Caring for granny in the back yard

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, Va., 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, Va., 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.

Viola's daughter, Socorrito "Soc" Baez-Page, 56, and her son-in-law, David Page, 59 — both doctors — began planning for her care well before Viola's husband died of cancer last February. 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 care

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. 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 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.

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 and prepares a vaporizer that delivers Viola's asthma medicine.

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.

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.

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, headquartered in Whately, Mass., sells modular "in-law" additions.

Viola's MedCottage is 12 by 24 feet, about the size of a master bedroom. With its beige aluminum siding and green shutters, the cottage looks like an elaborate dollhouse.

Stuffed with technology

The idea for the MedCottage came from the Rev. Kenneth Dupin, a Virginia minister 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 used universal design principles to accommodate people of all ages and abilities.

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," said Chris Cummins, executive vice president of MedCare Systems, a Virginia distributor. 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.

Viola's family is 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. 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, staying for so long every day that eventually administrators told Soc the arragement could not continue.

"She's very clingy, very persnickety about things," Soc said.

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 disliked nursing homes, and Soc's property was not well suited for an addition. Then Soc read about the MedCottage. Meanwhile, Viola moved into the family's house.

But there were problems. Living in the 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.

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 photos of Viola's grandchildren and personal knickknacks, 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 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, just a few steps away from her family. They consider it a small victory that Viola comes to dinner in the main house and then returns without a fuss to "my place."