The Covid-19 pandemic demonstrated many advantages of small-home senior living, and interest in these models among investors and operators surged as a result. Memory care is no exception to this trend, and providers who operate smaller communities are gearing up to grow.
Inspired by pioneering concepts such as Green House communities, small-home senior living often involves buildings with fewer than 20 residents, with some version of a universal worker staffing model. These communities aim to foster a sense of intimacy and community and maximize resident independence.
Due to lower resident populations, it is also easier for communities to group residents so that they live with those similar to each other, through cultural connections or needing similar levels of care. And as shown during the public health emergency, infection control can be easier and more effective, with fewer difficult-to-enforce restrictions, in smaller buildings with fewer residents.
Dallas, Texas-based Sage Oak is one example of a provider focused on small-home memory care, while Clover Hill Senior Living and Juniper Communities are two New Jersey-based operators also pursuing this model. Leaders with all the organizations point to its numerous advantages, as well as the need to be creative in addressing some of the challenges and pitfalls involved in small-home memory care.
Advantages of staying small
Operators utilizing the small home model have stated the first and foremost advantage of keeping the number of beds and units small relates to staffing levels and workloads.
The ideal resident-to-staff ratio at North Haledon, New Jersey-based Clover Hill Senior Living is six to one, according to Principal Darian Wilson.
Following the Covid pandemic, Wilson said he saw larger operators in the New Jersey area operating between 18 and 20 residents per care staff member, whereas Clover Hill remained steady.
“It really speaks to what this boutique size is all about,” Wilson said.
Alongside this benefit, Hornbuckle said small-home staffing ratios allow communities to take care of more clinically complex residents that need a higher touch.
Fellow New Jersey-based Juniper Communities has been taking the small home memory care approach since 1999, with intentional design elements involving 13 resident suites and private amenities.
“They are a true small house model in the sense of movement through space,” said Cindy Longfellow, Juniper’s vice president of business development, sales and marketing. “We don’t want an individual in a secure community to feel like they are confined.”
The reduced overall capacity has also made staffing easier, Longfellow said, as there is a focus on universal workers who can focus on getting to know their residents.
This philosophy has been helping Juniper keep four of its memory care communities full throughout 2023.
However, Wilson noted that needing fewer staff in general can be a double edged sword, as the impact of one member of the care staff being out for the day means an increased workload on the remaining workers.
An additional benefit for small home communities can be quality of life improvements, such as the dining options available for residents and reducing the risk of falls. For Sage Oak campuses, each home has an individual meal service included with care, and on average, chefs are cooking for 16 people.
“If you have a smaller footprint of a building, then caregivers can respond to things faster. It’s pretty hard for a caregiver to be more than 75 feet away from a resident in our setting,” Hornbuckle said.
The model is also “future proofed,” according to Hornbuckle, who said the baby boomer generation is going to want a personalized approach to care.
While Clover Hill’s current focus is primarily on assisted living, Wilson said there is going to be an increased focus on memory care as more small-home communities are developed.
“We can achieve that economy of scale with putting multiple places on one property, but enabling residents to live within the level that suits their care,” Wilson said.
While there are advantages to the small-home memory care model, challenges arise as well, particularly when operators acquire new buildings.
If a community is acquired and not built from the ground-up to accommodate small-home memory care residents, the needed renovations can reduce the number of total rooms available, Longfellow said. She added an additional challenge is the amount of outdoor space that is available, as an acquired community might have plenty of interior space, but “the outdoor space had been forgotten.”
Then there is the issue of economies of scale, which are harder to achieve. Sage Oak has begun “shoring up” communities into campus designs.
“What we figured was that if we were to build neighborhoods that essentially had multiple care homes on them, you got a lot of the operational scaling advantages that come with them,” Hornbuckle said.
Because of this, Sage Oak is focusing on developing its campus communities from the ground up rather than acquiring properties, as the company begins to increase its footprint in northern Texas.
In some states, zoning laws also make developing these properties difficult as well. According to Wilson, it took visiting over 20 towns around New Jersey before getting the space Clover Hill Senior Living currently has.
The demand for small-home memory care units does appear to be on the rise, however, and operators are looking to grow to meet that demand, whether that’s through acquisition or development. By 2030, Sage Oak is looking to have 1,000 beds across various campuses that it is planning to develop.
“Our long-term goal over the next six to seven years is to build out these boutique style neighborhoods where we still have all of the scaling but smaller populations,” Hornbuckle said.