Is This the Future of Senior Housing? Is This the Future of Senior Housing?

In survey after survey, older Americans say they want to live at home rather than move into assisted living or a nursing home. But what if assisted living and nursing home care were more homelike, with familiar staff and housemates? That’s the goal of the “Small Homes Project” at St. John’s Home in Rochester, New York, where administrators are nearly done converting a 455-resident high-rise from a typical, medicalized setting to a series of mini-homes styled as penthouse suites for small groups of residents. Is this the future of senior housing? And if so, how will residents and staffers benefit from this approach?

What inspired this new approach to senior housing?

The six-year St. John’s Home conversion was inspired by Green House design, which uses freestanding houses and dedicated staffers to care for no more than 12 residents per home. St. John’s tried the approach in a smaller community it owns and found that the results included better social connections for residents and much lower turnover among caregivers.

Rebecca Priest, administrator of skilled services at St. John’s, gave a TEDx talk on the Small Homes approach and the future of senior care. In it, she describes residents’ and staffers’ food-gathering field trips into the nearby woods and even a hunting trip arranged for a resident during deer season near their pilot project site. Ms. Priest recently spoke with about the high-rise senior living conversion project she’s overseeing in Rochester.

What does Small Homes senior living look like?

“In an ideal world, we could move our residents into freestanding houses,” Priest said, “but we’re in the middle of a city in a high-rise. So we have each floor configured like two penthouse apartments, each with room for 16 elders. When you get off the elevator, instead of seeing a nurses’ station, you walk into a lobby between the suites.”

The changes go beyond a more home-like layout. Each suite has its own dedicated direct-care staff and a schedule that accommodates residents’ needs. “Our residents told us they wanted to see the same caregivers every day and they wanted flexible mealtimes so they can, for example, sleep in without missing breakfast.”

New residents have taken quickly to the Small Homes lifestyle, Priest said, while residents who were used to the institutional model have taken a few months to adjust. “Everyone’s behavior has to change,” she said. “But then no one wants to go back to the old way.”

The changes benefit staffers, too. Priest noted in her TEDx talk that the number of seniors needing care will double by 2040 while the number of caregivers stays about the same. The industry needs to retain its caregivers with better pay and better career development, she said. This model is a way to do it, by training caregivers to take on more in-depth roles with a smaller number of clients.

How can you find or start a Green House or Small Homes project in your area?

You can search for local Green House communities here. If there are none nearby, Priest said finding like-minded community members and community groups is the key to getting one going. And no matter what kind of senior living options you have, Priest said, “remember that nursing home care should be a partnership between the staff and your family.”

Learn more about assisted living and nursing home options at

Casey Kelly-Barton is an Austin-based freelance writer whose childhood was made awesome by her grandmothers, great-grandmother, great-aunts and -uncles, and their friends.


  1. Jannette J March 30, 2017 Reply

    Hey Casey!
    I like what you have mentioned but in my opinion home care is the best option for seniors to lead a healthy lifestyle while enjoying their independence without having to adjust timings according to the caregivers. In fact, the caregiver must follow the routine of seniors to allow them stay happy without over stressing their minds. They allow seniors to age in place with family and cherished memories around them.

  2. Terri Bowlin March 31, 2017 Reply

    Really nice approach! The small homes concept seems to be a great way to give the residents a homelike feel. I love that the staff remains the same for each group and that the residents can have better social connections and flexibility in their schedules.

  3. Barbara April 7, 2018 Reply

    I still select the Assisted Living as the best retirement care options for elderly love one. Because, only assisted living can provide a 100% care and monitor your health.

  4. Jay Towers August 31, 2018 Reply

    No Casey, Hong Kong is not the future of senior housing.

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