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Introducing a New Kind of Intergenerational Care-Based Cohousing

Explore Carehaus, an innovative housing model that blends care and community

spinner image renderings show the modern design of the future Carehaus
Courtesy: Carehaus

What would it be like to be a well-paid professional caregiver who lives with your family — a spouse or young kids, perhaps — in a beautiful building alongside older adults who receive your care?

That’s the concept behind Carehaus, a groundbreaking care-based cohousing community in Baltimore’s Johnston Square neighborhood that is slated to commence construction this summer. Older adults, some low-income and disabled, will live alongside caregivers and the caregivers’ families, sharing rich programming, utilities and meals.

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Inventive independent living 

At a time when there is a rising shortage of affordable housing for older adults, increased social isolation, limited interaction between generations, low pay and high turnover for caregivers, and eye-popping prices for traditional senior living communities, Carehaus’ intergenerational housing model is unique. To attract and retain professional caregivers, salaries will be above industry standards and include subsidized meals and housing, with no worrying about a long commute or family back home. Colleagues can help, too, with lifting a heavy client, for instance, or with childcare.

The five-story building, sited on an abandoned corner lot in an underserved community, is designed to encourage people of all ages to socialize. Every floor will have a common room or shared space for specific activities and informal conversation as well as outdoor terraces that connect to one another.

While each of the 21 units will have a small kitchen, there will be a large space on the first floor where residents can share meals or cook communally.

At times, that common space and adjacent courtyard will be open to people from the neighborhood. Also on tap will be either a public café or a community health center. This means more people for residents to meet and an inviting new space that is inclusive for those nearby.

“One of the social determinants of health is social interaction,” says Caitlin Coyle, director of the Center for Social and Demographic Research on Aging at UMass Boston’s Gerontology Institute. “It sounds like Carehaus is creating an environment for all residents to have that ongoing social interaction and an opportunity to create a sense of community within the building.” That cohesion, the thought goes, could allow residents to stay healthier longer.

Coyle also sees the advantages of having caregivers, their families and older adults live together. “It creates closer, more familial relationships and therefore enriches the caregiving experience on both sides,” says Coyle. “People talk about family caregivers and professional caregivers, and this is a situation where those two versions of caregiving come together.”

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Courtesy: Carehaus

Making Carehaus a neighborhood anchor

The project was conceived by Massachusetts Institute of Technology (MIT) alumna and fellow Marisa Morán Jahn. For more than 14 years, the award-winning artist has advocated for caregivers and created public art with them about their working conditions.

“The institutional environment doesn’t support the needs of caregivers and contributes to their high turnover rate,” Jahn, 47, says. At the same time, “when most of us think about senior care and housing in the U.S., it’s the last place where we would want to go,” she adds. “I wanted to design a beautiful building that dignifies care for both.”

In 2019, Jahn approached architect Rafi Segal, an MIT associate professor and colleague. Together they worked on the concept, bringing in Baltimore developer and investor Ernst Valery, who has a track record in affordable housing in underserved communities.

“Carehaus is strategically located near public transportation; downtown Baltimore, with its cultural institutions; and a medical center. Many developers don’t see the inherent good and opportunities but rather race, ethnicity and economics,” says Valery, who is Haitian American.

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When the project is completed at the end of 2025, Valery, 47, believes that Carehaus will help culturally and economically revitalize the predominantly Black East Baltimore neighborhood. It will not only attract young families and more developers, he thinks, but improve the lives of older adults who are going to age in place.

Some of the programming will draw from the neighborhood and city. Perhaps staff from an arts organization a couple of blocks away might come to Carehaus and do arts and crafts projects with residents. Or maybe a guest lecturer from a downtown Baltimore museum, a nutritionist or a financial literacy expert might visit. The cofounders are already exploring such partnerships.

Residents aren’t required to need care when they move in but will know it’s there if they do. The goal is for half of the older adults to be low-income people who qualify for public subsidies toward rent and/or food; the others will be mixed income and pay market rate. Two to four units will be reserved for caregivers and their families, and one unit for a part-time site manager.

