Miriam and Leonard Beadle were living in Lancaster, Va., about five years ago when they both came down with an incapacitating case of influenza. Alone and isolated in the country, both in their late 70s, they suddenly became aware of their physical vulnerability.
"We began to think we couldn't get sick and live that way down there," Miriam Beadle said. "We couldn't afford to get full-time nursing and we couldn't have gotten help even if we could have afforded it."
The Beadles were in a quandary -- they worried about their health and well-being as they grew older, but were reluctant to sacrifice their independence, not to mention their life's savings, by moving into a nursing home.
After years of independent living, the Beadles decided the time had come to make a change. They had a daughter in New Jersey, but didn't want to impose on her. A nursing home, they felt, was out of the question.
The solution they found was part way between the extremes of total dependence in a nursing home and total isolation: They moved into an apartment of their own in Goodwin House in Alexandria, a church-sponsored apartment building that offers residents nursing care whenever and for as long as they need it at no additional charge.
Goodwin House is not new, nor is it the only facility of its kind in the area or nation. What makes Goodwin House of larger interest is that it is part of a growing private and public effort to find ways to care for increasing numbers of older people who, for the most part, can maintain an independent way of life but who may need help from time to time.
As the over-65 population grows, more and more Americans are finding themselves in the same predicament as the Beadles. According to demographic projections, in the next 20 years the over-65 population will increase about 20 percent, and the 80-plus population will grow 70 percent, assuming no further progress from biomedical research to increase longevity.
Nursing homes are the fastest growing sector financially in American health care. About $22 billion was spent for the care of 1.3 million people in nursing homes in the United States last year, according to the Health Care Financing Administration. By 1985, the figure will grow to an estimated $42 billion annually.
Nursing homes have an undisputed role in American life and to varying degrees fulfill the needs they are intended to serve. But, as with the Beadles, they are not for everybody. In addition, some experts say that 10 percent or more of persons in nursing homes do not need to be there, although the estimates vary.
"With the growing number of older persons, we could face the problem of overbuilding nursing homes," Dr. Robert Butler, director of the National Institute on Aging, said. "We must find better ways of helping those people who could remain in their own homes." According to Butler, finding alternatives to nursing homes not only will provide a living situation for older persons that is socially and psychologically more beneficial, but also will result in a "tremendous savings" in medical-care costs across the country.
Alternatives to nursing homes, which are generally expensive and discourage independence, do exist for older people who are essentially able to care for themselves. In addition to Goodwin House, which is one of a number of housing facilities operated by the Episcopal Church by itself or jointly with other church groups, the Jewish Council for the Aging for Greater Washington, Associated Catholic Charities and a variety of publicly sponsored programs are available, depending upon a person's means.
Goodwin House requires payment of a "founder's fee," ranging from about $32,000 to $60,000, depending upon the size and type of apartment desired. A monthly fee of about $700 for one person or $1,300 for a couple covers rent, three meals a day, utilities, domestic service and whatever nursing care is needed for as long as it is needed. If a resident exhausts his or her funds, a "fellowship" program is available. No one accepted into Goodwin House is put out for lack of funds, according to program director James K. Meharg Jr.
The Jewish Council for the Aging for Greater Washington has been arranging apartments for older people in the metropolitan area for the past seven years. The council's nonsectarian program is designed for single persons, grouped in apartments of three in conventional apartment buildings. Each apartment has a homemaker who comes in Monday through Friday for a total of 20 hours a week to make the main meal for the apartment's inhabitants, to shop and to take care of laundry and housekeeping. A social worker visits each apartment at least once a week to see if the elderly are having any problems.
Residents must be able to walk, to share in light household chores and to use the telephone. They are free to come and go as they wish.
Marion Schechter, 63, lives in an apartment with two other women on Lockwood Drive in Silver Spring. When she was 54, Schechter had had a stroke that left her partially disabled. She lived for a while with a daughter but decided to look for an alternative to that.
When the question of a nursing home came up, Schechter said, her children "absolutely refused to consider it." Schechter heard about the Jewish Council's program. Since she had a son and a sister living in this area, she applied and was accepted. She has lived in her apartment for more than five years.
"It's just like a heaven-sent solution," she said of her experience. For Schechter, her apartment is home, the two women she lives with are friends. "I can truthfully say that when I'm away from here, I miss it."
Judy Shaffert, the social worker who supervises the shared-living program for the Jewish Council, said the arrangement is not always ideal. People sharing an apartment may not get along. Tensions and conflicts may develop. One older woman -- largely confined to her room because of arthritis and an unwillingness to use a wheelchair to get around -- complained to Shaffert that the other two women in the apartment frequently came into her bedroom, intruding on her privacy.
"I want to live by myself. I want to live by myself," she told Shaffert. When Shaffert asked the woman if that were possible, she ruefully conceded that it was not.
"I never tell people it's heaven here," Shaffert said later. "It's hard living with other people."
The Jewish Council program was begun in 1974. It currently supervises housing for 35 persons -- 29 women and six men -- most of whom are in their 80s, although the ages range from the 60s to the 90s. The council has apartments in the District of Columbia, Montgomery County and Alexandria. It costs a tenant $650 a month for room and board. Persons unable to come up with the full amount receive assistance from the council.
"We don't turn anyone away," council executive director Ruth Breslow said.
In addition to the Jewish Council program, Associated Catholic Charities in Washington is operating two houses in Northeast Washington for older persons. The first two residents, both men, moved into a city-owned house that had been made available at no cost to Catholic Charities for the program.
The two residents are paying $200 a month for rent, utilities, telephone, the services of a social worker and repairs to the house. They pay for food and prepare their meals themselves. Two four-bedroom, brick houses and a third, eight-bedroom house have been made available to Catholic Charities for the program.
Four more tenants have been approved in a community residential facility that will be established in the eight-bedroom house. Tenants of this house are partially disabled, although still able to care for themselves for the most part. A cook will prepare three meals a day and a resident manager will live in the house to help its residents with minor problems they encounter during the day. These tenants will pay up to $600 a month, depending upon their financial situation, to live in this facility. Applicants need not be Catholic to be eligible for the program.
A variety of public programs also exist. Montgomery County has almost 1,000 housing units available for elderly persons of limited means. One program, designed for the "frail elderly," has 160 apartments and offers residents three meals a day either in a common dining room or in the resident's apartment, cleaning help for the apartment and assistance with personal care for those who need it.
This program, which costs a resident about $220 a month plus 25 percent of his or her income for rent, is administered by the county, although the bulk of the funds come from the state.
Prince George's County also offers low-cost housing and meal programs for elderly persons who qualify. Both Arlington and Fairfax counties have housing and meal programs for the "well elderly" that are operated by private, nonprofit groups.
John A. Reed, chief of tenant relations for Montgomery County's Housing Opportunities Commission, said his agency's programs are designed to provide an alternative to nursing home care. "We find a lot of people are in nursing homes who really don't need to be there but just need a little bit of help," Reed said. "Our only purpose is to assist them to be more independent."