While images of nursing homes and assisted living often bring up visions of whitewashed walls, big buildings, and a hospital-like setting, other alternatives make clear that this is not always the case. 

Of the one million people in assisted living (also known as residential care homes, adult foster homes, and board and care homes), about one third live in residents of less than sixteen people, according to Karl Polzer, senior policy director of the National Council on Assisted Living.

The New York Times profiled one such assisted living facility in Northern New Jersey. The home, Horizon Manor, is a Victorian house with nine residents each living in their own room. The staff ratio, of three staff members during the day and two on each shift at night, provides a 3:1 or 4.5:1 ratio that certainly far exceeds most large-scale assisted living facilities. Yet the cost is lower.

The article notes that Horizon Manor costs about $48,000 annually, while a nearby Sunrise assisted living facility with 98 beds averages $65,000 annually. It adds that Horizon Manor does not charge extra for medication reminders or tier pricing based on patient needs.

It seems that this model is flourishing in the nursing home industry too. Green Houses are set up in a similar manner, with seven to ten bedrooms for seniors around a central common space.

The idea, first proposed by William H. Thomas, M.D. with seed funding by the Robert Wood Johnson Foundation, has taken off, with over 50 homes now operating in accordance with the model according to his book Life Worth Living: How someone you love can still enjoy life in a nursing home. “The nursing home ought to be different. It should not be a watered-down hospital for hopeless cases, rather it must be “home,” or at least as close to “home” as possible.”

Again, this model appears to be cheaper than the larger institutional set-up. The Wall Street Journal noted that an internal review found that it cost an average of $192 a day to care for a resident in a traditional nursing home, while it only cost $150 a day to care for a resident in a Green House. This amounts to a savings of nearly 25% a day.

With these alternative models providing more personalized care to seniors at lower prices, they are an option worth considering—especially as many seniors struggle to afford assisted living and nursing home care.

Write to Reva Minkoff