R. Z. Halleson

Introduction to The Death Called Change

When an entire industry enters an era of change for which it has made no plans, chaos is likely to ensue. Such was the case in retirement housing services for elderly people in the decades of the seventies, eighties, and well into the nineties.

The first sign of impending trouble occurred in the real estate industry, and while it was seen at first as a benefit to life care retirement homes, it was never understood even in retrospect as a precursor of what was about to happen within just a few years. Large and small apartment buildings in cities nationwide were converting from rental units to condominiums. The message to renters, many of them elderly people who had lived in their homes for forty and fifty years, was, "Buy your unit when your lease is up or get out!" To say that shock and panic reigned throughout much of this unprepared population was hardly an exaggeration.

Most cities during the seventies and eighties had a sprinkling of life care retirement homes, often church related, and these continued to flourish during the early years of the industry's transition. Some former renters, who had enough assets to pay the entrance fees required by these homes and enough income to pay the ongoing service fees, applied, believing this would be the last move they would ever have to make, and indeed for many it was because death intervened before the industry changes occurred. They signed contracts giving up tens of thousands of dollars in exchange for the promise of care for the rest of their lives. Retirement homes filled up to capacity with little or no effort on the part of staff, and this caused complacency to set in. Management languished. Members of sponsoring churches felt good about their mission to the elderly and gave willingly of their time to volunteer helping to keep staffing levels low. (We must be careful to not confuse retirement services for mid-to-upper income elderly with that given to America's indigent population. That is a totally different struggle and a story ripe for another telling.)

Life care retirement homes were unlicensed apartment buildings that offered many services for their elderly residents such as dining on the premises, housekeeping, and leisure activities. Some also built cottages if the property was large enough to accommodate this. To be admitted to such homes, applicants must prove that they were healthy and could handle all aspects of their lives without assistance. Should the day arrive when these residents needed health care, life care homes referred them to related licensed nursing homes, sometimes on their own premises, sometimes not.

In the early days of the industry, most life care homes had either attached wings or separate buildings on their own property that were licensed by the state to give full nursing care. In the years just before the death of the old era, some newer homes that implied life care services made arrangements with existing nearby nursing homes to take their residents on a priority basis bypassing any waiting list that the nursing care facility might have, and in this way they could fulfill the contract to take care of their residents as best they could until they died.
When the shift in retirement housing services came it was rapid. United States census data revealed that a burgeoning population of middle and upper class elderly existed and was still growing. These people had money. They owned houses that had been purchased for a song in the thirties and forties, and now in the eighties, these properties, even accounting for inflation, were worth many times what the owners had paid for them. This population was educated, smart, healthy, well-traveled, and above all, they planned ahead and took care of themselves. Yet the concept known as life care never really translated itself before or after the change into what it really meant: care until death. This was too frightening for most older people to think about. I am here. I am alive. I care about my family and my life. Yes, I know I will die someday, but not now. Above all, I cannot see myself as being bedridden, being at someone else's mercy. Others maybe, but me never.

There was money to be made from this growing population of relatively wealthy middle and upper class elderly. Construction companies looking for new ways to expand their businesses saw it first and began to build senior housing. From Minnesota to Texas, from Maryland to California, new forms of housing for the elderly sprang up. Cash flow for the builders was the bottom line, and what didn't work in one place was abandoned, and another form was tried in another place: rentals with services, rentals without services (The older apartment buildings that had become condominiums were not restricted to just the elderly as these were). Many took the form of high rise buildings, others large villages built around golf courses, many where property could be purchased near cities, others outside of small towns. They were being built new, or they were renovated from old hotels. Before construction on a building was finished, and sometimes even before it began, colorful sales brochures convinced people to sign the contracts so that they could be sure of a beautiful place in which to retire. Do it now. Don't lose out. You may not have this opportunity again.

For those elderly who had, as the industry likes to say, stayed in their homes too long, stand-alone assisted living homes were built, also unlicensed. These lovely facilities served a real need, not only for the elderly who needed some minimal care and supervision, but also for the builders who found these to be an excellent source of the cash flow they were seeking. Elderly people didn't usually live there for long periods of time, but there always seemed to be more to take their place. Assisted living homes became for some the interim step before the move to a licensed nursing care center.

For those who refused to move into congregate living but who needed help, home health agencies sprang up offering services from giving baths to supervising medications to physical therapy. People didn't have to move out of their homes anymore even if their health was not so good. They had real choices, and to make sure that seniors were aware of these choices, marketing and advertising agencies began to target the hearts, minds and pocketbooks of the nation's most well-to-do citizens: the elderly. In time hospice services to care for the dying at home also came along, and some hospitals added or converted existing space for hospice use.

Those original life care homes of usually two to four hundred residents, ultimately found themselves up against big businesses who understood economies of scale and efficient management. The big boys rolled right over the little guys and never looked back in their goal to build more and more profitable homes for seniors. If it sounds as if this was a bad thing, the answer to that is a most resounding no! An era was over, and it was time to move on. The fact is that even very large retirement housing facilities cannot exist without giving good-to-excellent services to their elderly residents because people talk, and reputations are built or broken on what consumers say to one another. For now, until history proves otherwise, let's just say that retirement housing services for older people who are healthy and who have the money have evolved quite well.


The Death Called Change is the story of Freden Home and three people who desperately, each for their own reasons, needed to see it survive. Chicago was, throughout this period, a hotbed of new construction and new agencies serving its seniors. Although the story takes place in Chicago's northern suburbs in the early eighties, all the people and the homes mentioned are fictional. This story was written in memory of the death of an era in retirement home services, the rapid changes that transformed it, and the people who lived and died while experiencing it.