Valery is aiming for rent to be $700 to $900 a month to make it affordable for those at 50 to 80 percent of median income. Market rate is expected to be in the $1,400 to $2,200 range. Food and care services are additional, but as Jahn notes, “overall rates are considerably more affordable than other senior care options.”

One way to keep down costs is for residents to pay only for the care they need. For example, they may require more care during periods of injury or recovery and less, if any, care after that. Rates will depend on the kind of care they need and the level of acuity. If residents require more care than they can get at Carehaus, they can either bring in additional help or move to, say, memory or skilled nursing elsewhere.

‘A cool place to live’

From the start, Jahn, Segal and Valery conferred with neighbors near the site to hear about their own visions for Carehaus. The cofounders also spoke with gerontologists, doctors, nurses, people with disabilities, and professional and family caregivers, including Sarah Szanton, M.D., professor and dean at Johns Hopkins School of Nursing and director of the Center on Innovative Care in Aging; Thomas K.M. Cudjoe, M.D., assistant professor, geriatric medicine and gerontology, Johns Hopkins University; Emmanuel Opati, assistant administrative director of telemedicine at Johns Hopkins Health System; and Bonnielin Swenor, director, Johns Hopkins University Disability Health Research Center.

“It was really important that the building not look like an old people’s home or have an institutional feel,” says Segal, the architect. “I want it to feel like a cool place to live that is hip and contemporary.”

The building, as planned, has distinctive angles, showing windows of different shapes and sizes. “The facade is a piece of art in itself that creates more of a public presence,” Segal explains.

There will be no corridors. Rather, each floor will have four or five units surrounding a common room. Natural light, vibrant colors and art will abound throughout the building. Public spaces will have large windows, with smaller ones in each unit to allow residents to see what’s happening on the street from their bed or sofa.

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On every floor in the common room, a different full-length mural will cover the walls. Each features rarely seen archival photographs of families from disadvantaged Baltimore communities in the 1960s juxtaposed against backdrops of colorful, hand-dyed and hand-painted paper made by Jahn.

For instance, one depicts a multigenerational marching band with members doing cartwheels and handstands and dancing along with the spectators. It will be very playful and joyful, says Jahn. Another depicts the seaside.

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Every floor of Carehaus will feature a different full-length mural.
Courtesy: Carehaus

There will be a different design theme and color on each floor. “We could have done the same white walls and an institutional-feel generic rug on every floor,” says Segal, 57. “It would have been more economical. But Carehaus works differently. We’re saying that this building is designed with attention and care for you. Having a space full of art gives a sense of belonging and identity.”

The cofounders knew that the building had to meet the needs of all residents, including those who have low vision or are disabled or cognitively impaired. The distinctive colors and art on each floor will help people find their way and recognize where they are.

For low-vision residents, the towel bar and faucets will be a different color than the sink — perhaps dark red, blue or black. Colors will also change at the threshold of doors and baseboards in rooms. The elevator will have large buttons, and everywhere will be well lit.

Bathroom tiles will be anti-slip, and the floors throughout the building will be made of soft materials in case someone falls.

“If we design well and understand the problems of aging — socially, physically and cognitively — then we can extend [the older residents’] independence,” says Segal.

To find older residents who will soon call Carehaus home, the founders are working with community partners such as CAPABLE (out of Johns Hopkins University) and other local organizations, and will be in accord with Fair Housing rules and regulations. Potential caregivers will be chosen through care management organizations as well as local groups that support caregivers, and their focus will be based on the strengths and needs of the residents. Preference will go to single women with young children who themselves would greatly benefit from having multiple sources of support for their families. 

A model that can be replicated

The care-based, intergenerational cohousing concept is creating buzz. Valery recently purchased land in Chicago to start a second Carehaus that will be designed for the needs of that neighborhood. Other areas showing interest are in Pittsburgh; Charles City, Virginia; Buffalo, New York; Memphis, Tennessee; Boston; and New York City.

Wherever one is built, Carehaus will be redefining senior housing. As Segal puts it, “Carehaus is designed to celebrate old age and caregiving.”

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