Not your grandma's nursing home

Christina Zaayer still gets those calls: "My mom needs a nursing home -- can you help me find one?"

When she asks the caller for more details about the mother's situation, she often finds that "maybe she doesn't need a nursing home at all," said Zaayer, a staff member at AgeWell in Edina who helps find housing and other resources for aging clients.

Until they've researched the market, many people assume a nursing home is still the only option for people who can no longer live on their own, she said. But nursing-home residency has sharply declined over the past couple of decades. Meanwhile, other senior housing choices have multiplied -- there are now about 500 options in the Twin Cities alone -- and most would consider them a more appealing choice for those who don't require skilled nursing care.

"Typically a stay in a nursing home is something you have to do, not something you want to do, you know what I mean?" said Steve Ordahl, senior vice president of business and fund development for Ecumen, a large Shoreview-based provider of senior housing.

Nursing homes actually represented a vast improvement in housing for the elderly when they first arose in the 1930s, after Social Security was established. Before that, people who could no longer support themselves might wind up in an almshouse, a prospect about as appealing as Will Carleton's 1897 poem "Over the Hill to the Poor House" makes it sound: "Over the hill to the poor-house I'm trudgin' my weary way -- I, a woman of seventy, and only a trifle gray. ... Many a step I've taken, a-toilin' to and fro, but this is a sort of journey I never thought to go."

If only that weary 70-year-old could see what's out there now. Some of the more upscale developments are so handsomely designed and offer so many amenities -- shopping, restaurants, bars serving happy hours, on-site concierges, movie theaters, libraries, art studios, fitness centers, Olympic-size pools, safety features, beautifully landscaped grounds -- that Zaayer wonders if aging baby boomers will find themselves "running to these places."

The development of new housing choices has been motivated, in part, by financial considerations. Ecumen once mainly operated nursing homes, but changed its focus "to being more in the hospitality business than in the healthcare business" after the government cut reimbursements for skilled-nursing care, Ordahl said. Since 2004, the company has slashed its nursing-home units by about a third and nearly quadrupled its supply of market-rate housing, whose costs aren't subsidized by the government.

Northfield Retirement Community in Northfield has grown from a single nursing home into a 30-acre campus with nine different housing options. Each building offers a different mix of services and care, including apartments for couples in which one spouse is active and independent and the other needs more help. Nursing-home beds, meanwhile, are down from 70 to 40.

These fiscal motivations have coincided with consumer demand for more attractive options. Much of the push for improvements comes not from current residents, members of a do-it-yourself generation who often hold modest expectations, but from demanding baby boomers who want better accommodations for their parents -- and, in the future, themselves. NRC's management talks to residents and their children, and "listens to what they want," said CEO Kyle Nordine. Ecumen's board, said Ordahl, "looked into the crystal ball and said, 'Really, do any of us want to live in a nursing home the way they're currently configured?'"

Kay and Vince Mattison figured it was time to look for a new home. Vince, an 86-year-old former 3M executive, is recovering from a stroke three years ago. Kay, a former artist, wanted to live closer to their daughters because at 87, she felt she was "getting too old to drive."

So the couple moved in June from a townhouse in Shoreview to an apartment in Ecumen's newly opened Seasons at Apple Valley. They eat their lunches in a dining area that's "like a fine restaurant in a hotel," Kay said, and Vince works out in the large fitness center.

"The place is beautifully appointed -- the carpet, the woodwork," she said. "I think it's just the perfect place for senior citizens."