Viola Baez wouldn't budge.
Her daughter's family had just invested about $125,000 in a new kind of home for her, a high-tech cottage that might revolutionize the way Americans care for their aging relatives. But Viola wouldn't even step inside.
She told her family she would rather continue living in the family's dining room than move into the shed-size dwelling that had been lowered by crane into the back yard of their Fairfax County home.
"You're throwing me out! You're sending me out to a doghouse! Why not put me in a manicomio?" Viola, 88 , told them, using the Spanish word for madhouse.
Then the air conditioner blew. As temperatures and tempers soared in the main house, Viola's family coaxed her into the cottage to cool off. Viola stayed the night, then another, and another, until summer had turned to fall.
As the first private inhabitant of a MedCottage, Viola is a reluctant pioneer in the search for alternatives to nursing homes for aging Americans. Her relatives agonized over the best way to care for Viola only after her ability to care for herself became questionable. Their decision exposed intergenerational friction that worsened after the new dwelling arrived.
The MedCottage, designed by a Blacksburg company with help from Virginia Tech, is essentially a portable hospital room. Virginia state law, which recognized the dwellings a few years ago, classifies them as "temporary family health-care structures." But many simply know them as "granny pods," and they have arrived on the market as the nation prepares for a wave of graying baby boomers to retire.
Over the past decade, the population of Americans who are 65 or older has grown faster than the total population, the Census Bureau says. In less than 20 years, the number of Americans who are 65 or older will top 72 million, or more than twice the population of older Americans in 2000, and many will need to find living arrangements that balance their need for independence and special care.
Viola's family understood this. Her daughter, Socorrito Baez-Page, 56, who goes by Soc, and her son-in-law, David Page, 59 — both of whom are doctors — began planning her care well before Viola's husband died of cancer last February. They explored many options and had firsthand experience with several. Soc and David had taken care of or arranged various types of care, including assisted living and hospice, for other parents.
Their decision to buy the first MedCottage in private use, along with Viola's bumpy adjustment to life inside it, offers a look at an unusual solution to an increasingly common situation and the emotional trade-offs that arise from it.
Daily routines
The soft whoosh of an oxygen machine fills the MedCottage when Viola opens her eyes at the light streaming from the windows above her bed.
"Hello," Soc says.
Soc has been up for a while. She stands almost at the center of the MedCottage, a self-enclosed space that blends bedroom, kitchenette, foyer and bath the way that a fork and spoon combine to form a spork. Soc has already folded up the rollout bed where she has spent the night at her mother's side, and performed other chores before Viola wakes.
Viola asks for a bathrobe, and Soc helps her into it, careful not to tangle the oxygen tubes trailing from her mother's nose.
A week after Viola underwent surgery to remove a cataract, Viola's left eye also looks puffy, as if she's been crying again, as she has almost daily since her husband died.
"Open your eye," Soc says, speaking in Spanish, as she administers drops. Viola blinks, as if it's painful.
"Eyes closed, please," Soc says. "Cinco minuto."
After the eye medicine, Viola maneuvers her walker across the MedCottage to the bathroom. While Viola washes up, Soc brews a mug of instant coffee for her in the microwave oven and prepares a vaporizer that delivers Viola's asthma medicine.
Viola's walker squeaks softly as she returns and takes a seat at the kitchenette's counter. Her hands tremble as she takes the mug and sips the coffee through the straw, so as not to spill any hot liquid.
When the vaporizer is ready, Soc puts a mask on Viola. While mist pours from the vents in her mother's face mask, Soc rummages through a cabinet filled with medicine bottles and puts pills in a small cup at her mother's elbow. Then Soc prepares her mother's breakfast, which is crackers and string cheese.
Viola appears small, hunkered down in her chair. But her eyes can become huge when she talks about growing up in Puerto Rico or her life with her late husband. At times, she struggles for words, but when they come, they flow in a rush, sometimes in Spanish. She chuckles with pride when she recalls driving a motorcycle on her honeymoon in Florida, and then becomes somber in a swift change of mood. Tears well in her eyes one afternoon as she explains that she is in "luto," wearing only black or dark clothing as a sign of mourning.
"He treated me like I was a queen," she says of her husband. "Without him, nothing is special. Nothing."
Overhead, a small green light blinks, an indicator that one of the MedCottage's surveillance cameras is powered up and that perhaps an additional family member is watching Viola, too.
Design elements
Several firms have entered the market for auxiliary dwelling units, or ADUs, as they're known in the building industry. These include FabCab, a Seattle-based company that makes ADUs and full-size homes. Practical Assisted Living Solutions, or PALS, a firm based in Meriden, Conn., makes freestanding modules; and the Home Store, which is headquartered in Whately, Mass., sells modular "in-law" additions called "Elderly Cottage Housing Opportunity" additions.
