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Healthy homes offer option to assisted-living facilities

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Despite the surge in attractive, high-quality assisted-living facilities, most people would much prefer to live independently and remain in their own homes as long as possible. The houses in which we have raised our children, however great or modest, are our palaces. They are full of memories and reflect our individuality. Increasingly, forward-thinking, creative architecture, adaptable information technologies and health services beamed into the home will pose substantial competition to other retirement offerings.

Those who can afford the option of moving into a high-end assisted-living facility have probably worked long and hard and are disinclined toward institutional limitations and stringent policies of a facility that is not their own. I have had three retired patients this year, a commercial pilot, an investment banker and a successful attorney, all of whom became disenchanted during the transition despite careful planning. Each shared how difficult it was to give up the control over their own lives and, had there been a better option, might have tried to remain longer in their homes.

To get there, architectural features will include enhanced modularity and the ability to reconfigure space to suit function. Aging in place requires flexible functionality and safety that suits a young couple, a multigenerational household and an empty nest. This means accommodation for both communal activities and individual solace.

A modular floor plan should be coupled with preplanned, after-market options to be installed as the physical health and functional needs of residents warrant. Imagine adjustable counters and sinks, safety bars, roll-in showers and gravity solutions for those who can no longer get up and down the stairs.

Increasingly, homes also will embed high-tech solutions to collect health data like blood pressure and blood sugar. They will track medication compliance and physical activity and, when warranted, provide clearly visible and audible reminders. Technology also will empower telemedicine into the home. Data collected will be monitored by nurses at a remote site and, as appropriate, relayed to medical providers, family and emergency responders. These high-tech platforms will be combined with hands-on health services for medical care, occupational therapy, physical therapy and lifestyle maintenance.

Technologies to monitor health will be integrated with additional control panels that monitor and, when possible, modulate the internal environment (temperature and light), the external environment (air quality, natural radiation, ultraviolet intensity), utility use (water and power), and entertainment and communications. Inventory control of medications, foods and disposable items will be monitored and reordered accordingly when stores become depleted.

Complex, multidimensional, material and high-tech solutions that suit the evolving needs of individuals and their families throughout the life cycle call for a new perspective on the traditional operations and maintenance contract. O&M will no longer simply be a sunken but necessary cost required to sell a product. Buyers will want to ensure that items are maintained and repaired, but they also will want to enjoy a quarterly or annual assessment to evaluate their changing requirements and understand what new solutions might suit them.

Owners of residences that empower people to age in place will want to connect with like-minded neighbors and be part of healthy, sustainable communities. This will give rise to branded living complexes engaged in this vision. Think community vegetable gardens, dynamic elder education and van transport for that stand-up paddleboard.

To be genuine, developers of these new sustainable communities must create and nourish a culture of wellness among their partners and staff. Window dressing alone is simply not enough. There is no other option but to walk the talk.

As battery technology improves, those with solar panels will pull out of the electric grid. In much the same way, healthy homes of the future will support independence, enhanced health and long life. For much of the population, assisted-living facilities will be hard pressed to compete.

Ira Zunin, M.D., M.P.H., M.B.A., is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to

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