When her father became ill just before Christmas last year, Dr. Socorrito Baez-Page faced an increasingly common conundrum. Her aging parents wanted to stay in their town house, but her mother couldn’t handle the caregiving alone.  So Dr. Baez-Page, a general practitioner in Alexandria, Va., moved her parents into her home, converting the dining room and TV nook on the main floor into a bedroom. But the four steps down to the bathroom in the split-level home have proved hazardous.  Nobody is happy. “My mother is embarrassed to have to use the commode by her bed at night,” said Dr. Baez-Page. And space for everybody is tight.  The solution? Though many families are often forced to consider nursing homes under these circumstances, the Page family found another option. They ordered a MEDCottage — a prefabricated 12-by-24-foot bedroom-bathroom-kitchenette unit that can be set up as a free-standing structure in their backyard. It’s more than a miniature house — it’s decked out with high-tech monitoring and safety features that rival those of many nursing homes.  The floors, for instance: “It’s got special rubber floors, so even if you fall, you’ll be safe,” noted Dr. Baez-Page’s husband, Dr. David Page. Indeed, according to Kenneth Dupin, a minister and the founder of N2Care, the Virginia company that worked with the Virginia Tech College of Engineering to design the MEDCottage, you can drop an egg from 18 inches onto the special flooring without breaking it.  The Australians, who began building simple backyard homes for the elderly in the ’70s, call them granny flats. In the United States, these self-contained units have earned another nickname: granny pods.  This month, the Pages will become the first family in the country to take delivery of a high-tech MEDCottage. The cottage is laid out as an open-plan apartment with a kitchen area (equipped with a microwave, small refrigerator and washer-dryer combo), a bed area and a bathroom large enough in which to maneuver a wheelchair. The utilities and plumbing connect to the primary residence.  But the granny pod also brims with high-tech touches. In order to make midnight bathroom visits safer, for instance, a runway mat stretching from the bed to the toilet lights up automatically when you step on it. It turns itself off after 10 minutes.  Tracks along the ceiling accommodate a lift or a trapeze hook. Residents who have balance issues can grab onto a hook to provide stability as they move around the cottage. The lift helps those with more serious mobility challenges.  “One of the primary reasons people have to go to nursing homes is that caregivers can’t lift them anymore and get them out of bed and keep them mobile,” Mr. Dupin said.  If the cottage resident does fall, she will be visible on a camera system hooked up to the caregiver’s computer in the main house. It’s not exactly Big Brother: The cameras sweep an area 12 inches above the floor, so normally all they transmit are images of feet and ankles.  For those needing more elaborate medical monitoring, the MEDCottage is equipped with a system that tracks blood pressure, glucose, heart rate and blood gases (changes in blood levels of oxygen or carbon dioxide can signal heart failure and other serious conditions), sharing that information with family and physicians. If the resident fails to take medication from a dispenser on time, the system — speaking aloud — reminds the patient and sends a text message to the caregiver.  Zoning rules can create barriers. “Local zoning varies by county, and it’s not necessarily easy to set these pods up,” said Rodney Harrell, housing policy specialist at the AARP Public Policy Institute. Currently about half of the states allow these accessory dwellings for a family member, according to Mr. Dupin. (Several additional states, including New York, are considering legislation explicitly permitting granny pods.)  But setting one up is especially easy in Virginia. A state law passed in 2010 permits temporary medical dwellings on a resident’s property, as long as a physician verifies that the patient needs assistance with at least two daily functions — like bathing, eating and dressing — and the unit is removed when there is no longer a need for it (so the pods don’t turn into rental properties).  The cottage costs about $85,000 new; Mr. Dupin’s distributors will buy it back for about $38,000 after 24 months of use. “If you compare it to nursing home costs, which can run $6,000 to $8,000 per month in Virginia, even higher in New York, that’s cheap,” said Mr. Dupin.  Of course, unlike nursing homes, granny pods don’t come equipped with 24-hour professional care and three meals a day. Hiring a health care aide (around $19 an hour) just during weekdays can easily add another $39,000 per year.  But a growing number of elderly people — 88 percent of those over 65 — say they want to live in their own homes, in their own communities, as they age, according to a 2010 AARP survey.  The government is catching on to this trend, and to the potential savings. According to Lynn Feinberg, a caregiving specialist at the AARP Public Policy Institute, a provision of the Affordable Care Act going into effect this year will pay for health care delivered in the home instead of in the doctor’s office.  If you can afford them, granny pods have advantages: “Older adults have their own living space and privacy, which has the potential to reduce much of the stress associated with caring for aging parents,” said Bernard A. Steinman, senior research associate at the Institute for Community Inclusion at the University of Massachusetts.  Still, the setup may not work for everybody. “Some families may have dynamics and/or history that make the option undesirable, or the level of care needed by the older adult may exceed what the family is able to provide,” Dr. Steinman said.  But for Dr. Baez-Page, the convenience of having her mother close but still living independently is especially important. Her father has died, and her mother will be living alone in the granny pod. “The MEDCottage will be six feet away from our kitchen windows,” she said, adding that she will be able to get to her mother in seconds.  For caregivers in the tristate area who like the idea of aging in place, there’s another prefab alternative: P.A.L.S., short for Practical Assisted Living Structures.  Rob Pintoff, a retired pharmacist in Farmington, Conn., said that toting up the numbers convinced him that P.A.L.S. was the way to care for his ailing 83-year-old mother-in-law, Enid Zlotnick.  Attaching a portable pod didn’t cost much more than retrofitting his home, and the unit could be set up faster and with less mess. So last year he contacted Henry Racki, P.A.L.S. creator and a Connecticut home builder who also is a certified aging-in-place specialist.  “It was amazing to watch this modular unit come off the flatbed with a crane,” recalled Mr. Pintoff. “One moment there was nothing there, and the next the walls were up, like the Amish coming together.”  Though each P.A.L.S. unit is customized to the client’s needs, the standard 20-by-14-foot bedroom and bathroom unit starts at about $67,000. Homeowners can also lease a unit. A five-year lease runs about $1,700 per month, after which you own the unit.  The pod comes with phone and TV cable lines built into the wall (no wires to trip on), a closet with levers that lower the clothes to wheelchair level, motion detectors that automatically turn the knee-high night-light system on, showers with grab bars and various types of no-step entries, wheelchair-accessible sinks and comfort-height toilets.  So far, Mr. Racki has set up 10 of these mini-homes in Connecticut, Massachusetts and New York. Zoning in Connecticut doesn’t usually allow for full kitchens, Mr. Racki said, but they can be included. He helps clients get all the permits and zoning approvals needed.  None of the P.A.L.S. purchasers so far have requested high-tech medical monitoring. But a system similar to the MEDCottage’s can be added for $16,000.  Mr. Pintoff is convinced the addition was the right choice. “Enid’s happy — the only other option was a nursing home,” he said. In fact, Mr. Pintoff does not plan to sell his unit in the future. “It looks like it belongs there, it adds value, and it might be useful for my wife and me one day.”
Home builders are experimenting with prefabricated cottages designed to be erected in the backyard as stand-alone residences for elderly family members.