The MedCottage in Fairfax is about 12 by 24 feet, the size of a typical master bedroom. With its beige aluminum siding — and cosmetic touches such as green shutters — the cottage looks a little like an elaborate dollhouse. The interior, painted gray and white, seems so airy and comfortable that Soc jokes about reusing the dwelling someday as a mountain cabin.
The idea for the MedCottage came from the Rev. Kenneth J. Dupin, a minister in southwest Virginia who wondered why Americans didn't take better care of their elders. He created N2Care, a company that designed the MedCottage with help from the Virginia Tech Corporate Research Center. They stuffed its steel shell with the latest in biometric and communications technology, and crafted its features using universal design principles to accommodate people of all ages and people with disabilities. The company's sales pitch includes dropping an egg onto its specially designed floor from a height of 7 feet to show that the egg won't break.
"People think it's a rubber egg until we hold it over a hard surface and drop it from 5 inches," said Chris M. Cummins, executive vice president of MedCare Systems, a Mechanicsville, Va.-based distributor.
In addition to surveillance cameras, the dwelling has an Internet portal by which family members, doctors or other caregivers can monitor an occupant's vital signs, receive medical alerts or change the dwelling's temperature and security settings. The MedCottage retails for about $85,000, but with delivery and installation, Viola's family has spent closer to $125,000.
"Most people look at that and get sticker shock," Cummins said.
But Cummins also said that the company offers financing and repurchase programs that make the MedCottage a bargain compared with assisted-living facilities that charge $40,000 or more a year.
Family drama
Viola's family is close-knit. Soc recalls taking her daughters, Erin and Shannon, to the Kennedy Center for a National Symphony Orchestra concert when the girls were so little that they listened while perched in car seats.
Although Erin, 30, is now a lawyer and Shannon, 28, teaches in Fairfax schools, the family still goes to the symphony en masse, and the daughters still live in the family's 1972 split-level on Vengo Court.
The family is strikingly candid about the stress that comes with Viola's daily care. Her physical problems include spinal stenosis, arthritis and asthma, and she takes about 16 medications. Relatives say Viola has traits that would challenge any caregiver, and some have become more conspicuous with age. She is moodier now, and needier. When Viola went into an assisted-living facility temporarily for physical therapy after a fall, she threw a fit that lasted hours. Soc calmed her by promising not to leave. Soc stayed for so long every day that eventually administrators told Soc the arrangement could not continue.
"She's very clingy, very persnickety about things," Soc said.
Viola's late husband, Luis Baez, also pampered her. He was a first lieutenant in the Army when they married. Later, as a civilian architect for the Navy and the Coast Guard, he helped design the Westwind class of icebreakers. In the 1950s, he and Viola bought an Arlington County duplex. But their home became difficult to maneuver as they aged. About the time Luis began thinking of alternatives, he became ill with rapidly progressing renal cancer.
Soc and David began discussing whether Viola would move in, whether to build an addition, or whether Viola should go into an assisted-living residence. Viola and Luis disliked nursing homes, and Soc's property was not well suited for an addition. Then Soc read about the MedCottage, which Luis endorsed before his death.
When Luis, 82, died Feb. 28, Viola's granddaughters took turns staying at her Arlington home while Soc and David arranged the MedCottage purchase. Then Viola moved into the house on Vengo Court.
But there were problems. Living in the family's dining room, Viola disliked being so close to the kitchen when people were cooking. She complained about getting around in the house, saying that there were too many steps, not enough handrails, and that the shower was hard to access. She fought over the thermostat setting because she was too cold, even when everyone else was sweating. And she hated being alone. She wouldn't shower unless someone was nearby.
By late June, the MedCottage arrived. Workers cut down trees to make room and a crane lowered the cottage onto six concrete piers in the yard.
Relatives brought photographs of Viola's grandchildren and knickknacks, including a colorful row of miniature houses. Over the bed they hung Roman Catholic icons, including a painting of "Nuestra Senora del Perpetuos Socorro," whose name, like Soc's, means "help" in Spanish.
But Viola wanted nothing to do with the place. As the standoff dragged on, Soc worried that their money had been wasted, that their MedCottage would end up being the biggest, most expensive storage shed on the planet. Then the air conditioner in the house went kaput, and Viola retreated to the MedCottage for relief.
Viola now seems used to her new home. On a cabinet in the kitchenette sits a row of faded black-and-white photographs of Viola, wearing a pretty dress and an alluring smile, that she sent to her new husband when he was away on duty.
Although the MedCottage has made it possible for Viola to live a few steps away from her family, Soc sometimes wishes that Viola were as self-assured and independent as the younger version in those old photos.
But these days, the family also counts it as a small victory when Viola comes to dinner in the main house and then returns without a fuss to "my place."
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