Coming Home

The Foundation's interest in assisted living comes from one of its targets in the chronic care area: increasing the capacity of communities to meet the supportive care needs of chronically ill people. To achieve this, communities must consider the types of services they think are most important and then develop strategies for making those services available. The models that are the focus of Foundation grantees are adult day care, which is the subject of the chapter by Rona Henry and her colleagues in this volume; volunteer services for chronically ill people living in the community, which was discussed by Paul Jellinek and his colleagues in last year's Anthology; and assisted living, which is examined in this chapter.

With the dramatic growth of continuing-care retirement communities, assisted-living facilities are more available than they were a decade ago. However, continuing-care retirement communities tend to be very expensive, and beyond the reach of most seniors. Moreover, they are found largely in urban and suburban locations. Recognizing the need for assisted-living facilities that people with limited means living in rural areas could afford, in 1992 the foundation approved a program called Coming Home: Integrated Systems of Care for the Rural Elderly. The program represented something of a departure from the Foundation's traditional activities, as it involved real estate development. Alper traces the program from its inception through its modifications and implementation. He concludes by drawing practical lessons from the Coming Home experience.