may not relate to how they feel on a particular day and that is in fact very similar to how people live in their own homes! As ‘household’ homes are not clinical in nature they do not have large cafeteria style dining rooms. They tend to have smaller rooms that offer an experience similar to dining in one’s own home.

Staff operating protocols are also different in the ‘household’ model. In traditional homes staff members are giving specific and limited roles. Someone may be the health aide for a specific illness or the dinner cart operator or the receptionist or something else pre-determined but the roles never intersect. In a ‘household’ senior care setting employees operate like a ‘jack of all trades’ and this allows the employee to have more interest in his or her job as well as develop a closer relationship with the resident as they are interacting in a correlated manner that more closely simulates normal human relationships. It would not be uncommon for instance, to see a resident and a nurse cooking dinner together in a ‘household model’ senior home; such freedom is not encouraged in traditional homes.


‘Household’ models aim to replicate the feeling of being at home and ‘aging in place’ therefore they prefer to use technology in a subtle manner. They tend not to have loud overhead intercom systems and other similar clinical type technological processes as they seek to emulate a quiet, peaceful, relaxing home. An intercom system could for instance be replaced with quiet pagers. Some homes incorporate tracking devices beneath beds to track how often residents get up at night, some have strategically placed cameras that offer privacy while allowing staff to track the whereabouts of residents and others allow family members who live far away to log into camera feeds and see the day to day activities of family members. This setting advocates personalized technology use (as one would at home) while scaling back on technology with an institutional feel.

While this all sounds great, the question remains: is the Household Model financially viable? The answer: absolutely. Jalane White at Pleasant View Home in Kansas states “when we built our household model eight years ago, we didn’t have any trouble filling those beds.” By the way, they now have a waiting list. If this is financially sustainable then why don’t we see more of these homes? More than 90% of senior homes in the United States have already been built and are in operation under the institutional model. Operators are not incentivized to spend the capital to convert purely for the good of the elderly if their existing product is making money. Consumers drive markets. The market for senior care will only change if consumers are aware that they have an option, the Household Model, and use it. Only then will the existing infrastructure shift towards care that balances the interests of families and operators rather than the current one-sided system.

The Opes Group is currently working on a ‘household’ model home in Florida that we are proud to share with our clients. Please contact us if you are interested in learning more about why this environment is better for your loved one. You don’t have to take our word for it, take a look at what the New York Times has to say. There is a better way to treat our elders. Together we can bring about the change that we want to see in the world.