Enabling Home-like Living for the Severely Dependent

Key Insight

Peter Sanborn Place, initially a subsidized apartment building for low-income seniors, evolved under its director, Jacquie Carson, into a model of care that enables severely disabled individuals to live in their own homes until the end of their lives. Despite not being a certified nursing home or assisted living facility, it systematically accommodated its aging tenants by arranging for aides, physical therapists, visiting nurses, and eventually securing funding for overnight staff, including for a resident with Alzheimer's disease. This defiance of traditional care models highlights a commitment to individualized, home-based support.

Carson's philosophy, 'We'll figure this out,' involves an unwavering determination to navigate numerous obstacles, often battling the medical system directly. This includes protecting residents from potential harms during hospital visits, ensuring their safe return to the apartment complex rather than being diverted to rehabilitation centers, and educating primary care doctors on maintaining residents' capabilities through physical therapy, even for those with dementia. This approach ensures that residents like Ruth Barrett, an 85-year-old requiring oxygen and a hydraulic lift, can continue to live in their own places while retaining the freedom to make personal choices, even 'poor choices' like ordering a forbidden margarita.

Achieving this level of personalized care requires constant innovation and overcoming both practical and systemic challenges, such as residents' initial objections to others' declining abilities and staff reluctance to handle pet care beyond basic tasks. Carson has developed solutions, like staff emptying cat litter boxes and assisting with small dogs, to preserve residents' cherished pets. Furthermore, the program facilitated the emotional reunion of a resident, Ruth Beckett, with her intellectually disabled son, Wayne, by accommodating them in adjacent apartments, demonstrating a profound understanding that maintaining family connections can be paramount to a person's reason for living, even outweighing concerns for their own life.